Is PET/CT more effective than PET/ MRI in the diagnosis of prostate cancer in patients aged more than 50 years?

Abstract

Aim The aim of this study was to compare the diagnostic accuracy of positron emission tomography (PET)/computed tomography (CT) with PET/magnetic resonance imaging (MRI) for the diagnosis of prostate cancer (PCa) in patients aged over 50 years.

Background The use of PET imaging in the evaluation of PCa is recognised as potentially valuable strategy for initial diagnosis, subsequent staging, and disease monitoring. The combination of PET imaging with CT or MRI remains an under-explored area in the literature. This review therefore sought to evaluate existing literature to determine key features of the diagnostic accuracy of PET/CT and PET/MRI in this context, while comparing these imaging approaches.

Methods A systematic literature review was completed using online databases to identify published research of relevance to the topic. Prospective and retrospective diagnostic accuracy studies were included in the final data set, with a focus on studies published within the last ten years (2010-2020). A total of five studies were identified that met all of the relevant inclusion criteria for the review.

Results The five identified studies suggested that PET/MRI was generally superior to PET/Ct for the diagnosis of PCa, although important caveats should be noted within this outcome. Specifically, the value of PET/CT and PET/MRI may both be limited in the evaluation of nodal or osseous lesions in proximity to the bladder or kidneys, where artefactual data may obscure visualisation. Furthermore, variations in the tracer used for PET imaging may influence the diagnostic accuracy of these techniques. A lack of reporting of sensitivity and specificity data in these studies is a significant limitation to quantifying difference in diagnostic utility.

Conclusion This systematic literature review suggests that the combined use of PET and MRI may be advantageous over PET/CT for imaging quality and visualisation or PCa lesions. Furthermore, the lower radiation dose associated with this technique may be clinically appealing. More data are needed to clarify and quantify diagnostic accuracy of PET/MRI in this context.