Haroon, A; Ahmed, HU; Cathcart, P; Almuhaideb, A; Kayani, I; Dickson, J; Kirkham, A; ... Bomanji, J; + view all Haroon, A; Ahmed, HU; Cathcart, P; Almuhaideb, A; Kayani, I; Dickson, J; Kirkham, A; Freeman, A; Emberton, M; Bomanji, J; - view fewer (2016) F-18-FECH PET/CT to Assess Clinically Significant Disease in Prostate Cancer: Correlation With Maximum and Total Cancer Core Length Obtained via MRI-Guided Template Mapping Biopsies. American Journal of Roentgenology , 207 (6) pp. 1297-1306. 10.2214/AJR.15.15679.

Text Emberton UCL OPEN ACCES MR Template and 18F Choline PET .pdf - Accepted Version Access restricted to UCL open access staff Download (1MB)

Abstract

OBJECTIVE. The objective of this study was to detect clinically significant and insignificant prostate cancer on 18F-fluoroethylcholine (FECH) PET/CT and to correlate findings with transperineal template-guided prostate mapping (TPM) biopsy. SUBJECTS AND METHODS. Fifty-six lobes of the prostate were analyzed in 28 men who underwent FECH PET/CT and TPM. Whole-body images and pelvic images were acquired at 60 and 90 minutes after tracer administration. FECH PET/CT findings were correlated with TPM. Sensitivity, specificity, positive predictive values, negative predictive values, and AUC of dual phase FECH PET/CT were calculated. RESULTS. Mean age of the patients was 68.8 years (range, 53–79 years), and mean prostate-specific antigen level was 12.1 ng/mL (range, 0.6–45 ng/mL). Mean maximum cancer core length was 4.4 mm (median, 4 mm; range, 1–14 mm) and mean total cancer core length, 14.6 mm (median, 14.6 mm; range, 1–82 mm). Prostate cancer was identified in 38 lobes with a Gleason score of 6 in five lobes (13%), 7 in 27 lobes (71%), 8 in four lobes (11%), and 9 in two lobes (5%). FECH PET/CT showed findings of prostate cancer in 46/56 lobes (82%). The ranges for maximum standardized uptake value for 60- and 90-minute FECH PET/CT were 1.3–11.4 and 1.2–10.9, respectively. Clinically significant cancer was seen in 30 of 38 positive lobes; eight had clinically insignificant disease. For 60-minute imaging, the sensitivity, specificity, and ROC AUC were 75%, 75%, and 0.746 (95% CI, 0.612–0.853). For 90-minute imaging, the sensitivity, specificity, and ROC AUC were 73.7%, 58.3%, and 0.646 (95% CI, 0.498–0.776). Overall sensitivity, specificity, positive predictive value, and negative predictive value were 95%, 50%, 82.6%, and 80%, respectively. CONCLUSION. FECH PET/CT can detect prostate cancer and localizes TPM biopsy-proven clinically significant prostate cancer with sensitivity of greater than 89.7%. Of the two imaging durations, 60-minute imaging is more sensitive and specific than 90-minute imaging.

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