<sup>68</sup>Ga-PSMA-11 PET/MRI versus multiparametric MRI in men referred for prostate biopsy: primary tumour localization and interreader agreement

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Abstract

Background

Magnetic resonance imaging (MRI) is recommended by the European Urology Association guidelines as the standard modality for imaging-guided biopsy. Recently positron emission tomography with prostate-specific membrane antigen (PSMA PET) has shown promising results as a tool for this purpose. The aim of this study was to compare the accuracy of positron emission tomography with prostate-specific membrane antigen/magnetic resonance imaging (PET/MRI) using the gallium-labeled prostate-specific membrane antigen ( ⁶⁸Ga-PSMA-11) and multiparametric MRI (mpMRI) for pre-biopsy tumour localization and interreader agreement for visual and semiquantitative analysis. Semiquantitative parameters included apparent diffusion coefficient (ADC) and maximum lesion diameter for mpMRI and standardized uptake value (SUV _max) and PSMA-positive volume (PSMA _vol) for PSMA PET/MRI.

Results

Sensitivity and specificity were 61.4% and 92.9% for mpMRI and 66.7% and 92.9% for PSMA PET/MRI for reader one, respectively. RPE was available in 23 patients and 41 of 47 quadrants with discrepant findings. Based on RPE results, the specificity for both imaging modalities increased to 98% and 99%, and the sensitivity improved to 63.9% and 72.1% for mpMRI and PSMA PET/MRI, respectively. Both modalities yielded a substantial interreader agreement for primary tumour localization (mpMRI kappa = 0.65 (0.52–0.79), PSMA PET/MRI kappa = 0.73 (0.61–0.84)). ICC for SUV _max, PSMA _vol and lesion diameter were almost perfect (≥ 0.90) while for ADC it was only moderate (ICC = 0.54 (0.04–0.78)). ADC and lesion diameter did not correlate significantly with Gleason score ( ρ = 0.26 and ρ = 0.16) while SUV _max and PSMA _vol did ( ρ = − 0.474 and ρ = − 0.468).

Conclusions

PSMA PET/MRI has similar accuracy and reliability to mpMRI regarding primary prostate cancer (PCa) localization. In our cohort, semiquantitative parameters from PSMA PET/MRI correlated with tumour grade and were more reliable than the ones from mpMRI.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41824-022-00135-4.

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Author and article information

Contributors

Irene A. Burger:

ORCID: http://orcid.org/0000-0001-8029-8692

irene.burger@usz.ch

Journal

Journal ID (nlm-ta): Eur J Hybrid Imaging

Journal ID (iso-abbrev): Eur J Hybrid Imaging

Title: European Journal of Hybrid Imaging

Publisher: Springer International Publishing (Cham )

ISSN (Electronic): 2510-3636

Publication date (Electronic): 18 July 2022

Publication date PMC-release: 18 July 2022

Publication date Collection: December 2022

Volume: 6

Electronic Location Identifier: 14

Affiliations

[1 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Department of Nuclear Medicine, , University Hospital Zürich, University of Zurich, ; Rämistrasse 100, 8091 Zurich, Switzerland

[2 ]GRID grid.11899.38, ISNI 0000 0004 1937 0722, Department of Radiology and Oncology, Faculdade de Medicina FMUSP, , Universidade de São Paulo, ; São Paulo, Brazil

[3 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, University of Zurich, ; Zurich, Switzerland

[4 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Diagnostic and Interventional Radiology, , University Hospital Zurich, University of Zurich, ; Zurich, Switzerland

[5 ]GRID grid.51462.34, ISNI 0000 0001 2171 9952, Department of Radiology, , Memorial Sloan Kettering Cancer Center, ; New York City, USA

[6 ]GRID grid.7400.3, ISNI 0000 0004 1937 0650, Department of Urology, , University Hospital Zürich, University of Zurich, ; Zurich, Switzerland

[7 ]GRID grid.10438.3e, ISNI 0000 0001 2178 8421, Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, , University of Messina, ; Messina, Italy

[8 ]GRID grid.412004.3, ISNI 0000 0004 0478 9977, Department of Pathology and Molecular Pathology, , University Hospital Zurich, University of Zurich, ; Zurich, Switzerland

[9 ]GRID grid.410567.1, Department of Urology, , University Hospital Basel, ; Basel, Switzerland

[10 ]GRID grid.482962.3, ISNI 0000 0004 0508 7512, Department of Nuclear Medicine, , Kantonsspital Baden, ; Baden, Switzerland

Author information

Irene A. Burger http://orcid.org/0000-0001-8029-8692

Article

Publisher ID: 135

DOI: 10.1186/s41824-022-00135-4

PMC ID: 9288941

PubMed ID: 35843966

SO-VID: ae0c78bf-4066-4a3c-9a36-d9db62ca6c2f

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 20 February 2022

Date accepted : 3 April 2022

Funding

Funded by: Iten-kohaut Foundation

Funded by: Sick legat

Funded by: FundRef http://dx.doi.org/10.13039/501100002322, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior;

Funded by: FundRef http://dx.doi.org/10.13039/100000054, National Cancer Institute;

Award ID: P30CA008748

Award Recipient : Anton S. Becker

Funded by: FundRef http://dx.doi.org/10.13039/100007117, Peter Michael Foundation;

Custom metadata

Keywords: biopsy guidance,psma pet,mpmri,targeted biopsy,primary staging,interreader agreement,template biopsy,pet/mri,suvmax,adc

Data availability:

Keywords: biopsy guidance, psma pet, mpmri, targeted biopsy, primary staging, interreader agreement, template biopsy, pet/mri, suvmax, adc