The Contribution of Multiparametric Pelvic and Whole-Body MRI to Interpretation of <sup>18</sup>F-Fluoromethylcholine or <sup>68</sup>Ga-HBED-CC PSMA-11 PET/CT in Patients with Biochemical Failure After Radical Prostatectomy
Bibliographic record
Abstract
Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of <sup>18</sup>F-fluoromethylcholine (<sup>18</sup>F-FCH) or <sup>68</sup>Ga-HBED-CC PSMA-11 (<sup>68</sup>Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. <b>Methods:</b> The current analysis was performed as part of a prospective, multicenter trial on <sup>18</sup>F-FCH or <sup>68</sup>Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (>0.2 ng/mL) and high-risk features (Gleason score > 7, PSA doubling time < 10 mo, or PSA > 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR–wbMR) were compared for each radiotracer and each individual patient (for <sup>18</sup>F-FCH, or <sup>68</sup>Ga-PSMA for patients who had <sup>68</sup>Ga-PSMA PET) and to a composite reference standard. <b>Results:</b> There were 86 patients with PET (<sup>18</sup>F-FCH [<i>n</i> = 76] and/or <sup>68</sup>Ga-PSMA [<i>n</i> = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on <sup>18</sup>F-FCH PET/mpMR, versus 11 of 76 (14.5%) on <sup>18</sup>F-FCH PET (<i>P</i> = 0.039), and in 11 of 26 (42.3%) on <sup>68</sup>Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on <sup>68</sup>Ga-PSMA PET (<i>P</i> = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET (<i>P</i> = 0.039) or mpMR (<i>P</i> = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET (<i>P</i> = 1.0) but only 12 of 86 (14%) on wbMR (<i>P</i> = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET (<i>P</i> = 0.683) or wbMR (<i>P</i> = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. <b>Conclusion:</b> Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to <sup>18</sup>F-FCH or <sup>68</sup>Ga-PSMA PET did not improve detection of regional or distant metastases.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".