68 Ga-PSMA-PET/CT in comparison with 18 F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study

Eva Dyrberg, Helle W Hendel, Tri Hien Viet Huynh, Tobias Wirenfeldt Klausen, Vibeke B Løgager, Claus Madsen, Erik M Pedersen, Maria Pedersen, Henrik S Thomsen

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68 Citations (Scopus)

Abstract

Objectives: To determine the diagnostic accuracy of 68 gallium prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in comparison with 18 F-fluoride-based PET/CT (NaF-PET/CT) and whole-body magnetic resonance imaging (WB-MRI) for the detection of bone metastases in patients with prostate cancer. Methods: Sixty patients with prostate cancer were included in the period May 2016 to June 2017. The participants underwent three scans (index tests) within 30 days: a NaF-PET/CT, a WB-MRI and a PSMA-PET/CT. Experienced specialists assessed the scans. In the absence of a histological reference standard, the final diagnosis was determined as a panel diagnosis. Measures of the diagnostic performances of the index tests were calculated from patient-based dichotomous outcomes (0 or ≥ 1 bone metastasis) and pairwise compared (McNemar test). For each index test, the agreement with the final diagnosis with regard to the number of bone metastases detected (0, 1–5, > 5) and the inter-reader agreement was calculated (kappa coefficients). Results: Fifty-five patients constituted the final study population; 20 patients (36%) were classified as having bone metastatic disease as their final diagnosis. The patient-based diagnostic performances were (sensitivity, specificity, overall accuracy) PSMA-PET/CT (100%, 100%, 100%), NaF-PET/CT (95%, 97%, 96%) and WB-MRI (80%, 83%, 82%). The overall accuracy of PSMA-PET/CT was significantly more favourable compared to WB-MRI (p = 0.004), but not to NaF-PET/CT (p = 0.48). PSMA-PET/CT classified the number of bone metastases reliably compared to the final diagnosis (kappa coefficient 0.97) and with an “almost perfect” inter-reader agreement (kappa coefficient 0.93). Conclusions: The overall accuracy of PSMA-PET/CT was significantly more advantageous compared to WB-MRI, but not to NaF-PET/CT. Key Points: • PSMA-PET/CT assessed the presence of bone metastases correctly in all 55 patients • PSMA-PET/CT was more advantageous compared to WB-MRI • No difference was found between PSMA-PET/CT and NaF-PET/CT

Original languageEnglish
JournalEuropean Radiology
Volume29
Issue number3
Pages (from-to)1221-1230
Number of pages10
ISSN0938-7994
DOIs
Publication statusPublished - 2019

Keywords

  • Aged
  • Aged, 80 and over
  • Antigens, Surface/pharmacology
  • Bone Neoplasms/diagnosis
  • Gallium Radioisotopes/pharmacology
  • Glutamate Carboxypeptidase II/pharmacology
  • Humans
  • Magnetic Resonance Imaging/methods
  • Male
  • Middle Aged
  • Positron Emission Tomography Computed Tomography/methods
  • Prospective Studies
  • Prostatic Neoplasms/pathology
  • Reproducibility of Results
  • Whole Body Imaging/methods

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