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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
Authors:Matthias 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
Institution:1. Department of Urology, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Stra?e 22, 81675, Munich, Germany
2. Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Stra?e 22, 81675, Munich, Germany
3. Department of Radiology, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Stra?e 22, 81675, Munich, Germany
4. Department of Pathology and Pathologic Anatomy, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Stra?e 22, 81675, Munich, Germany
5. Institute of Medical Statistics and Epidemiology, Klinikum rechts der Isar, Technische Universit?t München, Ismaninger Stra?e 22, 81675, Munich, Germany
6. Department of Nuclear Medicine, Universit?tsmedizin Rostock, Universit?t Rostock, Gertrudenplatz 1, 18057, Rostock, Germany
Abstract:

Purpose

The aim of this study was to prospectively compare diffusion-weighted magnetic resonance imaging (DWI) and 11C]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 11C]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 11C]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 11C]choline PET/CT were 62, 96 and 92 %, respectively. Neither DWI nor 11C]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 11C]choline PET/CT followed by DWI and CT.
Keywords:
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