title: Value of bimodal (18)F-choline-PET/MRI and trimodal (18)F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy.
abstract: Between 27% and 53% of all patients who undergo radical prostatectomy (RP) or radiation therapy (RT) as the first-line treatment of prostate cancer (PCa) develop a biochemical recurrence. Imaging plays a pivotal role in restaging by helping to distinguish between local relapse and metastatic disease (i.e., lymph-node and skeletal metastases). At present, the most promising tools for assessing PCa patients with biochemical recurrence are multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET)/computed tomography (CT) with radio-labeled choline derivatives. The main advantage of mpMRI is its high diagnostic accuracy in detecting local recurrence, while choline-PET/CT is able to identify lymph-node metastases when they are not suspicious on morphological imaging. The most recent advances in the field of fusion imaging have shown that multimodal co-registration, synchronized navigation, and combined interpretation are more valuable than the individual; separate assessment offered by different diagnostic techniques. The objective of the present essay was to describe the value of bimodal choline-PET/mpMRI fusion imaging and trimodal choline-PET/mpMRI/transrectal ultrasound (TRUS) in the assessment of PCa recurrence after RP and RT. Bimodal choline-PET/mpMRI fusion imaging allows morphological, functional, and metabolic information to be combined, thereby overcoming the limitations of each separate imaging modality. In addition, trimodal real-time choline-PET/mpMRI/TRUS fusion imaging may be useful for the planning and real-time guidance of biopsy procedures in order to obtain histological confirmation of the local recurrence.
authors.affiliation: Unit of Radiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy, francesco.paparo@galliera.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Paparo
authors.forename: Arnoldo
authors.initials: A
authors.lastname: Piccardo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bacigalupo
authors.forename: Andrea
authors.initials: A
authors.lastname: Romagnoli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Piccazzo
authors.forename: Michela
authors.initials: M
authors.lastname: Monticone
authors.forename: Luca
authors.initials: L
authors.lastname: Cevasco
authors.forename: Fabio
authors.initials: F
authors.lastname: Campodonico
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Conzi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Rollandi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002794:Choline; D003936:Diagnosis, Computer-Assisted; D005462:Fluorine Radioisotopes; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy / Q000601:surgery; D019275:Radiopharmaceuticals; D014463:Ultrasonography
chemical_list: D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; D002794:Choline