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Prospective comparison of computed tomography, diffusion-weighted magnetic resonance imaging and [11C]choline positron emission tomography/computed tomography for preoperative lymph node staging in prostate cancer patients.

AbstractPURPOSE:
The aim of this study was to prospectively compare diffusion-weighted magnetic resonance imaging (DWI) and [(11)C]choline positron emission tomography/computed tomography (PET/CT) with computed tomography (CT) for preoperative lymph node (LN) staging in prostate cancer (PCa) patients.
METHODS:
Between June 2010 and May 2012, CT, DWI and [(11)C]choline PET/CT were performed preoperatively in 33 intermediate- and high-risk PCa patients undergoing radical prostatectomy (RP) and extended pelvic lymph node dissection (ePLND) including obturator fossa and internal, external and common iliac fields. Patient- and field-based performance characteristics for all three imaging techniques based on histopathological results are reported. Imaging techniques were compared by means of the area under the curve (AUC).
RESULTS:
LN metastases were detected in 92 of 1,012 (9%) LNs from 14 of 33 (42%) patients. On patient-based analysis, sensitivity, specificity and accuracy for CT were 57, 68 and 64%, respectively, for DWI were 57, 79 and 70%, respectively, and for [(11)C]choline PET/CT were 57, 90 and 76%, respectively. On field-based analysis, these numbers for CT were 47, 94 and 88%, respectively, for DWI were 56, 97 and 92%, respectively, and for [(11)C]choline PET/CT were 62, 96 and 92%, respectively. Neither DWI nor [(11)C]choline PET/CT performed significantly better than CT on pairwise comparison of patient- and field-based results.
CONCLUSION:
All three imaging techniques exhibit a rather low sensitivity with less than two thirds of LN metastases being detected on patient- and field-based analysis. Overall diagnostic efficacy did not differ significantly between imaging techniques, whereas distinct performance characteristics, esp. patient-based specificity, were best for [(11)C]choline PET/CT followed by DWI and CT.
AuthorsMatthias M Heck, Michael Souvatzoglou, Margitta Retz, Roman Nawroth, Hubert Kübler, Tobias Maurer, Mark Thalgott, Bettina M Gramer, Gregor Weirich, Ina-Christine Rondak, Ernst J Rummeny, Markus Schwaiger, Jürgen E Gschwend, Bernd Krause, Matthias Eiber
JournalEuropean journal of nuclear medicine and molecular imaging (Eur J Nucl Med Mol Imaging) Vol. 41 Issue 4 Pg. 694-701 (Apr 2014) ISSN: 1619-7089 [Electronic] Germany
PMID24297503 (Publication Type: Comparative Study, Journal Article)
Chemical References
  • Carbon Radioisotopes
  • Radiopharmaceuticals
  • Choline
Topics
  • Adult
  • Aged
  • Aged, 80 and over
  • Carbon Radioisotopes
  • Choline
  • Diffusion Magnetic Resonance Imaging
  • Humans
  • Lymphatic Metastasis (diagnosis, diagnostic imaging)
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Positron-Emission Tomography
  • Prospective Studies
  • Prostatic Neoplasms (diagnosis, diagnostic imaging)
  • Radiopharmaceuticals
  • Tomography, X-Ray Computed

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