title: Value of PET/CT and MR lymphography in treatment of prostate cancer patients with lymph node metastases.
abstract: OBJECTIVE
  To determine the clinical value of two novel molecular imaging techniques: (11)C-choline positron emission tomography (PET)/computed tomography (CT) and ferumoxtran-10 enhanced magnetic resonance imaging (magnetic resonance lymphography [MRL]) for lymph node (LN) treatment in prostate cancer (PCa) patients. Therefore, we evaluated the ability of PET/CT and MRL to assess the number, size, and location of LN metastases in patients with primary or recurrent PCa.
  
  
  METHODS
  A total of 29 patients underwent MRL and PET/CT for LN evaluation. The MRL and PET/CT data were analyzed independently. The number, size, and location of the LN metastases were determined. The location was described as within or outside the standard clinical target volume for elective pelvic irradiation as defined by the Radiation Therapy Oncology Group. Subsequently, the results from MRL and PET/CT were compared.
  
  
  RESULTS
  Of the 738 LNs visible on MRL, 151 were positive in 23 of 29 patients. Of the 132 LNs visible on PET/CT, 34 were positive in 13 of 29 patients. MRL detected significantly more positive LNs (p < 0.001) in more patients than PET/CT (p = 0.002). The mean diameter of the detected suspicious LNs on MRL was significantly smaller than those detected by PET/CT, 4.9 mm and 8.4 mm, respectively (p < 0.0001). In 14 (61%) of 23 patients, suspicious LNs were found outside the clinical target volume with MRL and in 4 (31%) of 13 patients with PET/CT.
  
  
  CONCLUSIONS
  In patients with PCa, both molecular imaging techniques, MRL and (11)C-choline PET/CT, can detect LNs suspicious for metastasis, irrespective of the existing size and shape criteria for CT and conventional magnetic resonance imaging. On MRL and PET/CT, 61% and 31% of the suspicious LNs were located outside the conventional clinical target volume. Therefore, these techniques could help to individualize treatment selection and enable image-guided radiotherapy for patients with PCa LN metastases.
authors.affiliation: Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. A.Fortuin@rad.umcn.nl
authors.forename: Ansje S
authors.initials: AS
authors.lastname: Fortuin
authors.forename: Willem M L L G
authors.initials: WM
authors.lastname: Deserno
authors.forename: Hanneke J M
authors.initials: HJ
authors.lastname: Meijer
authors.forename: Gerrit J
authors.initials: GJ
authors.lastname: Jager
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Oscar A
authors.initials: OA
authors.lastname: Debats
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
authors.forename: Christian
authors.initials: C
authors.lastname: Schick
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Krause
authors.forename: Inge
authors.initials: I
authors.lastname: van Oort
authors.forename: Alfred J
authors.initials: AJ
authors.lastname: Witjes
authors.forename: Yvonne L
authors.initials: YL
authors.lastname: Hoogeveen
authors.forename: Emile N J Th
authors.initials: EN
authors.lastname: van Lin
authors.forename: Jelle O
authors.initials: JO
authors.lastname: Barentsz
mesh_terms: D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D003287:Contrast Media; D003911:Dextrans; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008207:Lymphatic Metastasis; D008220:Lymphography / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D058185:Magnetite Nanoparticles; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000532:radiotherapy; D061089:Radiotherapy, Image-Guided / Q000379:methods; D014057:Tomography, X-Ray Computed
chemical_list: D002250:Carbon Radioisotopes; D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; C097921:ferumoxtran-10; D002794:Choline