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Background  The aim of this study was to prospectively compare the detection rate of  68 Ga-PSMA versus  11 C-Choline in men with prostate cancer with biochemical recurrence and to demonstrate the added value of a tri-modality PET/CT-MRI system.    Methods  We analysed 36 patients who underwent both  11 C-Choline PET/CT and  68 Ga-PSMA PET/CT scanning within a time window of 1-2 weeks. Additionally, for the  68 Ga-PSMA scan, we used a PET/CT-MRI (3.0 T) system with a dedicated shuttle, acquiring MRI images of the pelvis.    Results  Both scans were positive in 18 patients (50%) and negative in 8 patients (22%). Nine patients were positive with  68 Ga-PSMA alone (25%) and one with  11 C-Choline only (3%). The median detected lesion per patient was 2 for  68 Ga-PSMA (range 0-93) and 1 for  11 C-Choline (range 0-57). Tumour to background ratios in all concordant lesions ( n  = 96) were higher for  68 Ga-PSMA than for  11 C-Choline (110.3 ± 107.8 and 27.5 ± 17.1, mean ± S.D., for each tracer, respectively  P  = 0.0001). The number of detected lesions per patient was higher for  11 C-Choline in those with PSA ≥ 3.3 ng/mL, while the number of detected lesions was independent of PSA levels for  68 Ga-PSMA using the same PSA cut-off value. Metastatic pelvic lesions were found in 25 patients (69%) with  68 Ga-PSMA PET/CT, in 18 (50%) with  11 C-Choline PET/CT and in 21 (58%) with MRI (3.0 T). MRI was very useful in detecting recurrence in cases classified as indeterminate by means of PET/CT alone at prostate bed.    Conclusions  In patients with prostate cancer with biochemical recurrence  68 Ga-PSMA detected more lesions per patient than  11 C-Choline, regardless of PSA levels. PET/CT-MRI (3.0 T) system is a feasible imaging modality that potentially adds useful relevant information with increased accuracy of diagnosis.

68Ga-PSMA and 11C-Choline comparison using a tri-modality PET/CT-MRI (3.0 T) system with a dedicated shuttle