PT - JOURNAL ARTICLE AU - Metser, Ur AU - Chua, Sue AU - Ho, Bao AU - Punwani, Shonit AU - Johnston, Edward AU - Pouliot, Frederic AU - Tau, Noam AU - Hawsawy, Asmaa AU - Anconina, Reut AU - Bauman, Glenn AU - Hicks, Rodney J. AU - Weickhardt, Andrew AU - Davis, Ian D. AU - Pond, Greg AU - Scott, Andrew M. AU - Tunariu, Nina AU - Sidhu, Harbir AU - Emmett, Louise TI - The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of <sup>18</sup>F-Fluoromethylcholine or <sup>68</sup>Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy AID - 10.2967/jnumed.118.225185 DP - 2019 Sep 01 TA - Journal of Nuclear Medicine PG - 1253--1258 VI - 60 IP - 9 4099 - http://jnm.snmjournals.org/content/60/9/1253.short 4100 - http://jnm.snmjournals.org/content/60/9/1253.full SO - J Nucl Med2019 Sep 01; 60 AB - Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of 18F-fluoromethylcholine (18F-FCH) or 68Ga-HBED-CC PSMA-11 (68Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. Methods: The current analysis was performed as part of a prospective, multicenter trial on 18F-FCH or 68Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (&gt;0.2 ng/mL) and high-risk features (Gleason score &gt; 7, PSA doubling time &lt; 10 mo, or PSA &gt; 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR–wbMR) were compared for each radiotracer and each individual patient (for 18F-FCH, or 68Ga-PSMA for patients who had 68Ga-PSMA PET) and to a composite reference standard. Results: There were 86 patients with PET (18F-FCH [n = 76] and/or 68Ga-PSMA [n = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on 18F-FCH PET/mpMR, versus 11 of 76 (14.5%) on 18F-FCH PET (P = 0.039), and in 11 of 26 (42.3%) on 68Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on 68Ga-PSMA PET (P = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (P = 0.039) or mpMR (P = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET (P = 1.0) but only 12 of 86 (14%) on wbMR (P = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (P = 0.683) or wbMR (P = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. Conclusion: Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to 18F-FCH or 68Ga-PSMA PET did not improve detection of regional or distant metastases.