68Ga-PSMA-11 PET/MRI versus multiparametric MRI in men referred for prostate biopsy: primary tumour localization and interreader agreement

Daniela A Ferraro; Andreas M Hötker; Anton S Becker; Iliana Mebert; Riccardo Laudicella; Anka Baltensperger; Niels J Rupp; Jan H Rueschoff; Julian Müller; Ashkan Mortezavi; Marcelo T Sapienza; Daniel Eberli; Olivio F Donati; Irene A Burger

doi:10.1186/s41824-022-00135-4

⁶⁸Ga-PSMA-11 PET/MRI versus multiparametric MRI in men referred for prostate biopsy: primary tumour localization and interreader agreement

Eur J Hybrid Imaging. 2022 Jul 18;6(1):14. doi: 10.1186/s41824-022-00135-4.

Authors

Daniela A Ferraro^#^{1

2

3}, Andreas M Hötker^#⁴, Anton S Becker^{4

5}, Iliana Mebert^{1

6}, Riccardo Laudicella^{1

7}, Anka Baltensperger^{1

6}, Niels J Rupp⁸, Jan H Rueschoff⁸, Julian Müller¹, Ashkan Mortezavi^{6

9}, Marcelo T Sapienza², Daniel Eberli⁶, Olivio F Donati^#⁴, Irene A Burger^#^{10

11

12}

Affiliations

¹ Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
² Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
³ University of Zurich, Zurich, Switzerland.
⁴ Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁵ Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, USA.
⁶ Department of Urology, University Hospital Zürich, University of Zurich, Zurich, Switzerland.
⁷ Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy.
⁸ Department of Pathology and Molecular Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
⁹ Department of Urology, University Hospital Basel, Basel, Switzerland.
¹⁰ Department of Nuclear Medicine, University Hospital Zürich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland. irene.burger@usz.ch.
¹¹ University of Zurich, Zurich, Switzerland. irene.burger@usz.ch.
¹² Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland. irene.burger@usz.ch.

^# Contributed equally.

Abstract

Background: Magnetic resonance imaging (MRI) is recommended by the European Urology Association guidelines as the standard modality for imaging-guided biopsy. Recently positron emission tomography with prostate-specific membrane antigen (PSMA PET) has shown promising results as a tool for this purpose. The aim of this study was to compare the accuracy of positron emission tomography with prostate-specific membrane antigen/magnetic resonance imaging (PET/MRI) using the gallium-labeled prostate-specific membrane antigen (⁶⁸Ga-PSMA-11) and multiparametric MRI (mpMRI) for pre-biopsy tumour localization and interreader agreement for visual and semiquantitative analysis. Semiquantitative parameters included apparent diffusion coefficient (ADC) and maximum lesion diameter for mpMRI and standardized uptake value (SUV_max) and PSMA-positive volume (PSMA_vol) for PSMA PET/MRI.

Results: Sensitivity and specificity were 61.4% and 92.9% for mpMRI and 66.7% and 92.9% for PSMA PET/MRI for reader one, respectively. RPE was available in 23 patients and 41 of 47 quadrants with discrepant findings. Based on RPE results, the specificity for both imaging modalities increased to 98% and 99%, and the sensitivity improved to 63.9% and 72.1% for mpMRI and PSMA PET/MRI, respectively. Both modalities yielded a substantial interreader agreement for primary tumour localization (mpMRI kappa = 0.65 (0.52-0.79), PSMA PET/MRI kappa = 0.73 (0.61-0.84)). ICC for SUV_max, PSMA_vol and lesion diameter were almost perfect (≥ 0.90) while for ADC it was only moderate (ICC = 0.54 (0.04-0.78)). ADC and lesion diameter did not correlate significantly with Gleason score (ρ = 0.26 and ρ = 0.16) while SUV_max and PSMA_vol did (ρ = - 0.474 and ρ = - 0.468).

Conclusions: PSMA PET/MRI has similar accuracy and reliability to mpMRI regarding primary prostate cancer (PCa) localization. In our cohort, semiquantitative parameters from PSMA PET/MRI correlated with tumour grade and were more reliable than the ones from mpMRI.

Keywords: ADC; Biopsy guidance; Interreader agreement; PET/MRI; PSMA PET; Primary staging; SUVmax; Targeted biopsy; Template biopsy; mpMRI.

Abstract

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