title: 18F-Choline PET/MRI: The Additional Value of PET for MRI-Guided Transrectal Prostate Biopsies.
abstract: We assessed the value of fusion (18)F-fluoromethylcholine ((18)F-choline) PET/MRI for image-guided (targeted) prostate biopsies to detect significant prostate cancer (Gleason ≥ 3 + 4) compared with standard (systematic 12-core) biopsies.
  
  
  METHODS
  Within an ongoing prospective clinical trial, hybrid (18)F-choline PET/CT and multiparametric 3T MRI (mpMRI) of the pelvis were performed in 36 subjects with a rising prostate-specific antigen for known (n = 15) or suspected (n = 21) prostate cancer before a prostate biopsy procedure. PET and T2-weighted MR volumes of the prostate were spatially registered using commercially available software. Biopsy targets were selected on the basis of visual appearance on MRI and graded as low, intermediate, or high risk for significant disease. Volumes of interest were defined for MR-identified lesions. (18)F-choline uptake measures were obtained from the MR target and a mirrored background volume of interest. The biopsy procedure was performed after registration of real-time transrectal ultrasound with T2-weighted MR and included image-guided cores plus standard cores. Histologic results were determined from standard and targeted biopsy cores as well as prostatectomy specimens (n = 10).
  
  
  RESULTS
  Fifteen subjects were ultimately identified with Gleason ≥ 3 + 4 prostate cancer, of which targeted biopsy identified significantly more (n = 12) than standard biopsies (n = 5; P = 0.002). A total of 52 lesions were identified by mpMRI (19 low, 18 intermediate, 15 high risk), and mpMRI-assigned risk was a strong predictor of final pathology (area under the curve = 0.81; P < 0.001). When the mean (18)F-choline target-to-background ratio was used, the addition of (18)F-choline to mpMRI significantly improved the prediction of Gleason ≥ 3 + 4 cancers over mpMRI alone (area under the curve = 0.92; P < 0.001).
  
  
  CONCLUSIONS
  Fusion PET/MRI transrectal ultrasound image registration for targeted prostate biopsies is clinically feasible and accurate. The addition of (18)F-choline PET to mpMRI improves the identification of significant prostate cancer.
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan mpiert@umich.edu.
authors.forename: Morand
authors.initials: M
authors.lastname: Piert
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Montgomery
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Lakshmi Priya
authors.initials: LP
authors.lastname: Kunju
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Javed
authors.initials: J
authors.lastname: Siddiqui
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Virginia
authors.initials: V
authors.lastname: Rogers
authors.affiliation: Department of Pathology, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Thekkelnaycke
authors.initials: T
authors.lastname: Rajendiran
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, Michigan.
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Johnson
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Xia
authors.initials: X
authors.lastname: Shao
authors.affiliation: Department of Radiology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Davenport
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002794:Choline / Q000031:analogs & derivatives*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D057054:Molecular Imaging / Q000379:methods; D064847:Multimodal Imaging / Q000379:methods*; D000072078:Positron Emission Tomography Computed Tomography / Q000379:methods*; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014463:Ultrasonography
chemical_list: D019275:Radiopharmaceuticals; C516370:fluoromethylcholine; D002794:Choline
keywords: 18F-fluoromethylcholine; PET/MRI; molecular imaging; prostate cancer; targeted prostate biopsy