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Diagnostic Accuracy of 18F Choline PET/CT using Time-of-Flight Reconstruction Algorithm in Prostate Cancer Patients With Biochemical Recurrence

Hausmann, Daniel MD*; Bittencourt, Leonardo K. MD; Attenberger, Ulrike I. PhD*; Sertdemir, Metin MD*; Weidner, Anja MD*; Büsing, Karen A. PhD*; Brade, Joachim DMath; Wenz, Frederik PhD§; Schoenberg, Stefan O. PhD*; Dinter, Dietmar J. PhD*

Clinical Nuclear Medicine:
doi: 10.1097/RLU.0b013e3182a23d37
Original Articles

Purpose: Image quality (IQ) of PET in voluminous body regions can be limited, which impairs the assessment of small metastatic lesions. Time-of-flight (TOF) reconstruction algorithm may deliver an increase of spatial resolution. The purpose of this study was to evaluate the impact of TOF on IQ, lesion detection rate, lesion volume (V) and SUVmax in 18F choline PET/CT of prostate cancer patients with biochemical recurrence compared to standard PET/CT reconstruction (standard).

Patients and Materials: During a period of 9 months, 32 patients with prostate cancer (mean [SD] age, 71 [7.8] years) and biochemical recurrence were included in this prospective institutional review board–approved study. Each patient underwent a state-of-the-art 3-dimensional 18F choline PET/CT. A total of 76 lesions were assessed by 2 board-certified nuclear medicine physicians and a third-year resident. Lesion volume and SUVmax of local recurrence, lymph nodes, and organ metastases were compared between TOF and standard. Image quality and lesion demarcation were rated according to a 5-point Likert-type scale. Interobserver agreement was assessed.

Results: Eight additional lesions were detected using TOF (SUVmax, 3.64 [0.95]; V, 0.58 cm3 [0.50]). Image quality was reduced (IQ standard, 1.28; TOF, 1.77; P < 0.01) in calculated TOF images, although quality of lesion demarcation was improved (lesion demarcation: standard, 1.66; TOF, 1.26; P < 0.01). SUVmax was significantly increased in TOF images (SUVmax standard, 6.9 [4.1]; TOF, 8.1 [4.1]; P < 0.01), whereas V did not show significant differences (V standard, 5.3 [10.4] cm3; TOF, 5.4 [10.3] cm3; P = 0.41). Interobserver agreement was good for combined ratings (1 + 2 and 3 + 4).

Conclusions: Application of TOF seems to be of additional value to detect small metastatic lesions in patients with prostate cancer and biochemical recurrence, which may have further clinical implications for secondary treatment.

Author Information

From the *Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany; †CDPI Clinics-Abdominal and Pelvic Imaging, Rio de Janeiro Federal University, Rio de Janeiro, Brazil; ‡Institute of Medical Statistics; and §Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Received for publication April 8, 2013; revision accepted May 14, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Daniel Hausmann, MD, Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany. E-mail:

© 2014 by Lippincott Williams & Wilkins