Value of PET/CT and MR Lymphography in Treatment of Prostate Cancer Patients With Lymph Node Metastases

• Published in: International journal of radiation oncology, biology, physics Vol. 84; no. 3; pp. 712 - 718
• Main Authors: Fortuin, Ansje S., M.D, Deserno, Willem M.L.L.G., M.D., M.Sc., Ph.D, Meijer, Hanneke J.M., M.D, Jager, Gerrit J., M.D., Ph.D, Takahashi, Satoru, M.D., Ph.D, Debats, Oscar A., M.D., M.Sc, Reske, Sven N., M.D., Ph.D, Schick, Christian, M.D, Krause, Bernd J., M.D., Ph.D, van Oort, Inge, M.D., Ph.D, Witjes, Alfred J., M.D., Ph.D, Hoogeveen, Yvonne L., Ph.D, van Lin, Emile N.J.Th., M.D., Ph.D, Barentsz, Jelle O., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2012; Elsevier
• Subjects: 11C-choline PET/CT; Aged; Biological and medical sciences; CARBON 11; Carbon Radioisotopes; Cardiovascular system; CHOLINE; Computed tomography; Contrast Media; Dextrans; Gynecology. Andrology. Obstetrics; Hematology, Oncology and Palliative Medicine; Humans; Investigative techniques, diagnostic techniques (general aspects); IRON OXIDES; IRRADIATION; Lymph node; LYMPH NODES; Lymph Nodes - diagnostic imaging; Lymph Nodes - pathology; Lymphatic Metastasis; Lymphography - methods; MAGNETIC RESONANCE; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Magnetite Nanoparticles; Male; Male genital diseases; Medical sciences; METASTASES; Middle Aged; MRI; Multimodal Imaging - methods; NANOSTRUCTURES; NEOPLASMS; Nephrology. Urinary tract diseases; NMR IMAGING; PARAMAGNETISM; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Positron emission tomography; PROSTATE; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; Radiotherapy, Image-Guided - methods; Tomography, X-Ray Computed; Tumors; Tumors of the urinary system; Ultra-small super-paramagnetic iron-oxide nanoparticles; Urinary tract. Prostate gland; 11C-choline PET/CT; Lymph node; Magnetic resonance imaging; Computed tomography; MRI; Ultra-small super-paramagnetic iron-oxide nanoparticles; Prostate cancer; Positron emission tomography; Radionuclide study; Choleretic; Iron oxide; Prostate disease; Nanoparticle; Malignant lymphadenopathy; C-choline PET/CT; Lymphography; Cancerology; Male genital diseases; Human; Urinary system disease; Radiodiagnosis; Malignant hemopathy; Malignant tumor; Nuclear magnetic resonance imaging; Lymph node metastasis; Treatment; Choline; Medical imagery; Computerized axial tomography; Cancer; Emission tomography
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2011.12.093

Purpose To determine the clinical value of two novel molecular imaging techniques:11 C-choline positron emission tomography (PET)/computed tomography (CT) and ferumoxtran-10 enhanced magnetic resonance imaging (magnetic resonance lymphography [MRL]) for lymph node (LN) treatment in prostate cancer (PCa) patients. Therefore, we evaluated the ability of PET/CT and MRL to assess the number, size, and location of LN metastases in patients with primary or recurrent PCa. Methods and Materials A total of 29 patients underwent MRL and PET/CT for LN evaluation. The MRL and PET/CT data were analyzed independently. The number, size, and location of the LN metastases were determined. The location was described as within or outside the standard clinical target volume for elective pelvic irradiation as defined by the Radiation Therapy Oncology Group. Subsequently, the results from MRL and PET/CT were compared. Results Of the 738 LNs visible on MRL, 151 were positive in 23 of 29 patients. Of the 132 LNs visible on PET/CT, 34 were positive in 13 of 29 patients. MRL detected significantly more positive LNs ( p < 0.001) in more patients than PET/CT ( p = 0.002). The mean diameter of the detected suspicious LNs on MRL was significantly smaller than those detected by PET/CT, 4.9 mm and 8.4 mm, respectively ( p < 0.0001). In 14 (61%) of 23 patients, suspicious LNs were found outside the clinical target volume with MRL and in 4 (31%) of 13 patients with PET/CT. Conclusion In patients with PCa, both molecular imaging techniques, MRL and11 C-choline PET/CT, can detect LNs suspicious for metastasis, irrespective of the existing size and shape criteria for CT and conventional magnetic resonance imaging. On MRL and PET/CT, 61% and 31% of the suspicious LNs were located outside the conventional clinical target volume. Therefore, these techniques could help to individualize treatment selection and enable image-guided radiotherapy for patients with PCa LN metastases.