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Journal of Nuclear Medicine

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Research ArticleOncology

18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification for MRI-Guided Transrectal Prostate Biopsies

Matthew S. Davenport, Jeffrey S. Montgomery, Lakshmi Priya Kunju, Javed Siddiqui, Prasad R. Shankar, Thekkelnaycke Rajendiran, Xia Shao, Eunjee Lee, Brian Denton, Christine Barnett and Morand Piert
Journal of Nuclear Medicine March 2020, 61 (3) 337-343; DOI: https://doi.org/10.2967/jnumed.119.225789
Matthew S. Davenport
1Radiology Department, University of Michigan, Ann Arbor, Michigan
2Urology Department, University of Michigan, Ann Arbor, Michigan
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Jeffrey S. Montgomery
2Urology Department, University of Michigan, Ann Arbor, Michigan
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Lakshmi Priya Kunju
3Pathology Department, University of Michigan, Ann Arbor, Michigan
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Javed Siddiqui
3Pathology Department, University of Michigan, Ann Arbor, Michigan
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Prasad R. Shankar
1Radiology Department, University of Michigan, Ann Arbor, Michigan
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Thekkelnaycke Rajendiran
3Pathology Department, University of Michigan, Ann Arbor, Michigan
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Xia Shao
1Radiology Department, University of Michigan, Ann Arbor, Michigan
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Eunjee Lee
4Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
5Department of Information and Statistics, Chungnam National University, Daejeon, South Korea
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Brian Denton
6RTI Health Solutions, Research Triangle Park, North Carolina; and
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Christine Barnett
6RTI Health Solutions, Research Triangle Park, North Carolina; and
7Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, Michigan
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Morand Piert
1Radiology Department, University of Michigan, Ann Arbor, Michigan
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  • FIGURE 1.
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    FIGURE 1.

    Coregistered axial 3D T2-weighted fast-spin echo MRI (A), 18F-choline PET (SUV range, 0–6) (B), apparent diffusion coefficient map (C), and PET/mpMRI (D). Small 0.16 cm3 right peripheral zone intermediate-risk lesion (yellow circles) was confirmed as Gleason 4+4 cancer. Respective mirrored background volume of interest (blue circles) is shown, resulting in 18F-choline TBR of 1.61. Diffusely increased 18F-choline uptake is noted in benign prostate hyperplasia (arrow).

  • FIGURE 2.
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    FIGURE 2.

    Receiver-operating-characteristic curves of models L1/P1 (red line), L2/P2 (green line), L3/P3 (blue line), and L4/P4 (gray line) relative to mpMRI base-case (dashed line) for lesion-based and subject-based data, separate for readers 1 and 2 as well as Likert and PI-RADS scoring systems.

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    FIGURE 3.

    Bubble plot of mpMRI-identified lesions stratified by 18F-choline PET TBR and presence (red circles) or absence (blue circles) of Gleason ≥ 3+4 cancer on per-lesion basis. Circle diameter represents target volume (Supplemental Table 2). Dashed line indicates 18F-choline TBR threshold of 1.58.

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    FIGURE 4.

    For 56 evaluable subjects, relationship of diagnosis before study enrollment to final pathology and subsequent clinical management. Connecting lines (plain dashed: benign; solid: cancer; long-short dashed: no prior biopsy) indicate management decisions related to final pathology. ▲ = Gleason 3+3 cancer; ▼ = Gleason 3+4 cancer.

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Journal of Nuclear Medicine: 61 (3)
Journal of Nuclear Medicine
Vol. 61, Issue 3
March 1, 2020
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18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification for MRI-Guided Transrectal Prostate Biopsies
Matthew S. Davenport, Jeffrey S. Montgomery, Lakshmi Priya Kunju, Javed Siddiqui, Prasad R. Shankar, Thekkelnaycke Rajendiran, Xia Shao, Eunjee Lee, Brian Denton, Christine Barnett, Morand Piert
Journal of Nuclear Medicine Mar 2020, 61 (3) 337-343; DOI: 10.2967/jnumed.119.225789

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18F-Choline PET/mpMRI for Detection of Clinically Significant Prostate Cancer: Part 1. Improved Risk Stratification for MRI-Guided Transrectal Prostate Biopsies
Matthew S. Davenport, Jeffrey S. Montgomery, Lakshmi Priya Kunju, Javed Siddiqui, Prasad R. Shankar, Thekkelnaycke Rajendiran, Xia Shao, Eunjee Lee, Brian Denton, Christine Barnett, Morand Piert
Journal of Nuclear Medicine Mar 2020, 61 (3) 337-343; DOI: 10.2967/jnumed.119.225789
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Keywords

  • 18F-fluoromethylcholine
  • PET/MRI
  • prostate cancer
  • targeted prostate biopsy
  • interrater agreement
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