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European Radiology
Published in: European Radiology 8/2018

01-08-2018 | Oncology

18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients

Authors: Kirsten M. Selnæs, Brage Krüger-Stokke, Mattijs Elschot, Frode Willoch, Øystein Størkersen, Elise Sandsmark, Siver A. Moestue, May-Britt Tessem, Dag Halvorsen, Eirik Kjøbli, Anders Angelsen, Sverre Langørgen, Helena Bertilsson, Tone F. Bathen

Published in: European Radiology | Issue 8/2018

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Abstract

Objective

To investigate the diagnostic potential of simultaneous 18F-fluciclovine PET/MRI for pelvic lymph node (LN) staging in patients with high-risk prostate cancer.

Methods

High-risk prostate cancer patients (n=28) underwent simultaneous 18F-fluciclovine PET/MRI prior to surgery. LNs were removed according to a predefined template of eight regions. PET and MR images were evaluated for presence of LN metastases according to these regions. Sensitivity/specificity for detection of LN metastases were calculated on patient and region basis. Sizes of LN metastases in regions with positive and negative imaging findings were compared with linear mixed models. Clinical parameters of PET-positive and -negative stage N1 patients were compared with the Mann-Whitney U test.

Results

Patient- and region-based sensitivity/specificity for detection of pelvic LN metastases was 40 %/87.5 % and 35 %/95.7 %, respectively, for MRI and 40 %/100 % and 30 %/100 %, respectively, for PET. LN metastases in true-positive regions were significantly larger than metastases in false-negative regions. PET-positive stage N1 patients had higher metastatic burden than PET-negative N1 patients.

Conclusion

Simultaneous 18F-fluciclovine PET/MRI provides high specificity but low sensitivity for detection of LN metastases in high-risk prostate cancer patients. 18F-Fluciclovine PET/MRI scan positive for LN metastases indicates higher metastatic burden than negative scan.

Key Points

• 18F-Fluciclovine PET/MRI has high specificity for detection of lymph node metastasis.
• 18F-Fluciclovine PET/MRI lacks sensitivity to replace ePLND.
• 18F-Fluciclovine PET/MRI may be used to aid surgery and select adjuvant therapy.
• 18F-Fluciclovine PET-positive patients have more extensive disease than PET-negative patients.
• Size of metastatic lymph nodes is an important factor for detection.
Appendix
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Metadata
Title
18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients
Authors
Kirsten M. Selnæs
Brage Krüger-Stokke
Mattijs Elschot
Frode Willoch
Øystein Størkersen
Elise Sandsmark
Siver A. Moestue
May-Britt Tessem
Dag Halvorsen
Eirik Kjøbli
Anders Angelsen
Sverre Langørgen
Helena Bertilsson
Tone F. Bathen
Publication date
01-08-2018
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 8/2018
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-017-5213-1

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