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Performance of 18F-fluciclovine PET/MR in the evaluation of osseous metastases from castration-resistant prostate cancer

  • Barbara J. Amorim
  • Vinay Prabhu
  • Sara S. Marco
  • Debra Gervais
  • Willian E. Palmer
  • Pedram Heidari
  • Mark Vangel
  • Philip J. Saylor
  • Onofrio A. CatalanoEmail author
Original Article
  • 25 Downloads
Part of the following topical collections:
  1. Oncology – Genitourinary

Abstract

Purpose

18F-Fluciclovine is indicated for evaluation of suspected prostate cancer (PCa) biochemical recurrence. There are few studies investigating fluciclovine with PET/MR and none evaluated osseous metastases. Our aim was to assess the performance of 18F-fluciclovine PET/MR (fluciclovine-PET/MR) for detecting osseous metastases in patients with castration-resistant prostate cancer (CRPC). We also investigated possible correlations between SUVmax and ADCmean.

Methods

We evaluated 8 patients with CRPC metastatic to bones, some before and some after radium therapy, who underwent 13 fluciclovine-PET/MR studies. We analyzed the performance of radionuclide bone scan (RBS), MR alone, fluciclovine-PET alone, and fluciclovine-PET/MR in detecting osseous metastases. Lesion size, characteristics (early sclerotic, late sclerotic, mixed, lytic), SUVmax, and ADCmean were assessed. The reference standard was a combination of clinical information and correlation with both prior and follow-up imaging.

Results

Of 347 metastatic bony lesions in 13 studies, 238/347 (68%) were detected by fluciclovine-PET alone, 286/347 (82%) by RBS, 344/347 (99%) by MR alone, and 347/347 (100%) by fluciclovine-PET/MR. Fluciclovine-PET/MR and MR had the best performance (p < 0.001). There was no statistically significant difference between fluciclovine-PET/MR and MR alone (p = 0.25). Fluciclovine-PET had a lower detection rate especially with late sclerotic lesions (p < 0.001). There was a moderate inverse correlation between lesion SUVmax and ADCmean (r = − 0.49; p < 0.001).

Conclusions

This study suggests that fluciclovine-PET/MR and MR have high sensitivity for detecting osseous metastases in CRPC. Fluciclovine-PET alone underperformed in detecting late sclerotic lesions. The inverse correlation between SUVmax and ADCmean suggests a possible relationship between tumor metabolism and cellularity.

Keywords

PET/MR Fluciclovine Prostate cancer Osseous metastases 

Notes

Funding information

This study was financially supported by grant funding from Bayer and by provision of fluciclovine dosing from Blue Earth Diagnostics.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This study was approved by our local Institutional Review Board and all patients signed written, informed consent.

References

  1. 1.
    Ferlay J, Colombet M, Soerjomataram I, Mathers C, Parkin DM, Piñeros M, et al. Estimating the global cancer incidence and mortality in 2018: GLOBOCAN sources and methods. Int J Cancer. 2019;144:1941–53.Google Scholar
  2. 2.
    Bouman-Wammes EW, de Klerk JMH, Bloemendal HJ, Van Dodewaard-de Jong JM, Lange R, Ter Heine R, et al. Bone-targeting radiopharmaceuticals as monotherapy or combined with chemotherapy in patients with castration-resistant prostate cancer metastatic to bone. Clin Genitourin Cancer. 2019;17:e281–92.CrossRefGoogle Scholar
  3. 3.
    Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006;47:287–97.Google Scholar
  4. 4.
    Shen G, Deng H, Hu S, Jia Z. Comparison of choline-PET/CT, MRI, SPECT, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a meta-analysis. Skelet Radiol. 2014;43:1503–13.CrossRefGoogle Scholar
  5. 5.
    Corfield J, Perera M, Bolton D, Lawrentschuk N. 68Ga-prostate specific membrane antigen (PSMA) positron emission tomography (PET) for primary staging of high-risk prostate cancer: a systematic review. World J Urol. 2018;36:519–27.CrossRefGoogle Scholar
  6. 6.
    Schuster DM, Nanni C, Fanti S, Oka S, Okudaira H, Inoue Y, et al. Anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid: physiologic uptake patterns, incidental findings, and variants that may simulate disease. J Nucl Med. 2014;55:1986–92.CrossRefGoogle Scholar
  7. 7.
    Zacho HD, Nielsen JB, Haberkorn U, Stenholt L, Petersen LJ. 68 Ga-PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature. Clin Physiol Funct Imaging. 2017.Google Scholar
  8. 8.
    Savir-Baruch B, Zanoni L, Schuster DM. Imaging of prostate cancer using fluciclovine. PET Clin. 2017;12:145–57.CrossRefGoogle Scholar
  9. 9.
    Ziai P, Hayeri MR, Salei A, Salavati A, Houshmand S, Alavi A, et al. Role of optimal quantification of FDG PET imaging in the clinical practice of radiology. Radiographics. 2016;36:481–96.CrossRefGoogle Scholar
  10. 10.
    Zhou J, Gou Z, Wu R, Yuan Y, Yu G, Zhao Y. Comparison of PSMA-PET/CT, choline-PET/CT, NaF-PET/CT, MRI, and bone scintigraphy in the diagnosis of bone metastases in patients with prostate cancer: a systematic review and meta-analysis. Skelet Radiol. 2019.Google Scholar
  11. 11.
    Dyrberg E, Hendel HW, Huynh THV, Klausen TW, Løgager VB, Madsen C, et al. 68Ga-PSMA-PET/CT in comparison with 18F-fluoride-PET/CT and whole-body MRI for the detection of bone metastases in patients with prostate cancer: a prospective diagnostic accuracy study. Eur Radiol. 2019;29:1221–30.CrossRefGoogle Scholar
  12. 12.
    Elschot M, Selnæs KM, Sandsmark E, Krüger-Stokke B, Størkersen Ø, Giskeødegård GF, et al. Combined 18F-fluciclovine PET/MRI shows potential for detection and characterization of high-risk prostate cancer. J Nucl Med. 2018;59:762–8.CrossRefGoogle Scholar
  13. 13.
    Jambor I, Kuisma A, Kähkönen E, Kemppainen J, Merisaari H, Eskola O, et al. Prospective evaluation of 18F-FACBC PET/CT and PET/MRI versus multiparametric MRI in intermediate- to high-risk prostate cancer patients (FLUCIPRO trial). Eur J Nucl Med Mol Imaging. 2018;45:355–64.CrossRefGoogle Scholar
  14. 14.
    Selnæs KM, Krüger-Stokke B, Elschot M, Willoch F, Størkersen Ø, Sandsmark E, et al. 18F-Fluciclovine PET/MRI for preoperative lymph node staging in high-risk prostate cancer patients. Eur Radiol. 2018;28:3151–9.CrossRefGoogle Scholar
  15. 15.
    Freitag MT, Radtke JP, Hadaschik BA, Kopp-Schneider A, Eder M, Kopka K, et al. Comparison of hybrid (68)Ga-PSMA PET/MRI and (68)Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:70–83.CrossRefGoogle Scholar
  16. 16.
    Kranzbühler B, Nagel H, Becker AS, Müller J, Huellner M, Stolzmann P, et al. Clinical performance of 68Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy. Eur J Nucl Med Mol Imaging. 2018;45:20–30.CrossRefGoogle Scholar
  17. 17.
    Afshar-Oromieh A, Haberkorn U, Schlemmer HP, Fenchel M, Eder M, Eisenhut M, et al. Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging. 2014;41:887–97.CrossRefGoogle Scholar
  18. 18.
    Savir-Baruch B, Banks KP, McConathy JE, Molchanova-Cook OP, Parent EE, Takalkar A, et al. ACR-ACNM practice parameter for the performance of fluorine-18 fluciclovine-PET/CT for recurrent prostate cancer. Clin Nucl Med. 2018;43:909–17.Google Scholar
  19. 19.
    Oka S, Kanagawa M, Doi Y, Schuster DM, Goodman MM, Yoshimura H. PET tracer 18F-fluciclovine can detect histologically proven bone metastatic lesions: a preclinical study in rat osteolytic and osteoblastic bone metastasis models. Theranostics. 2017;7:2048–64.CrossRefGoogle Scholar
  20. 20.
    Janssen J-C, Woythal N, Meißner S, Prasad V, Brenner W, Diederichs G, et al. [68Ga]PSMA-HBED-CC uptake in osteolytic, osteoblastic, and bone marrow metastases of prostate cancer patients. Mol Imaging Biol. 2017;19:933–43.CrossRefGoogle Scholar
  21. 21.
    Gu J, Khong P-L, Wang S, Chan Q, Law W, Zhang J. Quantitative assessment of diffusion-weighted MR imaging in patients with primary rectal cancer: correlation with FDG-PET/CT. Mol Imaging Biol. 2011;13:1020–8.CrossRefGoogle Scholar
  22. 22.
    Wetter A, Lipponer C, Nensa F, Heusch P, Rübben H, Schlosser TW, et al. Quantitative evaluation of bone metastases from prostate cancer with simultaneous [18F] choline PET/MRI: combined SUV and ADC analysis. Ann Nucl Med. 2014;28:405–10.CrossRefGoogle Scholar
  23. 23.
    Shaish H, Kang SK, Rosenkrantz AB. The utility of quantitative ADC values for differentiating high-risk from low-risk prostate cancer: a systematic review and meta-analysis. Abdom Radiol (NY). 2017;42:260–70.CrossRefGoogle Scholar
  24. 24.
    Pham TT, Liney GP, Wong K, Barton MB. Functional MRI for quantitative treatment response prediction in locally advanced rectal cancer. Br J Radiol. 2017;90:20151078.CrossRefGoogle Scholar
  25. 25.
    Attenberger U, Catana C, Chandarana H, Catalano OA, Friedman K, Schonberg SA, et al. Whole-body FDG PET-MR oncologic imaging: pitfalls in clinical interpretation related to inaccurate MR-based attenuation correction. Abdom Imaging. 2015;40:1374–86.CrossRefGoogle Scholar
  26. 26.
    Ringheim A, Campos Neto G d C, Martins KM, Vitor T, da Cunha ML, Baroni RH. Reproducibility of standardized uptake values of same-day randomized 68Ga-PSMA-11 PET/CT and PET/MR scans in recurrent prostate cancer patients. Ann Nucl Med. 2018;32:523–31.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Radiology, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  2. 2.Martinos Center for Biomedical Imaging, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  3. 3.Division of Nuclear MedicineState University of Campinas (UNICAMP)CampinasBrazil
  4. 4.Division of Nuclear MedicinePuerta de Hierro University HospitalMadridSpain
  5. 5.Biostatistics Center, Massachusetts General HospitalHarvard Medical SchoolBostonUSA
  6. 6.Massachusetts General Hospital Cancer CenterHarvard Medical SchoolBostonUSA
  7. 7.Department of RadiologyUniversity of Naples “Parthenope”NaplesItaly

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