Volume 70, Issue 5, Pages (November 2016)

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Volume 70, Issue 5, Pages 829-836 (November 2016) Simultaneous 68Ga-PSMA HBED-CC PET/MRI Improves the Localization of Primary Prostate Cancer Matthias Eiber, Gregor Weirich, Konstantin Holzapfel, Michael Souvatzoglou, Bernhard Haller, Isabel Rauscher, Ambros J. Beer, Hans- Jürgen Wester, Juergen Gschwend, Markus Schwaiger, Tobias Maurer European Urology Volume 70, Issue 5, Pages 829-836 (November 2016) DOI: 10.1016/j.eururo.2015.12.053 Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 1 A 65-year-old patient with a biopsy-proven prostate cancer Gleason score of 6 and a prostate-specific antigen of 24.5 ng/ml. (A) Transverse T2-weighted images show considerable benign prostatic hyperplasia in the central zone presenting with one large and multiple surrounding small nodules. Prostate Imaging Reporting and Data System (PI-RADS) scoring using information from diffusion-weighted imaging (apparent diffusion coefficient map shown in B) and dynamic contrast-enhanced (enhancement curve in C) resulted in a PI-RADS scores of 2 for the right and left midgland sextants. Positron emission tomography (PET) and fused T2-weighted/PET images show intense focal uptake projecting on the right peripheral zone. Note that only slight diffuse uptake is present in the central gland. (D) In PET a score of 5 was given. (E) In the combined PET/magnetic resonance imaging (MRI), due to missing clearly suspicious findings on MRI, a score of 4 was given for the right midgland sextant. (F) Hematoxylin and eosin gross section histopathology shows an oval Gleason score 6 tumor focus in the right peripheral zone. Note that the different anteroposterior positive focus of the tumor nodus in imaging and histopathology is related to slightly different planes. European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 2 A 67-year-old patient with a biopsy-proven prostate cancer Gleason score of 7a and a prostate-specific antigen of 5.4 ng/ml. (A, B) Transverse T2-weighted images of apical sextants show slightly hypointense signal with restricted diffusion in the apparent diffusion coefficient map but isointense impression in the b-value 800 s/mm2 in the transitional zone. (C) Dynamic contrast-enhanced curve exhibits pronounced enhancement with a type 2 curve pattern resulting in a Prostate Imaging Reporting and Data System score of 3. (D) Positron emission tomography (PET) and (E) fused T2-weighted/PET images show intense focal uptake projecting ventrally to the urethra. Due to the high intensity of gallium 68 (68Ga)-prostate-specific membrane antigen (PSMA) HBED-CC uptake both in PET and 68Ga-PSMA HBED-CC PET/MRI, a score of 5 was applied. (F) Hematoxylin and eosin gross section histopathology shows a corresponding tumor focus. European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

Fig. 3 Receiver operating characteristic curves for multiparametric magnetic resonance imaging (mpMRI), positron emission tomography (PET), and gallium 68 (68Ga)-prostate-specific membrane antigen (PSMA) HBED-CC PET/MRI on a sextant-based analysis. European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions

European Urology 2016 70, 829-836DOI: (10.1016/j.eururo.2015.12.053) Copyright © 2016 European Association of Urology Terms and Conditions