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11C-choline PET/CT and multiparametric MRI in patients with biochemical relapse of prostate cancer
11C-colina PET/TAC y RM multiparamétrica en la recidiva bioquímica del cáncer de próstata
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Imágenes PET/TC axial precoz y tardía. Foco hipermetabólico en isquion izquierdo (SUV<span class="elsevierStyleInf">máx</span><span class="elsevierStyleHsp" style=""></span>5,7) sin traducción morfológica, que presenta dinámica acumulativa en la imagen tardía (SUV<span class="elsevierStyleInf">máx</span><span class="elsevierStyleHsp" style=""></span>6,1) sugestiva de lesión por M1 ósea.</p> <p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">D. Secuencia potenciada en T2. Plano axial. Lesión hipointensa en isquion izquierdo de 20<span class="elsevierStyleHsp" style=""></span>mm. E. Secuencia de difusión. La lesión ósea descrita en la secuencia con valor de b elevado es marcadamente hiperintensa en relación con restricción de la difusión.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J.R. Garcia, N. Romera, M. Cozar, M. Soler, M. Moragas, M. Escobar" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J.R." 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"apellidos" => "Escobar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad PET/TC, CETIR, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Centro Médico Teknon, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleSup">11</span>C-colina PET/TAC y RM multiparamétrica en la recidiva bioquímica del cáncer de próstata" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1623 "Ancho" => 3166 "Tamanyo" => 242390 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient with a history of prostate cancer treated with radiotherapy 4 years ago having elevated PSA (10<span class="elsevierStyleHsp" style=""></span>ng/ml). (A)–(C). PET/CT axial early and late imaging. Hypermetabolic focus on left ischium (SUVmax 5.7) without morphological translation, which presents cumulative dynamics in the late imaging (SUVmax 6.1) suggestive of M1 bone injury. (D) T2-weighed sequence. Axial plane. Hypointense lesion in the left ischium of 20<span class="elsevierStyleHsp" style=""></span>mm. (E) Difussion sequence. The bone lesion described in the sequence with high b value is markedly hyperintense regarding restricted diffusion.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Clinical problem with casuistry</span><p id="par0005" class="elsevierStylePara elsevierViewall">Biochemical recurrence after prostatectomy is defined as the elevation of PSA<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>0.2<span class="elsevierStyleHsp" style=""></span>ng/ml.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> The definition of biochemical recurrence after radiotherapy is more controversial, but an increase of 0.2<span class="elsevierStyleHsp" style=""></span>ng/ml in 6–12 months is accepted.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> It is important if the recurrence is local or there exists lymph node involvement or metastatic bone involvement or a combination between them, since it determines patient management, being able to consider radical therapy for local recurrence, but a systemic treatment, combined or not with systemic treatment is necessary for metastatic disease.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Prostate biopsy is the traditional method for detecting local recurrence; however, it is invasive, costly, and it has a relatively low but not negligible complication rate (such as infection). Moreover, the negative biopsy does not exclude local recurrence due to potential sampling error, so repeat biopsy is needed. Therefore, the biopsy is not recommended by the EAU in patients with PSA<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>ng/ml.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In this casuistry, we compared the diagnostic usefulness of PET/CT with <span class="elsevierStyleSup">11</span>C-choline and multiparametric MRI in the detection of local recurrence, lymph node involvement, intrapelvic involvement in patients with biochemical recurrence of prostate cancer.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We included 21 patients with a history of prostate cancer, initially treated with surgery (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>12) or radiotherapy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9) who had increased PSA (postsurgery 0.3–3.6<span class="elsevierStyleHsp" style=""></span>ng/ml; postradiotherapy 2.4–8.8<span class="elsevierStyleHsp" style=""></span>ng/ml). All patients underwent: full body ‘two phase’ PET/CT study and multiparametric prostate MRI.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">11</span>C-choline has been synthesized in the cyclotron located in the same system. The tracer was administered with the intracameral patient (296<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29<span class="elsevierStyleHsp" style=""></span>MBq) initiating the acquisition immediately. After performing CT of attenuation correction, 2 consecutive full body PET emission acquisition (9 steps/2<span class="elsevierStyleHsp" style=""></span>min) were carried out, without patient mobilization.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The multiparametric prostate MRI includes performing anatomical sequences, diffusion study, and dynamic study after administration of intravenous paramagnetic contrast.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The interpretation of PET/CT with <span class="elsevierStyleSup">11</span>C-choline was performed by 2 specialists in nuclear medicine. The prostate multiparametric MRI interpretation by 2 specialists in X-ray diagnosis. Both were evaluated blindly from the other examination. We performed analysis of the detection rate of PET/CT with <span class="elsevierStyleSup">11</span>C-choline and prostate multiparametric MRI.</p><p id="par0040" class="elsevierStylePara elsevierViewall">From our results, all patients with both scans, or one of them positive, underwent directed diagnostic study and/or salvage treatment, performing clinical, analytical and imaging follow-up, between 12 and 18 months, revealing increased size or, alternatively, reduction or resolution of the lesion, associated with the reduction or normalization of PSA after therapy.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The patients with the 2 negative tests have reached the diagnosis of true negative, including the histological findings, post-biopsy, or the negative follow-up for at least 12–18 months, by means of diagnostic tests, without progression of the PSA level.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In 15 patients (71.4%) both examinations were concordant, 4 negative, and 11 positive: 7 local recurrences (5 postradiotherapy, 2 postprostatectomy), 3 unique pelvic adenopathies (2 infracentimeter, 3 postprostatectomy), 1 local recurrente, and 1 single bone metastasis (1 postradiotherapy).</p><p id="par0055" class="elsevierStylePara elsevierViewall">In 6 patients (28.6%) both examinations were discordant: 3 local recurrences identified in MRI without significance in PET (3 postprostatectomy), 1 local recurrence identified in PET without significance in MRI (postradiotherapy) and 2 bone metastases identified in PET outside the field of MRI.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Commentary</span><p id="par0060" class="elsevierStylePara elsevierViewall">Choline uptake is due to deregulation of choline in the tumor cells. Colin-kinase is an enzyme which is overexpressed in tumor cells. Overexpression of colin-kinase is independent of Ki67 in prostate tumors.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The MRI diffusion study, by means of modified T2-weighted sequences, provides information on the random motion of free water molecules. The diffusion is based on the fact that the restriction of water correlates with increased cellularity. The neoplastic tissue has a higher diffusion restriction, with low signal on the map of diffusion coefficient (ADC). In the dynamic study, after administration of intravenous contrast (gadolinium), the dynamics of contrast uptake and perfusion allows for the study of microvascular tissue, and indirectly of angiogenesis. 3 types of uptake curve have been described: type I progressive; type II plateau; and type III washing. The last 2 are associated with a neoplastic process.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This different biology means that there is no correlation between both techniques, as reflected in the first comparative studies. Thus, a superiority of multiparameter MRI over PET/CT with <span class="elsevierStyleSup">18</span>F-choline has been described in detecting local recurrence in patients with small lesions and low elevation of PSA (5–7<span class="elsevierStyleHsp" style=""></span>mm; PSA 0.8–1.4<span class="elsevierStyleHsp" style=""></span>ng/ml) but with similar sensitivity in >10<span class="elsevierStyleHsp" style=""></span>mm.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Our results are consistent with the findings described, and the 3 local recurrences identified postprostatectomy by means of multiparametric MRI have infracentimeter character (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Therefore, the spatial resolution of PET systems, around 7<span class="elsevierStyleHsp" style=""></span>mm, limits the sensitivity of the examination in detection of local recurrence. However, local recurrence identified by means of PET/CT study with <span class="elsevierStyleSup">11</span>C-choline, without translation in MRI, was after radiotherapy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), probably related to signal changes that occur after this treatment in the prostate gland.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">Detection of lymph node involvement is crucial in restaging of prostate cancer. The low negative predictive value of the analysis due to lesions of choline PET is related to the limitation of the technique in the detection of microscopic lymph node infiltration. However, the scan shows a high positive predictive value, which facilitates performing appropriate treatments.</p><p id="par0085" class="elsevierStylePara elsevierViewall">In our cases, both scans showed the same detection rate, even in the detection of lymph node infracentimeter infiltration (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Luboldt et al. performed a comparison between MRI and PET/CT with <span class="elsevierStyleSup">11</span>C-choline in the detection of bone metastases of prostate cancer, describing similar results between both techniques.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> Our results are consistent with these findings (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>), although it should be noted that PET/CT as whole-body scanning has allowed for the identification of metastatic bone lesions outside the field of MRI.</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Therefore, this casuistry shows that PET/CT with <span class="elsevierStyleSup">11</span>C-choline and multiparametric MRI have a complementary role for the detection of local recurrence of prostate cancer, with similar sensitivity for the detection of lymph node infiltration. PET/CT with <span class="elsevierStyleSup">11</span>C-choline, as whole-body technique, allows for bone staging. Therefore, its combination is necessary for a better combination of compression in restaging of patients with prostate cancer recurrence.</p><p id="par0095" class="elsevierStylePara elsevierViewall">For this reason, we believe that PET/MRI integrated teams, newly introduced, can play an important role in these patients, by obtaining optimal spatial and temporal data coregistration of PET and MRI, adding the benefits of both,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> additionally enabling a reduction of the radiation, by avoiding performance of CT study, as well as improvement in the management of patients, performing both examinations in a single session.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres485654" "titulo" => "Abstract" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinic problem and case series" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Comment" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec507923" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres485653" "titulo" => "Resumen" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Problema clínico con casuística" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Comentario" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec507924" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical problem with casuistry" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Commentary" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec507923" "palabras" => array:4 [ 0 => "<span class="elsevierStyleSup">11</span>C-choline positron emission tomography/computed tomography" 1 => "Multiparametric magnetic resonance imaging" 2 => "Biochemical relapse" 3 => "Prostate cancer" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec507924" "palabras" => array:4 [ 0 => "<span class="elsevierStyleSup">11</span>C-colina tomografía por emisión de positrones/tomografía computarizada" 1 => "Resonancia magnética multiparamétrica" 2 => "Recidiva bioquímica" 3 => "Cáncer de próstata" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Clinic problem and case series</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To assess the diagnostic usefulness of <span class="elsevierStyleSup">11</span>C-choline PET/CT vs. multi-parametric MRI in the prostate cancer relapse.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A retrospective study of 21 patients with prostate cancer treated initially with surgery (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>12), radiotherapy (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>9). PSA levels were increased (post-surgery: .3–3.6<span class="elsevierStyleHsp" style=""></span>ng/ml; post-radiotherapy: 2.4–8.8<span class="elsevierStyleHsp" style=""></span>ng/ml).</p><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">In an interval of time of 15 days all patients were underwent to: whole-body-dual-modality PET-CT carried out early after <span class="elsevierStyleSup">11</span>C-choline (296<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29<span class="elsevierStyleHsp" style=""></span>MBq) injection, and multiparametric prostate MRI with paramagnetic intravenous contrast (using anatomical imaging sequences, diffusion-weighted imaging and dynamic contrast-enhanced imaging).</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">On the basis of our results, all patients were underwent to directed diagnosis and/or clinical, analytic and imaging follow-up.</p><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">In 15 patients (71.4%) both procedures showed concordant results: 4 negative and 11 positive cases [7 local recurrences, 3 isolated pelvic lymph nodes (2 infracentimetric), 1 local relapse and only one M1 bone metastases].</p><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The results were discordant in 6 patients (28.6%): 3 local relapses in MRI with no PET significance, 1 local relapse in PET with no MRI significance. 2 bone metastases were identified with PET (out of the field-of-view of MRI)</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">11</span>C-choline PET/CT and multi-parametric MRI play a complementary role in the detection of local relapse in prostate cancer patients, with similar sensitivity for the detection of lymph involvement. Whole-body <span class="elsevierStyleSup">11</span>C-choline PET/CT technique is also useful for bone staging.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Clinic problem and case series" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Comment" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Problema clínico con casuística</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparar la utilidad diagnóstica de la PET/TC con <span class="elsevierStyleSup">11</span>C-colina y la RM multiparamétrica en la detección de la recidiva del cáncer de próstata a nivel pélvico.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Hemos estudiado retrospectivamente 21 pacientes con antecedente de cáncer de próstata, tratados inicialmente con cirugía (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>12) o radioterapia (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>9), que presentaban elevación del PSA (poscirugía 0,3–3,6<span class="elsevierStyleHsp" style=""></span>ng/ml; posradioterapia 2,4–8,8<span class="elsevierStyleHsp" style=""></span>ng/ml). A todos ellos, en un periodo de tiempo inferior a 15 días, se les realizó: estudio PET/TC «doble fase» de cuerpo completo, inmediatamente tras la administración de <span class="elsevierStyleSup">11</span>C-colina (296<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>29<span class="elsevierStyleHsp" style=""></span>MBq) y RM prostática multiparamétrica, empleando secuencias anatómicas, estudio de difusión y estudio dinámico tras la administración de contraste intravenoso paramagnético. A partir de nuestros resultados, a todos ellos se les realizó estudio diagnóstico dirigido y/o seguimiento clínico, analítico y de imagen.</p><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">En 15 pacientes (71,4%) ambas exploraciones fueron concordantes, 4 negativas y 11 positivas: 7 recidivas locales, 3 adenopatías pélvicas únicas (2 infracentimétricas), una recidiva local y una M1 ósea única. En 6 pacientes (28,6%) ambas exploraciones fueron discordantes: 3 recidivas locales identificadas en la RM y sin significación en la PET, una recidiva local identificada en la PET sin significación en la RM y 2 M1 óseas identificadas en la PET fuera del campo de RM.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comentario</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">La PET/TC con <span class="elsevierStyleSup">11</span>C-colina y la RM multiparamétrica tienen un papel complementario para la detección de recidiva local del cáncer de próstata, con sensibilidad similar para la detección de inflitración ganglionar. La PET/TC con <span class="elsevierStyleSup">11</span>C-colina, como técnica de cuerpo completo, permite la estadificación ósea.</p></span>" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "abst0015" "titulo" => "Problema clínico con casuística" ] 1 => array:2 [ "identificador" => "abst0020" "titulo" => "Comentario" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Garcia JR, Romera N, Cozar M, Soler M, Moragas M, Escobar M. <span class="elsevierStyleSup">11</span>C-colina PET/TAC y RM multiparamétrica en la recidiva bioquímica del cáncer de próstata. Actas Urol Esp. 2015;39:259–263.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 963 "Ancho" => 2332 "Tamanyo" => 265805 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Patient with a history of prostate cancer treated with surgery 3 years ago having high PSA (1.5<span class="elsevierStyleHsp" style=""></span>ng/ml). (A) and (B) Dynamic study with intravenous paramagnetic contrast. Postprostatectomy changes with hyperintense nodular lesion in right posterolateral vesicoureteral anastomosis, with initial rapid increased uptake curve, and late plateau-washing phase, highly suggestive of local recurrence.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1169 "Ancho" => 3251 "Tamanyo" => 191212 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Patient with a history of prostate cancer treated with radiotherapy 2 years ago having elevated PSA (2.8<span class="elsevierStyleHsp" style=""></span>ng/ml). (A) and (B) Axial early and late PET/CT imaging. Deposit of <span class="elsevierStyleSup">11</span>C-choline (SUVmax 2.0) in the middle third of the right prostate lobe showing cumulative dynamics in the late imaging (SUVmax 2.3), metabolic behavior suggestive of local recurrence.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1614 "Ancho" => 3254 "Tamanyo" => 379568 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Patient with a history of prostate cancer treated with total prostatectomy one year ago having elevated PSA (0.6<span class="elsevierStyleHsp" style=""></span>ng/ml). (A) and (B) Axial early and late PET/CT imaging. Single hypermetabolic adenopathy (SUVmax 4.3) in left external iliac chain with increased uptake in the late imaging (SUVmax 5.6) suggestive of tumor lymph node involvement. (C) T2-weighted sequence in coronal plane with surface coil. Adenopathy in left iliac external chain infracentimeter of 9<span class="elsevierStyleHsp" style=""></span>mm in diameter. (D) and (E) Axial plane difussion sequence with values <span class="elsevierStyleItalic">b</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0 and <span class="elsevierStyleItalic">b</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>900 and ADC map. In the sequence with high b value, adenopathy has marked restricted diffusion (hyperintense in <span class="elsevierStyleItalic">b</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>900), showing a very low ADC value (hypointense in ADC map).</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1623 "Ancho" => 3166 "Tamanyo" => 242390 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Patient with a history of prostate cancer treated with radiotherapy 4 years ago having elevated PSA (10<span class="elsevierStyleHsp" style=""></span>ng/ml). (A)–(C). PET/CT axial early and late imaging. Hypermetabolic focus on left ischium (SUVmax 5.7) without morphological translation, which presents cumulative dynamics in the late imaging (SUVmax 6.1) suggestive of M1 bone injury. (D) T2-weighed sequence. Axial plane. Hypointense lesion in the left ischium of 20<span class="elsevierStyleHsp" style=""></span>mm. (E) Difussion sequence. The bone lesion described in the sequence with high b value is markedly hyperintense regarding restricted diffusion.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Defining the ideal cutpoint for determining PSA recurrence after radical prostatectomy. Prostate specific antigen" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S.J. Freedland" 1 => "M.E. Sutter" 2 => "F. Dorey" 3 => "W.J. Aronson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2003" "volumen" => "61" "paginaInicial" => "365" "paginaFinal" => "369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12597949" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0045" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "European Association of Urology" "etal" => true "autores" => array:6 [ 0 => "A. Heidenreich" 1 => "P.J. Bastian" 2 => "J. Bellmunt" 3 => "M. Bolla" 4 => "S. 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Bockisch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00259-008-0951-6" "Revista" => array:6 [ "tituloSerie" => "Eur J Nucl Med Mol Imaging" "fecha" => "2009" "volumen" => "36" "paginaInicial" => "S113" "paginaFinal" => "S120" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19104802" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003900000004/v2_201504271107/S2173578615000463/v2_201504271107/en/main.assets" "Apartado" => array:4 [ "identificador" => "6272" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Casuistry" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003900000004/v2_201504271107/S2173578615000463/v2_201504271107/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578615000463?idApp=UINPBA00004N" ]
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