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Value of bimodal 18F-choline-PET/MRI and trimodal 18F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy

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Abstract

Between 27% and 53% of all patients who undergo radical prostatectomy (RP) or radiation therapy (RT) as the first-line treatment of prostate cancer (PCa) develop a biochemical recurrence. Imaging plays a pivotal role in restaging by helping to distinguish between local relapse and metastatic disease (i.e., lymph-node and skeletal metastases). At present, the most promising tools for assessing PCa patients with biochemical recurrence are multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET)/computed tomography (CT) with radio-labeled choline derivatives. The main advantage of mpMRI is its high diagnostic accuracy in detecting local recurrence, while choline-PET/CT is able to identify lymph-node metastases when they are not suspicious on morphological imaging. The most recent advances in the field of fusion imaging have shown that multimodal co-registration, synchronized navigation, and combined interpretation are more valuable than the individual; separate assessment offered by different diagnostic techniques. The objective of the present essay was to describe the value of bimodal choline-PET/mpMRI fusion imaging and trimodal choline-PET/mpMRI/transrectal ultrasound (TRUS) in the assessment of PCa recurrence after RP and RT. Bimodal choline-PET/mpMRI fusion imaging allows morphological, functional, and metabolic information to be combined, thereby overcoming the limitations of each separate imaging modality. In addition, trimodal real-time choline-PET/mpMRI/TRUS fusion imaging may be useful for the planning and real-time guidance of biopsy procedures in order to obtain histological confirmation of the local recurrence.

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Authors and Affiliations

  1. Unit of Radiology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Francesco Paparo, Lorenzo Bacigalupo, Riccardo Piccazzo, Luca Cevasco & Gian Andrea Rollandi

  2. Nuclear Medicine Unit, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Arnoldo Piccardo

  3. Unit of Urology, IRCCS Azienda Ospedaliera Universitaria San Martino – IST, University of Genoa, Via Leon Battista Alberti 4, 16132, Genoa, Italy

    Andrea Romagnoli, Michela Monticone & Giorgio Carmignani

  4. Unit of Urology, E.O. Ospedali Galliera, Mura delle Cappuccine 14, 16128, Genoa, Italy

    Fabio Campodonico & Giuseppe Maria Conzi

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  1. Francesco Paparo
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  2. Arnoldo Piccardo
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Paparo, F., Piccardo, A., Bacigalupo, L. et al. Value of bimodal 18F-choline-PET/MRI and trimodal 18F-choline-PET/MRI/TRUS for the assessment of prostate cancer recurrence after radiation therapy and radical prostatectomy. Abdom Imaging 40, 1772–1787 (2015). https://doi.org/10.1007/s00261-014-0345-0

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