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. 2023 Mar 30:10:100487.
doi: 10.1016/j.ejro.2023.100487. eCollection 2023.

Prediction of pelvic lymph node metastases and PSMA PET positive pelvic lymph nodes with multiparametric MRI and clinical information in primary staging of prostate cancer

Andreas M Hötker  1 , Urs Mühlematter  1 , Stephan Beintner-Skawran  2 , Soleen Ghafoor  1 , Irene Burger  3 , Martin Huellner  2 , Daniel Eberli  4 , Olivio F Donati  1   5
Affiliations

Prediction of pelvic lymph node metastases and PSMA PET positive pelvic lymph nodes with multiparametric MRI and clinical information in primary staging of prostate cancer

Andreas M Hötker et al. Eur J Radiol Open. .

Abstract

Purpose: To compare the accuracy of multiparametric MRI (mpMRI), 68Ga-PSMA PET and the Briganti 2019 nomogram in the prediction of metastatic pelvic lymph nodes (PLN) in prostate cancer, to assess the accuracy of mpMRI and the Briganti nomogram in prediction of PET positive PLN and to investigate the added value of quantitative mpMRI parameters to the Briganti nomogram.

Method: This retrospective IRB-approved study included 41 patients with prostate cancer undergoing mpMRI and 68Ga-PSMA PET/CT or MR prior to prostatectomy and pelvic lymph node dissection. A board-certified radiologist assessed the index lesion on diffusion-weighted (Apparent Diffusion Coefficient, ADC; mean/volume), T2-weighted (capsular contact length, lesion volume/maximal diameters) and contrast-enhanced (iAUC, kep, Ktrans, ve) sequences. The probability for metastatic pelvic lymph nodes was calculated using the Briganti 2019 nomogram. PET examinations were evaluated by two board-certified nuclear medicine physicians.

Results: The Briganti 2019 nomogram performed superiorly (AUC: 0.89) compared to quantitative mpMRI parameters (AUCs: 0.47-0.73) and 68Ga-PSMA-11 PET (AUC: 0.82) in the prediction of PLN metastases and superiorly (AUC: 0.77) in the prediction of PSMA PET positive PLN compared to MRI parameters (AUCs: 0.49-0.73). The addition of mean ADC and ADC volume from mpMRI improved the Briganti model by a fraction of new information of 0.21.

Conclusions: The Briganti 2019 nomogram performed superiorly in the prediction of metastatic and PSMA PET positive PLN, but the addition of parameters from mpMRI can further improve its accuracy. The combined model could be used to stratify patients requiring ePLND or PSMA PET.

Keywords: Multiparametric MRI; PET imaging; PSMA; Pelvic lymph nodes; Prostate cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Receiver operating characteristics (ROC) curves for best-performing quantitative MRI parameters, 68Ga-PSMA PET and the Briganti 2019 nomogram in the prediction of N + status on histopathology.
Fig. 2
Fig. 2
Receiver operating characteristics (ROC) curves for best-performing quantitative MRI parameters and the Briganti 2019 nomogram in the prediction of N + status on 68Ga-PSMA PET.
Fig. 3
Fig. 3
73-year-old patient with histopathologically proven prostate cancer (Gleason Score 4 + 5) and pelvic lymph node metastases in histopathological work-up after radical prostatectomy. (a) T2- weighted sequence showing a hypointense lesion in the right midglandular peripheral zone, (b) corresponding ADC map showing marked diffusions restriction and (c) 68Ga-PSMA PET/MR with avid tracer uptake in the lesion but now sign of metastatic pelvic lymph nodes. The Briganti 2019 nomogram correctly predicted the presence of lymph node metastases in this patient.
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