Comparison of the diagnostic accuracy of whole-body diffusion-weighted imaging and 18F-prostate-specific membrane antigen-1007 positron emission tomography combined with computed tomography for detecting bone metastases in prostate cancer

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Abstract

BACKGROUND: The increasing availability of 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) for prostate cancer staging highlighted its advantages, particularly its higher spatial resolution compared to analogs. Moreover, accumulating scientific data indicate an increase in false-positive findings, predominantly in bones, which may lead to unwarranted upstaging of the disease. Diffusion-weighted imaging may be used for the early detection of bone metastases.

AIM: This study aimed to assess and compare the diagnostic accuracy of whole-body 18F-PSMA-1007 positron emission tomography combined with computed tomography and whole-body and pelvic bone diffusion-weighted imaging in patients with prostate cancer.

METHODS: A retrospective single-center selective study was conducted. The imaging results of 119 patients with prostate cancer were divided into two groups: group 1 comprised 40 pairs of 18F-PSMA-1007 positron emission tomography combined with computed tomography and whole-body diffusion-weighted magnetic resonance imaging scans, and group 2 included 79 pairs of similar studies, with magnetic resonance imaging performed only for the pelvic bones. The diagnostic studies were performed at an inter-study interval ≤14 days. The metastatic bone lesions detected in different anatomical regions was counted using data from 18F-PSMA-1007 positron emission tomography combined with computed tomography and magnetic resonance imaging. Lesions were considered true positives if confirmed by additional magnetic resonance imaging pulse sequences and/or follow-up observation.

RESULTS: Whole-body diffusion-weighted imaging demonstrated higher specificity (58.1%) for detecting bone metastases than 18F-PSMA-1007 positron emission tomography combined with computed tomography (51.06%). However, its sensitivity was lower: 93.22% versus 97.55%.

CONCLUSION: Despite its advantages, 18F-PSMA-1007 positron emission tomography combined with computed tomography shows a high rate of false-positive bone findings. These are most commonly noted in the ribs, vertebrae, and pelvic bones. Suspicious bone lesions should be further evaluated to avoid unjustified disease upstaging. Thus, whole-body magnetic resonance imaging with diffusion-weighted sequences and selective fat signal suppression can be used.

About the authors

Pavel B. Gelezhe

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies; European Medical Center

Author for correspondence.
Email: gelezhe.pavel@gmail.com
ORCID iD: 0000-0003-1072-2202
SPIN-code: 4841-3234

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow; Moscow

Roman V. Reshetnikov

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: ReshetnikovRV1@zdrav.mos.ru
ORCID iD: 0000-0002-9661-0254
SPIN-code: 8592-0558

Cand. Sci. (Physics and Mathematics)

Russian Federation, Moscow

Ivan A. Blokhin

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: BlokhinIA@zdrav.mos.ru
ORCID iD: 0000-0002-2681-9378
SPIN-code: 3306-1387
Russian Federation, Moscow

Maria R. Kodenko

Research and Practical Clinical Center for Diagnostics and Telemedicine Technologies

Email: KodenkoM@zdrav.mos.ru
ORCID iD: 0000-0002-0166-3768
SPIN-code: 5789-0319

Cand. Sci. (Engineering)

Russian Federation, Moscow

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2. Fig. 1. Patient A, 56 years old, with mixed neuroendocrine carcinoma of the prostate T3aN1Mx, Gleason 8 (4+4). Condition after radical prostatectomy. Increased serum total prostate-specific antigen content to 1.87 ng/ml. Tumor recurrence in the area of ​​the vesicoureteral anastomosis: a ― axial positron emission computed tomography image: a focus of hyperfixation of the radiopharmaceutical drug, suspicious for a metastatic process, was detected in the body of the left iliac bone; b and c ― diffusion-weighted (b) and T1-weighted images without fat suppression (c) did not reveal focal changes in the left iliac bone; d — according to T1-weighted imaging with selective fat suppression, a zone of signal loss corresponding to reconversion of red bone marrow was revealed in the area of ​​the focus of hyperfixation of the radiopharmaceutical drug; pathological infiltrates of the bone marrow were not revealed; e — a focus of hyperfixation according to positron emission computed tomography with 18F-prostate-specific membrane antigen-1007 in the area of ​​the vesicourethral anastomosis.

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3. Fig. 2. Patient B, 77 years old, with prostate adenocarcinoma T4N2M0, Gleason 8 (4+4). Condition after complex treatment, several lines of hormonal therapy, chemotherapy, radiation therapy of the prostate gland, regional lymph node zones. Increased content of total prostate-specific antigen in blood serum to 0.4 ng/ml. Example of a false positive result: a ― image of positron emission computed tomography with 18F-prostate-specific membrane antigen-1007 in the axial plane: a focus of hyperfixation of the radiopharmaceutical drug is noted in the right arch of the LV vertebra, suspicious for a metastatic process; b and c ― diffusion-weighted (b) and T2-weighted (c) magnetic resonance imaging: signs of arthritis of the right facet joint LV-SI in the form of intra-articular effusion, moderate trabecular edema of adjacent articular surfaces.

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