Diagnostic Accuracy of 68Ga-PSMA-11 PET/MRI Compared with Multiparametric MRI in the Detection of Prostate Cancer

Robert M Hicks; Jeffry P Simko; Antonio C Westphalen; Hao G Nguyen; Kirsten L Greene; Li Zhang; Peter R Carroll; Thomas A Hope

doi:10.1148/radiol.2018180788

Diagnostic Accuracy of ⁶⁸Ga-PSMA-11 PET/MRI Compared with Multiparametric MRI in the Detection of Prostate Cancer

Radiology. 2018 Dec;289(3):730-737. doi: 10.1148/radiol.2018180788. Epub 2018 Sep 18.

Authors

Robert M Hicks¹, Jeffry P Simko¹, Antonio C Westphalen¹, Hao G Nguyen¹, Kirsten L Greene¹, Li Zhang¹, Peter R Carroll¹, Thomas A Hope¹

Affiliation

¹ From the Department of Radiology and Biomedical Imaging (R.M.H., A.C.W., T.A.H.), Department of Anatomic Pathology (J.P.S.), Department of Urology (J.P.S., A.C.W., H.G.N., K.L.G., P.R.C.), and UCSF Helen Diller Family Comprehensive Cancer Center (A.C.W., L.Z., P.R.C., T.A.H.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628.

Abstract

Purpose To compare the diagnostic accuracy of gallium 68 (⁶⁸Ga)-labeled prostate-specific membrane antigen (PSMA)-11 PET/MRI with that of multiparametric MRI in the detection of prostate cancer. Materials and Methods The authors performed a retrospective study of men with biopsy-proven prostate cancer who underwent simultaneous ⁶⁸Ga-PSMA-11 PET/MRI before radical prostatectomy between December 2015 and June 2017. The reference standard was whole-mount pathologic examination. Readers were blinded to radiologic and pathologic findings. Tumor localization was based on 30 anatomic regions. Region-specific sensitivity and specificity were calculated for PET/MRI and multiparametric MRI by using raw stringent and alternative neighboring approaches. Maximum standardized uptake value (SUV_max) in the tumor and Prostate Imaging Reporting and Data System (PI-RADS) version 2 grade were compared with tumor Gleason score. Generalized estimating equations were used to estimate population-averaged sensitivity and specificity and to determine the association between tumor characteristics and SUV_max or PI-RADS score. Results Thirty-two men (median age, 68 years; interquartile range: 62-71 years) were imaged. The region-specific sensitivities of PET/MRI and multiparametric MRI were 74% (95% confidence interval [CI]: 70%, 77%) and 50% (95% CI: 45%, 0.54%), respectively, with the alternative neighboring approach (P < .001 for both) and 73% (95% CI: 68%, 79%) and 69% (95% CI: 62%, 75%), respectively, with the population-averaged generalized estimating equation (P = .04). Region-specific specificity of PET/MRI was similar to that of multiparametric MRI with the alternative neighboring approach (88% [95% CI: 85%, 91%] vs 90% [95% CI: 87%, 92%], P = .99) and in population-averaged estimates (70% [95% CI: 64%, 76%] vs 70% [95% CI: 64%, 75%], P = .99). SUV_max was associated with a Gleason score of 7 and higher (odds ratio: 1.71 [95% CI: 1.27, 2.31], P < .001). Conclusion The sensitivity of gallium 68-labeled prostate-specific membrane antigen-11 PET/MRI in the detection of prostate cancer is better than that of multiparametric MRI. © RSNA, 2018 See also the editorial by Civelek in this issue.

Publication types

Comparative Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Gallium Radioisotopes*
Humans
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Positron-Emission Tomography / methods*
Prostate / diagnostic imaging
Prostate-Specific Antigen*
Prostatic Neoplasms / diagnostic imaging*
Radiopharmaceuticals
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity

Substances

Gallium Radioisotopes
Radiopharmaceuticals
Gallium-68
Prostate-Specific Antigen

Grants and funding

R01 CA212148/CA/NCI NIH HHS/United States