European Radiology

, Volume 29, Issue 3, pp 1221–1230 | Cite as

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

  • Eva DyrbergEmail author
  • Helle W. Hendel
  • Tri Hien Viet Huynh
  • Tobias Wirenfeldt Klausen
  • Vibeke B. Løgager
  • Claus Madsen
  • Erik M. Pedersen
  • Maria Pedersen
  • Henrik S. Thomsen



To determine the diagnostic accuracy of 68gallium prostate-specific membrane antigen (PSMA)-based positron emission tomography/computed tomography (PET/CT) in comparison with 18F-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.


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).


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).


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


Positron emission tomography computed tomography Magnetic resonance imaging Prostatic neoplasms Metastasis Bone and bones 



Apparent diffusion coefficient


Androgen deprivation therapy


Best valuable comparator


Computed tomography


Diffusion-weighted images


Estimated glomerular filtration rate


N,N′-bis[2-hydroxy-5-(carboxyethyl)benzyl]ethylenediamine-N,N′-diacetic acid


Magnetic resonance imaging


Sodium fluoride


Positron emission tomography


Prostate-specific antigen


Prostate-specific membrane antigen


Single-photon emission computed tomography


Standards for Reporting of Diagnostic Accuracy Studies


Short-T1 inversion recovery






95% confidence interval











This study has received funding by the University of Copenhagen and from Poul Lundbeck and Wife’s Foundation for the Promotion of Radiology in Denmark.

Compliance with ethical standards


The scientific guarantor of this publication is Eva Dyrberg.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Tobias W. Klausen and Stig S. Mortensen kindly provided statistical advice for this manuscript.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional review board approval was obtained.


• prospective

• diagnostic study

• performed at one institution

Supplementary material

330_2018_5682_MOESM1_ESM.docx (41 kb)
ESM 1 (DOCX 40 kb)


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Eva Dyrberg
    • 1
    • 2
    Email author
  • Helle W. Hendel
    • 2
  • Tri Hien Viet Huynh
    • 2
  • Tobias Wirenfeldt Klausen
    • 3
  • Vibeke B. Løgager
    • 1
  • Claus Madsen
    • 2
  • Erik M. Pedersen
    • 4
  • Maria Pedersen
    • 2
  • Henrik S. Thomsen
    • 1
  1. 1.Department of RadiologyCopenhagen University Hospital Herlev and GentofteHerlevDenmark
  2. 2.Department of Clinical Physiology and Nuclear Medicine, PET and CyclotronCopenhagen University Hospital Herlev and GentofteHerlevDenmark
  3. 3.Department of HematologyCopenhagen University Hospital Herlev and GentofteHerlevDenmark
  4. 4.Department of RadiologyAarhus University HospitalAarhus CDenmark

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