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Detection of Aggressive Primary Prostate Cancer with ¹¹C-Choline PET/CT Using Multimodality Fusion Techniques

¹ Department of Radiology, University of Michigan, Ann Arbor, Michigan; ² Department of Pathology, University of Michigan, Ann Arbor, Michigan; ³ Department of Urology, University of Michigan, Ann Arbor, Michigan; and ⁴ Department of Biostatistics, University of Michigan, Ann Arbor, Michigan

Correspondence: For correspondence or reprints contact: Morand Piert, University of Michigan Health System, Department of Radiology, Division of Nuclear Medicine, University Hospital, B1G505C, 1500 E. Medical Center Dr., Ann Arbor, MI 48109-0028. E-mail: mpiert{at}umich.edu

The aim of the study was to assess whether ¹¹C-choline PET/CT could identify high-risk primary adenocarcinoma of the prostate. Methods: ¹¹C-choline PET/CT and transpelvic MRI were performed in 14 patients with untreated localized primary adenocarcinoma of the prostate, followed by radical prostatectomy as a form of primary monotherapy within 14 d of in vivo imaging. To allow accurate coregistration of whole-mount histology with in vivo imaging, additional ex vivo MR images of the prostatectomy specimen were obtained. Nonlinear 3-dimensional image deformations were used for registrations of PET/CT, MRI, and histology. Volumes of interest from tumor and benign tissue were defined on the basis of histology and were transferred into coregistered ¹¹C-choline PET/CT volumes to calculate the mean (T_(mean)/B) and maximum (T_(max)/B) ratio of tumor to benign prostate background. On the basis of MIB-1/Ki-67 expression in tumor tissues represented on a tissue microarray, we assessed whether ¹¹C-choline uptake correlated with local Gleason score and tumor proliferation. Results: Histology confirmed 42 tumor nodules with Gleason scores between 3 + 2 and 4 + 4, with volumes ranging from 0.03 to 12.6 cm³. T_(mean)/B (P < 0.01) and T_(max)/B (P < 0.001) ratios were significantly increased in high–Gleason score (4 + 3) lesions versus 3 + 4 and lower disease but failed to distinguish between 3 + 4 disease versus 3 + 3 and lower. T_(mean)/B and T_(max)/B ratios were significantly increased in tumors with an MIB-1/Ki-67 labeling index greater than or equal to 5% (P < 0.01). Conclusion: On the basis of our preliminary data using ratios of tumor to benign prostate background, ¹¹C-choline preferentially identified aggressive primary prostate cancer.

Key Words: ¹¹C-choline • PET/CT • PET/MRI • primary prostate cancer • image fusion

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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