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Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

68Ga-labelled HBED-CC-PSMA is a highly promising tracer for imaging recurrent prostate cancer (PCa). The intention of this study was to evaluate the feasibility of PET/MRI with this tracer.

Methods

Twenty patients underwent PET/CT 1 h after injection of the 68Ga-PSMA ligand followed by PET/MRI 3 h after injection. Data from the two investigations were first analysed separately and then compared with respect to tumour detection rate and radiotracer uptake in various tissues. To evaluate the quantification accuracy of the PET/MRI system, differences in SUVs between PET/CT and corresponding PET/MRI were compared with differences in SUVs between PET/CT 1 h and 3 h after injection in another patient cohort. This cohort was investigated using the same PET/CT system.

Results

With PET/MRI, different diagnostic sequences, higher contrast of lesions and higher resolution of MRI enabled a subjectively easier evaluation of the images. In addition, four unclear findings on PET/CT could be clarified as characteristic of PCa metastases by PET/MRI. However, in PET images of the PET/MRI, a reduced signal was observed at the level of the kidneys (in 11 patients) and around the urinary bladder (in 15 patients). This led to reduced SUVs in six lesions. SUVmean values provided by the PET/MRI system were different in muscles, blood pool, liver and spleen.

Conclusion

PCa was detected more easily and more accurately with Ga-PSMA PET/MRI than with PET/CT and with lower radiation exposure. Consequently, this new technique could clarify unclear findings on PET/CT. However, scatter correction was challenging when the specific 68Ga-PSMA ligand was used. Moreover, direct comparison of SUVs from PET/CT and PET/MR needs to be conducted carefully.

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Acknowledgments

We wish to express our gratitude to the members of staff Regula Gnirs and Cora Weyrich, and also especially Dr. Henrik Hetzheim and Dr. Clemens Kratochwil.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany

    A. Afshar-Oromieh & U. Haberkorn

  2. Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany

    A. Afshar-Oromieh, H. P. Schlemmer, M. Fenchel & M. Röthke

  3. Clinical Cooperation Unit of Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany

    U. Haberkorn

  4. Department of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany

    M. Eder & M. Eisenhut

  5. Department of Urology, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg, Germany

    B. A. Hadaschik

  6. Department of Biostatistics, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, Germany

    A. Kopp-Schneider

Authors
  1. A. Afshar-Oromieh
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  2. U. Haberkorn
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  5. M. Eder
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  6. M. Eisenhut
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  7. B. A. Hadaschik
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Corresponding author

Correspondence to A. Afshar-Oromieh.

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Fig. 1

The reliability of SUVs provided by the PET/MRI system was evaluated In a previous study [9] mean SUVs of several tissues were measured using a Siemens Biograph 6 PET/CT system 1 h and 3 h p.i. In the present study, SUVs 1 h p.i. were also measured using the Siemens Biograph 6. The patients were then transferred to a Siemens Biograph mMR PET/MRI system to measure SUV values at 3 h p.i. Differences in the mean SUVs between 1 h and 3 h in the first patient cohort (orange column) were compared to the same values from the patient cohort in the present study (blue column). The results of this analysis are shown in Fig. 5. (JPEG 34 kb)

High Resolution Image (TIFF 418 kb)

Fig. 2

PET images with scatter correction (b, e) compared to attenuation-corrected PET images without scatter correction (c, f) in the only patient (patient 8) who showed visually less bright lesions around the urinary bladder. All other patients demonstrated brighter PSMA-positive tissues/lesions on PET images with scatter correction. a Fusion of PET and CT images, d PET image from the PET/CT system, b fusion of PET and MRI (T1 native) images corrected for scatter and attenuation, e MIP image corrected for scatter and attenuation, c fusion of attenuation-corrected PET image without scatter correction and MRI (T1 native) image, f attenuation-corrected MIP image without scatter correction. (JPEG 40 kb)

High Resolution Image (TIFF 9061 kb)

Fig. 3

Images in patient 8 with a significant halo around the urinary bladder which is clearly visible using extreme windowing in PET images with attenuation and scatter correction (d). Within the halo, SUVs are underestimated as demonstrated by VOIs in muscle inside and outside the halo (d). Extreme windowing can help detect suspicious lesions such as the suspicious lymph node (white arrows). This suspicious lymph node would not have been detected using the automatic windowing. a MR image (T1 with contrast medium and fat saturation) and b PET/MRI fusion image with attenuation and scatter correction as automatically produced by the PET/MRI system; c MR image (T1 with contrast medium and fat saturation) and d PET/MRI fusion image with attenuation and scatter correction with extreme windowing of the PET image. (JPEG 53 kb)

High Resolution Image (TIFF 1657 kb)

Fig. 4

68Ga-PSMA PET/CT images (a, b) and PET/MRI (c, d) in patient 8. This is another example of the benefits of late PET imaging (improved tracer uptake) compared to MRI (improved anatomical correlation; white arrows lymph node). a CT image without contrast medium, b PET/CT fusion image, c MR image (T1 with contrast medium and fat saturation), d PET/MRI fusion image. (JPEG 54 kb)

High Resolution Image (TIFF 1788 kb)

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Afshar-Oromieh, A., Haberkorn, U., Schlemmer, H.P. et al. Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging 41, 887–897 (2014). https://doi.org/10.1007/s00259-013-2660-z

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  • DOI: https://doi.org/10.1007/s00259-013-2660-z

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