Correlation of SUV(max) and Apparent Diffusion Coefficient Values Detected by Ga-68 PSMA PET/MRI in Primary Prostate Lesions and Their Significance in Lymph Node Metastasis: Preliminary Results of an On-going Study

OBJECTIVES: Gallium-68 (Ga-68) prostate specific membrane antigen (PSMA) positron emission tomography (PET) has been shown to be more accurate than multiparametric prostate magnetic resonance imaging (MRI) in detection of primary prostate lesions. Using hybrid PET/MRI we aim to detect the correlation between SUV(max) and apparent diffusion coefficient (ADC) in primary prostate lesions and to assess their prognostic value in detection of lymph node (LN) metastasis. METHODS: Twenty-six patients, who were diagnosed as having prostate cancer with biopsy and underwent Ga-68 PSMA PET/MRI together with biparametric prostate MRI (bpMRI) were included. SUV(max), SUV(mean) and ADC were recorded for index lesions drawing a region of interest (ROI) of 1 cm(2) around the pixel with the highest SUV(max) (ROI-1) and another ROI following borders of prostate tumor detected by bpMRI (ROI-2). Presence of LN metastasis was recorded according to PSMA PET/MRI. RESULTS: SUV(max) was inversely correlated with ADC (ROI-1: p=0.010; ROI-2: p=0.017 for b=800). SUV(max) and SUV(means) were both higher in patients with LN metastasis and ADC was lower in patients with LN metastasis for ROI-1. SUV(max) cut-off value of 19.8 for ROI-1 and 20.9 for ROI-2 had sensitivity and specificity of 77.8% and 76.5%, respectively for detection of LN metastasis, whereas ADC (b=800) cut-off value of 0.92x10(-3) mm(2)/s had sensitivity and specificity of 87.5% and 76.5%, respectively. SUV(max)/ADC (b=800) ratio increased the sensitivity and specificity to 100% and 82.4%, respectively. CONCLUSION: SUV and ADC values are inversely correlated in primary prostate lesions and the combined use of both values increases the diagnostic accuracy of hybrid PET/MRI in the detection of primary prostate lesions.