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Preoperative lymph node staging in patients with primary prostate cancer: comparison and correlation of quantitative imaging parameters in diffusion-weighted imaging and 11C-choline PET/CT

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An Erratum to this article was published on 01 July 2014

Abstract

Purpose

To compare the diagnostic performance of DWI and 11C-choline PET/CT in the assessment of preoperative lymph node status in patients with primary prostate cancer.

Material and methods

Thirty-three patients underwent DWI and 11C-choline PET/CT prior to prostatectomy and extended pelvic lymph node dissection. Mean standardised uptake value (SUVmean) and mean apparent diffusion coefficient (ADC) of 76 identified lymph nodes (LN) were measured and correlated with histopathology. ADC values and SUVs were compared using linear regression analysis.

Results

A significant difference between benign and malignant LN was observed for ADC values (1.17 vs. 0.96 × 10-3 mm2/s; P < 0.001) and SUVmean (1.61 vs. 3.20; P < 0.001). ROC analysis revealed an optimal ADC threshold of 1.01 × 10-3 mm2/s for differentiating benign from malignant LN with corresponding sensitivity/specificity of 69.70 %/78.57 % and an area under the curve (AUC) of 0.785. The optimal threshold for SUVmean was 2.5 with corresponding sensitivity/specificity of 69.72 %/90.48 % and with an AUC of 0.832. ADC values and SUVmean showed a moderate significant inverse correlation (r = -0.63).

Conclusion

Both modalities reveal similar moderate diagnostic performance for preoperative lymph node staging of prostate cancer, not justifying their application in routine clinical practice at this time. The only moderate inverse correlation between ADC values and SUVmean suggests that both imaging parameters might provide complementary information on tumour biology.

Key Points

• Conventional imaging shows low performance for lymph node staging in prostate cancer.

• DWI and 11C-choline PET/CT both provide additional functional information

• Both functional modalities reveal only moderate diagnostic performance.

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Acknowledgments

The scientific guarantor of this publication is Tibor Vag, MD, PhD. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The research leading to these results has received funding from the European Union Seventh Framework Program (FP7) under grant agreement no. 294582, ERC Grant MUMI, and from the Deutsche Forschungsgemeinschaft (DFG) under grant agreement no. SFB 824. One of the authors has significant statistical expertise. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Some study subjects or cohorts have been previously reported in Heck MM et al., Eur J Nucl Med Mol Imaging. 2013 Dec 3. [Epub ahead of print]. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

Tibor Vag and Matthias Heck contributed equally to this work.

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Authors and Affiliations

  1. Clinic of Nuclear Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Tibor Vag, Ambros J. Beer, Michael Souvatzoglou & Markus Schwaiger

  2. Clinic of Urology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Matthias M. Heck

  3. Institute of Pathology, Klinikum Rechts der Isar, Technical University Munich, Trogerstrasse 18, 81675, Munich, Germany

    Gregor Weirich

  4. Institute of Diagnostic and Interventional Radiology, Klinikum Rechts der Isar, Technical University Munich, Ismaninger Strasse 22, 81675, Munich, Germany

    Konstantin Holzapfel, Matthias Eiber & Ernst J. Rummeny

  5. Clinic of Nuclear Medicine, University Hospital Rostock, Getrudenplatz 1, 18057, Rostock, Germany

    Bernd Joachim Krause

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  1. Tibor Vag
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  2. Matthias M. Heck
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  9. Matthias Eiber
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Correspondence to Tibor Vag.

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Vag, T., Heck, M.M., Beer, A.J. et al. Preoperative lymph node staging in patients with primary prostate cancer: comparison and correlation of quantitative imaging parameters in diffusion-weighted imaging and 11C-choline PET/CT. Eur Radiol 24, 1821–1826 (2014). https://doi.org/10.1007/s00330-014-3240-8

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  • DOI: https://doi.org/10.1007/s00330-014-3240-8

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