Three-phase ¹⁸F-fluorocholine PET/CT in the evaluation of prostate cancer recurrence

Summary

Aim: Contribution of 3-phase ¹⁸F-fluorocholine PET/CT in suspected prostate cancer recurrence at early rise of PSA. Patients, methods: Retrospective analysis was performed in 47 patients after initial treatment with radiotherapy (n = 30) or surgery (n = 17). Following CT, 10 minutes list-mode PET acquisition was done over the prostate bed after injection of 300 MBq of ¹⁸F-fluorocholine. Three timeframes of 3 minutes each were reconstructed for analysis. All patients underwent subsequent whole body PET/CT. Delayed pelvic PET/CT was obtained in 36 patients. PET/CT was interpreted visually by two observers and SUV_max determined for suspicious lesions. Biopsies were obtained from 13 patients. Results: Biopsies confirmed the presence of cancer in 11 of 13 patients with positive PET for a total of 15 local recurrences in which average SUV_max increased during 14 minutes post injection and marginally decreased in delayed scanning. Conversely inguinal lymph nodes with mild to moderate metabolic activity on PET showed a clearly different pattern with decreasing SUV_max on dynamic images. Three-phase PET/CT contributed to the diagnostic assessment of 10 of 47 patients with biological evidence of recurrence of cancer. It notably allowed the discrimination of confounding blood pool or urinary activity from suspicious hyperactivities. PET/CT was positive in all patients with PSA ≥ 2 ng/ml (n = 34) and in 4/13 patients presenting PSA values <2 ng/ml. Conclusion: ¹⁸F-fluorocholine 3-phase PET/CT showed a progressively increasing SUV_max in biopsy confirmed cancer lesions up to 14 minutes post injection while decreasing in inguinal lymph nodes interpreted as benign. Furthermore, it was very useful in differentiating local recurrences from confounding blood pool and urinary activity.

Zusammenfassung

Ziel: Retrospektive Analyse der klinischen Wertigkeit einer 3-Phasen-Fluorcholin(FCH)-PET/CT bei 47 Patienten mit Verdacht auf frühes biochemisches Rezidiv eines Prostatakarzinoms. Patienten, Methoden: Die FCH-PET/CT wurde bei Patienten nach initialer Radiotherapie (n = 30) oder Chirurgie (n = 17) durchgeführt. Nach der CT wurden 300 MBq ¹⁸F-Fluorcholin appliziert und eine 10 Minuten dynamische PET in List-Mode-Technik über dem Prostatabett aufgenommen. Für die Analyse wurden hieraus drei statische Zeitabschnitte zu je 3 Minuten rekonstruiert. Anschließend erfolgte die Aufnahme der Ganzkörper-PET. Bei 36 Patienten wurde eine zusätzliche Spätaufnahme des Beckens aufgenommen. Die Analyse der PET/CT erfolgte visuell und anhand der SUV_max für verdächtige Befunde. Bei 13 Patienten mit positiver FCH PET/CT der Prostataloge wurden Biopsien analysiert. Ergebnisse: Histologisch bestätigt wurden 15 Lokalrezidive (4 bilateral) bei 11 von 13 FCHPET-positiven Patienten. In histologisch gesicherten Rezidiven stieg der SUV_max während der ersten 14 Minuten nach Injektion an und fiel anschließend leicht ab. Metabolisch aktive inguinale Lymphknoten zeigten im Gegensatz eine stetige Abnahme des SUV_max. Die Drei-Phasen-FCH-PET trug bei 10/47 Patienten entscheidend zur Diagnose bei, da sie die klare Abgrenzung von vaskulärer bzw. Harn-Aktivität gegenüber pathologischen Anreicherungen erlaubte. Bezüglich PSA war die FCH PET/CT bei allen Patienten ≥ 2ng/ml (n=34) positiv und bei 4/13 <2ng/ml. Schlussfolgerung: Die Drei-Phasen-FCH-PET/CT zeigte bei histologisch bestätigten Rezidiven einen initial zunehmenden SUV_max während in benignen inguinalen Lymphknoten ein stetiger Abfall zu verzeichnen war. Weiter erwies sie sich als sehr nützlich, um Lokalrezidive von vaskulärer bzw. Urinaktivität zu unterscheiden.

Keywords

¹⁸F-fluorocholine - 3-phase PET/CT - prostate cancer recurrence - rising PSA

Schlüsselwörter

¹⁸F-Fluorcholin - 3-Phasen PET/CT - Prostatakrebs-Rezidiv - PSA-Anstieg

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