title: Prostate cancer: 1HMRS-DCEMR at 3T versus [(18)F]choline PET/CT in the detection of local prostate cancer recurrence in men with biochemical progression after radical retropubic prostatectomy (RRP).
abstract: OBJECTIVE
  This study compares proton magnetic resonancespectroscopic imaging (1H-MRSI) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined techniques at 3T magnet versus [(18)F]choline PET/computed tomography (CT) in the detection of local prostate cancer recurrence in patients with biochemical progression after radical retropubic prostatectomy (RRP).
  
  
  METHODS
  84 consecutive patients at high risk of local recurrence underwent combined 1HMRSI-DCEMR and 18-Fcholine- PET/CT. MR scan protocol included turbo spin echo (TSE) T2-weighted sequences in the axial, sagittal and coronal planes; three-dimensional (3D) chemical shift imaging (CSI) sequences with spectral/spatial pulses optimized for quantitative detection of choline and citrate; dynamic contrast enhanced gradient-echo (GRE) T1-weighted sequence. The population was divided into two groups. Group A included 28 patients with a lesion size ranging between 5.00mm and 7.2mm and PSA reduction following radiation therapy. Group B included 56 patients with a lesion size between 7.6mm and 19.4mm. Sensitivity, specificity, positive predictive value (PPV) and accuracy were evaluated and receiver operating characteristic (ROC) curves were performed.
  
  
  RESULTS
  In Group A combined 1H-MRSI and DCE-MRI showed a sensitivity of 92%, a specificity of 75% (PPV 96%) while PET-CT examination showed a sensitivity of 62% and a specificity of 50% (PPV 88%) in identifying local recurrence. The accuracy of MRI was 89% while PET-CT showed an accuracy of 60%. Areas under the ROC curve (AUC) values for MR and PET-CT were 0.833 and 0.562, respectively. In Group B combined 1H-MRSI and DCEMR showed a sensitivity of 94% and a specificity of 100% (PPV 100%) with accuracy of 94%. PET-CT had a sensitivity of 92% and a specificity of 33% (PPV 98%) with accuracy of 91%. The AUCs for MR and PET-CT values were 0.971 and 0.837, respectively.
  
  
  CONCLUSIONS
  The diagnostic accuracy of combined 1HMRSI-DCEMR was higher than PET/CT to identify local prostate cancer recurrence, mostly in patients with low biochemical progression after RRP (0.2-2ng/mL).
authors.affiliation: Dept. of Radiological Sciences, Sapienza University of Rome, v.le Regina Elena, 324 - 00161 Rome, Italy. valeria.panebianco@uniroma1.it
authors.forename: Valeria
authors.initials: V
authors.lastname: Panebianco
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciarra
authors.forename: Danilo
authors.initials: D
authors.lastname: Lisi
authors.forename: Francesca
authors.initials: F
authors.lastname: Galati
authors.forename: Valeria
authors.initials: V
authors.lastname: Buonocore
authors.forename: Carlo
authors.initials: C
authors.lastname: Catalano
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Gentile
authors.forename: Andrea
authors.initials: A
authors.lastname: Laghi
authors.forename: Roberto
authors.initials: R
authors.lastname: Passariello
mesh_terms: D000368:Aged; D002794:Choline / Q000031:analogs & derivatives; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000517:prevention & control*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000601:surgery*; D011522:Protons; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D011522:Protons; D019275:Radiopharmaceuticals; C516370:fluoromethylcholine; D017430:Prostate-Specific Antigen; D002794:Choline