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Şahin K, Kibar A, Güneren C, Sağer MS, Sönmezoğlu K. 68Ga Prostate-specific Membrane Antigen Uptake in Metastatic Medullary Thyroid Carcinoma. Mol Imaging Radionucl Ther 2024; 33:54-56. [PMID: 38390812 PMCID: PMC10899746 DOI: 10.4274/mirt.galenos.2023.47855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/25/2023] [Indexed: 02/24/2024] Open
Abstract
We present the case of a 58-year-old man with advanced medullary thyroid carcinoma who had a treatment history with different types of modalities. In the follow-up, the patient had rising calcitonin and CEA levels. Metastatic lymph nodes, liver, and bone metastases with varying degrees of uptake were detected on 18F-fluorodeoxyglucose (FDG) and 68Ga-DOTATATE positron emission tomography/computed tomography (PET/CT). 68Ga prostate-specific membrane antigen (PSMA) PET/CT was performed to explore whether the patient might have a chance for PSMA-targeted radionuclide therapy, and increased PSMA expression was noted in most of the metastatic lesions, even some of which have higher PSMA uptake than 18F-FDG and 68Ga-DOTATATE.
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Affiliation(s)
- Kübra Şahin
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Türkiye
| | - Ali Kibar
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Türkiye
| | - Cansu Güneren
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Türkiye
| | - Muhammet Sait Sağer
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Türkiye
| | - Kerim Sönmezoğlu
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Türkiye
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Algın E, Okudan B, Açıkgöz Y, Sayan H, Bal Ö, Seven B. Impact of 68Ga-PSMA PET/CT on Survival and Management in Prostate Cancer. Curr Med Imaging 2024; 20:CMIR-EPUB-138008. [PMID: 38284703 DOI: 10.2174/0115734056276494231207101146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND 68Ga-labeled prostate-specific membrane antigen positron emission tomography-computed tomography (68Ga-PSMA PET/CT) has led to altered treatment plans for prostate cancer (PCa) patients. OBJECTIVE This study aimed to investigate the impact of 68Ga-PSMA PET/CT on overall survival (OS) and management in PCa. METHODS Consecutive 100 patients who had 68Ga-PSMA PET/CT and conventional imaging (CI) were included in this retrospective study. Disease stages and treatment plans according to both CI and 68Ga-PSMA PET/CT were compared. The effect of 68Ga-PSMA PET/CT on OS was assessed. RESULTS After 68Ga-PSMA PET/CT, the stage changed in 64 patients (64%). By the reason of 68Ga-PSMA PET/CT findings, treatment plans based on CI were changed in 73 patients (73%). According to the ROC analysis, patients with a PSA value below 8 had higher rates of change in staging (p<0.0001) and treatment (p=0.034). Both a PSA below 8 (OR 8.79 95% CI (2.72-28.43), p<0.001), and having a hormone-sensitive disease at the time of imaging (OR 5.6 95% CI (1.35-23.08), p=0.017) were significant independent factors predicting change in staging with 68Ga-PSMA PET/CT. The results of a phi correlation coefficient analysis showed a significant relationship between therapy and changes in staging (ϕ=0.638, p<0.0001). Two-year OS was statistically different in hormone-sensitive patients with and without treatment change (95% vs 81%, p=0.006). CONCLUSION 68Ga-PSMA PET/CT has the effect of changing the treatment in 73% of PCa patients. There is a positive correlation between the changes in staging and treatment. Survival of hormone sensitive patients has improved due to treatment changes based on PET/CT findings.
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Affiliation(s)
- Efnan Algın
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Berna Okudan
- Department of Nuclear Medicine, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Yusuf Açıkgöz
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Haluk Sayan
- Department of Radiation Oncology, Ankara City Hospital, Ankara, Turkey
| | - Öznur Bal
- Department of Medical Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Bedri Seven
- Department of Nuclear Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, University of Amasya, Amasya, Turkey
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Zang S, Jiang C, Zhang L, Fu J, Meng Q, Wu W, Shao G, Sun H, Jia R, Wang F. Deep learning based on 68Ga-PSMA-11 PET/CT for predicting pathological upgrading in patients with prostate cancer. Front Oncol 2024; 13:1273414. [PMID: 38260839 PMCID: PMC10800856 DOI: 10.3389/fonc.2023.1273414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Objectives To explore the feasibility and importance of deep learning (DL) based on 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT in predicting pathological upgrading from biopsy to radical prostatectomy (RP) in patients with prostate cancer (PCa). Methods In this retrospective study, all patients underwent 68Ga-PSMA-11 PET/CT, transrectal ultrasound (TRUS)-guided systematic biopsy, and RP for PCa sequentially between January 2017 and December 2022. Two DL models (three-dimensional [3D] ResNet-18 and 3D DenseNet-121) based on 68Ga-PSMA-11 PET and support vector machine (SVM) models integrating clinical data with DL signature were constructed. The model performance was evaluated using area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity. Results Of 109 patients, 87 (44 upgrading, 43 non-upgrading) were included in the training set and 22 (11 upgrading, 11 non-upgrading) in the test set. The combined SVM model, incorporating clinical features and signature of 3D ResNet-18 model, demonstrated satisfactory prediction in the test set with an AUC value of 0.628 (95% confidence interval [CI]: 0.365, 0.891) and accuracy of 0.727 (95% CI: 0.498, 0.893). Conclusion A DL method based on 68Ga-PSMA-11 PET may have a role in predicting pathological upgrading from biopsy to RP in patients with PCa.
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Affiliation(s)
- Shiming Zang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Cuiping Jiang
- Department of Ultrasound, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Lele Zhang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jingjing Fu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Qingle Meng
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Wenyu Wu
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guoqiang Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hongbin Sun
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ruipeng Jia
- Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Feng Wang
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Xu L, Chen R, Yu X, Liu J, Wang Y. 18F-FDG PET Is Not Inferior to 68Ga-PSMA PET for Detecting Biochemical Recurrent Prostate Cancer with a High Gleason Score: A Head-to-Head Comparison Study. Diagnostics (Basel) 2023; 14:7. [PMID: 38201316 PMCID: PMC10871097 DOI: 10.3390/diagnostics14010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/11/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
Previous studies have indicated that 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in biochemical recurrence (BCR) patients with poorly differentiated prostate adenocarcinoma had higher diagnostic sensitivity than those with well differentiated adenocarcinoma, but whether the performance of FDG PET can achieve the effect of prostate-specific membrane antigen (PSMA) PET in BCR patients with a high Gleason score remains poorly understood. This study aimed to compare the efficacies of 18F-FDG PET/CT and 68Ga-PSMA PET/CT for BCR patients and evaluate whether 18F-FDG PET was not inferior to 68Ga-PSMA PET for detecting BCR with a high Gleason score. This was a retrospective, head-to-head comparative study completed at Ren Ji Hospital between May 2018 and June 2021. Patients underwent both 18F-FDG and 68Ga-PSMA PET/CT. The detection rate of BCR at the patient level and at the anatomical region level was evaluated. In total, 145 patients were enrolled in this study. 18F-FDG PET/CT (24.1%, 35/145) had lower detection rates than 68Ga-PSMA PET/CT (59.3%, 86/145; p < 0.001) at the patient level and at any anatomical region (p < 0.05). The PSA level (p < 0.001, OR = 11.026, 95% CI: 3.214-37.824) and the Gleason score (p < 0.001, OR = 20.227, 95% CI: 5.741-71.267) were independent predictive factors of the detection rate on 18F-FDG PET/CT, while the PSA level (p < 0.001, OR = 4.862, 95% CI: 2.338-10.110) was the only predictor of the detection rate on 68Ga-PSMA PET/CT. 18F-FDG PET/CT had a similar detection rate as 68Ga-PSMA PET/CT in patients with a Gleason score of 9 at the patient level (64.3% vs. 71.4%, p = 0.567) and any anatomical region (all p > 0.05), but 18F-FDG PET/CT had a lower detection rate than 68Ga-PSMA PET/CT in patients with a Gleason score of 6-8. 18F-FDG PET is not inferior to 68Ga-PSMA PET for detecting BCR with a Gleason score of 9; therefore, 18F-FDG PET/CT could be considered in BCR patients with a Gleason score of 9. However, 68Ga-PSMA is a better tracer than 18F-FDG in PET/CT for treatment decision making in BCR patients with a Gleason score of 6-8.
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Affiliation(s)
- Lian Xu
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China;
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China; (R.C.); (X.Y.); (J.L.)
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China; (R.C.); (X.Y.); (J.L.)
| | - Xiaofeng Yu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China; (R.C.); (X.Y.); (J.L.)
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200025, China; (R.C.); (X.Y.); (J.L.)
| | - Yuetao Wang
- Department of Nuclear Medicine, The Third Affiliated Hospital of Soochow University, Changzhou 213003, China;
- Institute of Clinical Translation of Nuclear Medicine and Molecular Imaging, Soochow University, Changzhou 213003, China
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Daniels H, Gilbert R, Bonin L. The diagnostic accuracy of 68Ga-PSMA PET/CT versus 99mTc-MDP bone scintigraphy for identifying bone metastases in persons with prostate cancer: A systematic review. J Med Imaging Radiat Sci 2023; 54:545-555. [PMID: 37211439 DOI: 10.1016/j.jmir.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Prostate cancer (PCa) is the second most common cause of cancer related death in men. Accurate diagnosis of bone metastases is essential to treatment decision-making and follow-up. Recent primary studies have compared the accuracy of 68Ga-PSMA PET/CT versus 99mTc-MDP bone scintigraphy in the detection of PCa bone metastases. These studies suggest 68Ga-PSMA PET/CT to be superior. Comprehensive syntheses of these studies are now warranted. PURPOSE To synthesize studies comparing the accuracy of 68Ga-PSMA PET/CT versus 99mTc-MDP bone scintigraphy, the most used modality in the identification of bone metastases in PCa patients. METHODS A systematic review was conducted evaluating diagnostic accuracy studies which compared 68Ga-PSMA PET/CT and 99mTc-MDP bone scintigraphy. Bias and quality were assessed using the QUADAS-2 tool. Searches in three databases using search terms: Positron-Emission Tomography, prostatic neoplasm, 68Ga, and bone were conducted. Image acquisitions between modalities had to be performed within 3 months of each other. RESULTS Five single-centered studies were included in this review. Across all measures of accuracy, 68Ga PSMA PET/CT was superior to 99mTc-MDP bone scintigraphy in the detection of skeletal metastases. Patient-based sensitivities and specificities across included studies ranged from (91%-100% vs. 50%-91%) and (88%-100% vs 19%-96%) for 68Ga-PSMA PET/CT and 99mTc-MDP bone scintigraphy respectively. The overall risk of bias was moderate primarily due to the retrospective nature of most included studies. CONCLUSION 68Ga-PSMA PET/CT was more accurate than 99mTc-MDP bone scintigraphy in the detection of PCa bone metastases. Future studies should seek to define the clinical relevance of these findings.
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Affiliation(s)
- Hannah Daniels
- School of Health Sciences, Faculty of Health, Dalhousie University, 1276 South Park St. Halifax, NS B3H 2Y9, Canada.
| | - Robert Gilbert
- School of Health Sciences, Faculty of Health, Dalhousie University, 1276 South Park St. Halifax, NS B3H 2Y9, Canada
| | - Lisa Bonin
- School of Health Sciences, Faculty of Health, Dalhousie University, 1276 South Park St. Halifax, NS B3H 2Y9, Canada
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Chavoshi M, Mirshahvalad SA, Zamani S, Radmard AR, Fallahi B, Mousavi SA. Whole-body low-dose CT can be of value in prostate cancer decision-making: a retrospective study on 601 patients. Insights Imaging 2023; 14:124. [PMID: 37454388 DOI: 10.1186/s13244-023-01475-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVES To evaluate the diagnostic value of whole-body low-dose computed tomography (CT) to detect bone metastasis in prostate cancer (PCa) patients and its possible utility in therapeutic decision-making. Also, to determine the valuable CT features for lesion characterisation. METHODS This IRB-approved retrospective study reviewed PCa patients who underwent 68Ga-PSMA PET/CT in our centre from March 2017 to August 2022. Two board-certified radiologists and one nuclear medicine specialist reported all whole-body low-dose CT scans separately, unaware of the 68Ga-PSMA-PET results. The per-lesion and per-patient diagnostic performances were calculated. Also, the significance of CT features was evaluated. Moreover, the inter-observer agreement was analysed. A two-tailed p value < 0.05 was considered significant. RESULTS From 727 reviewed PCa patients, 601 (mean age = 68.7 ± 8.1) were found to be eligible, including 211 (35.1%) referrals for initial staging and 390 (64.9%) for evaluating the extent of the disease after biochemical recurrence. Per-patient diagnostic analysis for three reviewers showed 81.0-89.4% sensitivity and 96.6-98.5% specificity in detecting osteo-metastasis. It was able to correctly detect high-burden disease based on both CHAARTED and LATITUDE criteria. Regarding the value of underlying CT features, size > 1 cm, ill-defined borders, presence of soft-tissue component, and cortical destruction were statistically in favour of metastasis. Also, Hu > 900 was in favour of benign entities with 93% specificity. CONCLUSIONS Although not as accurate as 68Ga-PSMA PET/CT, whole-body low-dose CT might precisely classify PCa patients considering therapeutic decision-making. Additionally, we proposed diagnostic CT features that could help radiologists with better characterisation of the detected lesions. CRITICAL RELEVANCE STATEMENT The whole-body low-dose CT can be considered valuable in the clinical decision-making of prostate cancer patients. This modality may obviate performing multiple imaging sessions and high-cost scans in patients diagnosed with the high-burden disease.
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Affiliation(s)
- Mohammadreza Chavoshi
- Department of Hematology-Oncology, Hematology-Oncology and BMT Research Center/Tehran University of Medical Sciences, Tehran, Iran
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Mirshahvalad
- Joint Department of Medical Imaging (JDMI), University Medical Imaging Toronto (UMIT), University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, ON, Canada.
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sara Zamani
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amir Reza Radmard
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Fallahi
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Asadollah Mousavi
- Department of Hematology-Oncology, Hematology-Oncology and BMT Research Center/Tehran University of Medical Sciences, Tehran, Iran
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Soydal Ç, Demir B, Sütçü G, Araz M, Küçük NÖ. Comparison of 68Ga-PSMA PET/CT and 18F-PSMA PET/CT of a Patient with Prostate Cancer Recurrence on Urinary Bladder Wall. Mol Imaging Radionucl Ther 2023; 32:150-152. [PMID: 37337828 DOI: 10.4274/mirt.galenos.2023.47550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Prostate cancer is one of the most prevalent cancers in the world. After radical prostatectomy, prostate-specific antigen (PSA) levels are usually used as a marker of recurrence for prostate cancer. In the case of increased PSA levels, 68Ga-prostate-specific membrane antigen (PSMA) or 18F-PSMA, a new alternative, can be performed for the detection of recurrent disease. We report a case of a 49-year-old male patient with increasing PSA levels who was previously operated 8 years ago. Although no obvious pathological uptake was detected in 68Ga-PSMA positron emission tomography/computed tomography (PET/CT), 18F-PSMA PET/CT revealed a lesion with pathological uptake on the urinary bladder wall.
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Affiliation(s)
- Çiğdem Soydal
- Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Burak Demir
- Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Gizem Sütçü
- Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Mine Araz
- Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
| | - Nuriye Özlem Küçük
- Ankara University Faculty of Medicine, Department of Nuclear Medicine, Ankara, Turkey
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Telli T, Tuncel M, Karabulut E, Aksoy S, Erman M, Akdogan B, Caglar M. Prognostic factors of overall and prostate-specific antigen-progression-free survival in metastatic castration-resistant prostate cancer patients treated with 177 Lu-PSMA-617. A single-center prospective observational study. Prostate 2023; 83:792-800. [PMID: 36919876 DOI: 10.1002/pros.24518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Metastatic castration-resistant prostate cancer (mCRPC) is characterized by heterogeneity among patients as well as therapy responses due to diverse genetic, epigenetic differences, and resistance mechanisms. At this stage of the disease, therapy modalities should be individualized in light of the patients' clinical state, symptoms, and genetic characteristics. In this prospective study, we aimed to evaluate the outcome of patients with mCRPC treated with 177 Lutetium labeled PSMA-617 therapy (PSMA-RLT), as well as baseline and therapy-related parameters associated with survival. METHODS This prospective study included 52 patients who received two to six cycles of PSMA-RLT. Primary endpoints were overall survival (OS) and prostate-specific antigen (PSA)-progression-free survival (PFS). 18 F-Fluorodeoxyglucose (FDG) and 68 Ga-PSMA (PSMA) Positron Emission Tomography/Computer Tomography (PET/CT) scans were performed for a comprehensive assessment of tumor burden and heterogeneity. Biochemical, imaging, clinical, and therapy-related parameters were analyzed with the Kaplan-Meier, log-rank, and Cox regression analyses to predict OS and PFS. RESULTS Median OS and PSA-PFS were 17.7 (95% confidence interval [CI]: 15.2-20.2) and 6.6 months (95% CI: 4.5-8.8), respectively. Primary resistance to PSMA-RLT (hazard ratio [HR]: 12.57, 95% CI: 2.4-65.2, p: 0.003), <30% PSA response rate after first cycle of PSMA-RLT (HR: 1.016, 95% CI: 1.006-1.03, p: 0.003), FDG > PSMA disease (HR: 4.9, 95% CI: 1.19-20.62, p: 0.03), PSA doubling time (PSA DT) of ≤2.4 months (HR: 15.7, 95% CI: 3.7-66.4, p: <0.0001), and low hemoglobin levels (HR: 0.59, 95% CI: 0.41-0.83, p: 0.003) were correlated with poor OS in the multivariate analysis. Bone scintigraphy > PSMA disease (HR: 5.6; 95% CI: 1.8-17, p: 0.002) and high C-reactive protein (HR: 1.4, 95% CI: 1.1-1.7, p: 0.001) were significant predictive biomarkers for PFS in the multivariate analysis. CONCLUSION PSA response rate and pattern to PSMA-RLT are the most important predictors of survival in patients receiving PSMA-RLT. Being a strong predictive biomarker, combined FDG and PSMA PET can be helpful for the decision of PSMA-RLT eligibility.
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Affiliation(s)
- Tugce Telli
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Murat Tuncel
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Erdem Karabulut
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sercan Aksoy
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Mustafa Erman
- Department of Medical Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Bulent Akdogan
- Department of Urology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Meltem Caglar
- Department of Nuclear Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
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9
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Civan C, Kasper S, Berliner C, Fragoso-Costa P, Grünwald V, Pogorzelski M, Schaarschmidt BM, Lang S, Kersting D, Nader M, Lückerath K, Herrmann K, Fendler WP, Weber M. PSMA-Directed Imaging and Therapy of Salivary Gland Tumors: A Single-Center Retrospective Study. J Nucl Med 2023; 64:372-378. [PMID: 36137757 PMCID: PMC10071793 DOI: 10.2967/jnumed.122.264342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
We analyzed the diagnostic performance of prostate-specific membrane antigen (PSMA) PET/CT and the dosimetry, efficacy, and safety of 177Lu-PSMA-617 radioligand therapy (RLT) in salivary gland malignancies (SGMs). Methods: We identified 28 SGM patients with PSMA PET/CT from our database. CT and PSMA PET/CT images were evaluated separately by 3 masked readers in joint reading sessions. Pathologic findings were grouped into 6 TNM regions, and lesion-based disease extent was classified as no disease (n = 1, 4%), unifocal (n = 2, 7%), oligometastatic (n = 9, 32%), multifocal (n = 3, 11%), or disseminated (n = 13, 47%). For each region, the SUVmax of the lesion with the highest uptake was measured and the visual PSMA expression score was evaluated on a per-patient basis using PROMISE criteria. The association between PSMA expression and clinical and histopathologic markers was tested using the Student t test. Five patients underwent PSMA RLT with intratherapeutic dosimetry. Response was assessed using RECIST 1.1, and adverse events were graded according to version 5.0 of the Common Terminology Criteria for Adverse Events. Results: Compared with CT, PSMA PET/CT demonstrated additional metastatic lesions in 11 of 28 (39%) patients, leading to upstaging of TNM and lesion-based disease extent in 3 (11%) and 6 (21%) patients, respectively. PSMA PET/CT detected CT-occult local tumor, regional lymph nodes, nonregional lymph nodes, and bone metastases in 1 (4%), 4 (14%), 2 (7%), and 4 (14%) patients, respectively; no additional lesions were detected in the other predefined regions. PSMA expression level was higher than liver in 6 patients (25%). A significantly higher SUVmax was observed in male than female patients (15.8 vs. 8.5, P = 0.007) and in bone than lung lesions (14.2 vs. 6.4, P = 0.006). PSMA RLT was discontinued after 1 cycle in 3 of 5 patients because of insufficient tumor doses. No adverse events of grade 4 or higher occurred. Conclusion: In SGMs, PSMA PET/CT demonstrated a superior detection rate and led to upstaging in about one third of patients when compared with CT. The male sex and the presence of bone metastases were associated with significantly higher PSMA expression. PSMA RLT was well tolerated, but most patients did not have more than 1 cycle because of insufficient tumor doses.
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Affiliation(s)
- Caner Civan
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Stefan Kasper
- German Cancer Consortium, partner site Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Christoph Berliner
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Pedro Fragoso-Costa
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Viktor Grünwald
- German Cancer Consortium, partner site Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Michael Pogorzelski
- German Cancer Consortium, partner site Essen, Essen, Germany
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, Essen, Germany
| | - Benedikt Michael Schaarschmidt
- German Cancer Consortium, partner site Essen, Essen, Germany
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, Essen, Germany; and
| | - Stephan Lang
- German Cancer Consortium, partner site Essen, Essen, Germany
- Head and Neck Surgery, Department of Otorhinolaryngology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Katharina Lückerath
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
- German Cancer Consortium, partner site Essen, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany;
- German Cancer Consortium, partner site Essen, Essen, Germany
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Adnan A, Basu S. PSMA Receptor-Based PET-CT: The Basics and Current Status in Clinical and Research Applications. Diagnostics (Basel) 2023; 13. [PMID: 36611450 DOI: 10.3390/diagnostics13010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) is a 100 kD, 750 amino acid (AA) long type II transmembrane glycoprotein that has a short N-terminal intracellular domain with 19 AA, 24 AA transmembrane proteins and a large C-terminal extracellular domain with 707 AA. PSMA has been mapped to chromosome 11p 11-12 in the region of the folate hydrolase gene (FOLH1) and has no known natural ligand. The protein possesses enzymatic activity-glutamate carboxypeptidase II (GCP-II)-and is thought to have role in folate uptake (FOLH1 gene). 'PSMA' expression, although significantly up-regulated in prostate carcinoma (more in high-risk and aggressive variants), is not exclusive for it and is noted in various other benign and malignant conditions, especially in the neovasculature. Currently, PSMA PET-CT is approved for high-risk and biochemically recurrent prostate carcinoma (PCa), and in patient selection for PSMA based theranostics. This review aims to highlight the clinical evolution of the PSMA molecule and PSMA PET-CT as a diagnostic modality, various indications of PSMA PET-CT, the appropriateness criteria for its use, pitfalls and artefacts, and other uses of PSMA PET apart from prostate carcinoma.
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11
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Ben Shimol J, Lewin R, Symon Z, Rosenzweig B, Leibowitz-Amit R, Eshet Y, Domachevsky L, Davidson T. The Utility of 68Ga-PSMA PET/CT in Decisions Regarding Administering Salvage Radiotherapy to Men with Prostate Cancer. Int J Environ Res Public Health 2022; 20:537. [PMID: 36612859 PMCID: PMC9819101 DOI: 10.3390/ijerph20010537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Numerous papers have described 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT)'s sensitivity in identifying prostate cancer (PCa) recurrence. This study aimed to characterize the role of 68Ga-PSMA PET/CT in deciding to re-irradiate pelvic structures. METHODS 68Ga-PSMA PET/CT scans performed at Sheba Medical Center over seven years in 113 men were reviewed. All had undergone radiation to the prostate (70, 61.9%) or post-radical prostatectomy radiation to the prostate fossa (PF) (43, 48.1%), and had local or oligometastatic PCa recurrence and received salvage radiotherapy (SRT) based on PET/CT findings. RESULTS Mean age was 70.7 years. The mean grade group was 2.9; the mean prostate-specific antigen was 9.0. The 68Ga-PSMA PET/CT positive findings included: 37 (32.7%) in the prostate, 23 (20.4%) in seminal vesicles, 7 (6.2%) in the PF, and 3 (2.7%) in the seminal vesicle fossa. The mean standardized uptake value was 10.6 ± 10.2 (range: 1.4-61.6); the mean lesion size was 1.8 ± 3.5 mm (range: 0.5-5.1). SRT was directed toward the prostate and seminal vesicles in 48 (42.5%), PF in 18 (15.9%), and intrapelvic lymph node and bone in 47 (41.6%). Toxicities were mostly mild to moderate. CONCLUSION 68Ga-PSMA PET/CT-identified relapse with targeted SRT was well-tolerated and may result in less onerous treatments.
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Affiliation(s)
- Jennifer Ben Shimol
- Barzilai Medical Center, Ashqelon 7830604, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Ron Lewin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Zvi Symon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Radiation Oncology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Urology, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Raya Leibowitz-Amit
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Oncology Institute, Shamir Medical Center, Zerifin 7033001, Israel
| | - Yael Eshet
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Liran Domachevsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Ramat Gan 5262000, Israel
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12
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Assadi M, Manafi-Farid R, Jafari E, Keshavarz A, Divband G, Moradi MM, Adinehpour Z, Samimi R, Dadgar H, Jokar N, Mayer B, Prasad V. Predictive and prognostic potential of pretreatment 68Ga-PSMA PET tumor heterogeneity index in patients with metastatic castration-resistant prostate cancer treated with 177Lu-PSMA. Front Oncol 2022; 12:1066926. [PMID: 36568244 PMCID: PMC9773988 DOI: 10.3389/fonc.2022.1066926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction This study was conducted to evaluate the predictive values of volumetric parameters and radiomic features (RFs) extracted from pretreatment 68Ga-PSMA PET and baseline clinical parameters in response to 177Lu-PSMA therapy. Materials and methods In this retrospective multicenter study, mCRPC patients undergoing 177Lu-PSMA therapy were enrolled. According to the outcome of therapy, the patients were classified into two groups including positive biochemical response (BCR) (≥ 50% reduction in the serum PSA value) and negative BCR (< 50%). Sixty-five RFs, eight volumetric parameters, and also seventeen clinical parameters were evaluated for the prediction of BCR. In addition, the impact of such parameters on overall survival (OS) was evaluated. Results 33 prostate cancer patients with a median age of 69 years (range: 49-89) were enrolled. BCR was observed in 22 cases (66%), and 16 cases (48.5%) died during the follow-up time. The results of Spearman correlation test indicated a significant relationship between BCR and treatment cycle, administered dose, HISTO energy, GLCM entropy, and GLZLM LZLGE (p<0.05). In addition, according to the Mann-Whitney U test, age, cycle, dose, GLCM entropy, and GLZLM LZLGE were significantly different between BCR and non BCR patients (p<0.05). According to the ROC curve analysis for feature selection for prediction of BCR, GLCM entropy, age, treatment cycle, and administered dose showed acceptable results (p<0.05). According to SVM for assessing the best model for prediction of response to therapy, GLCM entropy alone showed the highest predictive performance in treatment planning. For the entire cohort, the Kaplan-Meier test revealed a median OS of 21 months (95% CI: 12.12-29.88). The median OS was estimated at 26 months (95% CI: 17.43-34.56) for BCR patients and 13 months (95% CI: 9.18-16.81) for non BCR patients. Among all variables included in the Kaplan Meier, the only response to therapy was statistically significant (p=0.01). Conclusion This exploratory study showed that the heterogeneity parameter of pretreatment 68Ga-PSMA PET images might be a potential predictive value for response to 177Lu-PSMA therapy in mCRPC; however, further prospective studies need to be carried out to verify these findings.
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Affiliation(s)
- Majid Assadi
- The Persian Gulf Nuclear Medicine Research Center, Department of Nuclear Medicine, Molecular Imaging, and Theranostics, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran,*Correspondence: Majid Assadi, ;
| | - Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmail Jafari
- The Persian Gulf Nuclear Medicine Research Center, Department of Nuclear Medicine, Molecular Imaging, and Theranostics, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Ahmad Keshavarz
- IoT and Signal Processing Research Group, ICT Research Institute, Faculty of Intelligent Systems Engineering and Data Science, Persian Gulf University, Bushehr, Iran
| | | | - Mohammad Mobin Moradi
- Research Center for Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rezvan Samimi
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Habibollah Dadgar
- Cancer Research Center, RAZAVI Hospital, Imam Reza International University, Mashhad, Iran
| | - Narges Jokar
- The Persian Gulf Nuclear Medicine Research Center, Department of Nuclear Medicine, Molecular Imaging, and Theranostics, Bushehr Medical University Hospital, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Benjamin Mayer
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
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13
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Chen R, Wang Y, Zhu Y, Shi Y, Xu L, Huang G, Liu J. The Added Value of 18F-FDG PET/CT Compared with 68Ga-PSMA PET/CT in Patients with Castration-Resistant Prostate Cancer. J Nucl Med 2022; 63:69-75. [PMID: 34980667 DOI: 10.2967/jnumed.120.262250] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/21/2021] [Indexed: 12/25/2022] Open
Abstract
68Ga-prostate-specific membrane antigen (68Ga-PSMA) PET/CT is a commonly used imaging modality in prostate cancers. However, few studies have compared the diagnostic efficiency between 68Ga-PSMA and 18F-FDG PET/CT and evaluated whether a heterogeneous metabolic phenotype (especially 68Ga-PSMA-negative [-], 18F-FDG-positive [+] lesions) exists in patients with castration-resistant prostate cancer (CRPC). We determined the added value of 18F-FDG PET/CT compared with 68Ga-PSMA PET/CT in CRPC patients and identified CRPC patients who may benefit from additional 18F-FDG PET/CT. Methods: The data of 56 patients with CRPC who underwent both 68Ga-PSMA and 18F-FDG PET/CT from May 2018 to February 2021 were retrospectively analyzed. The patients were classified into 2 groups: with or without 68Ga-PSMA-, 18F-FDG+ lesions. The differences in patient characteristics between the 2 groups and predictors of patients who have at least 1 68Ga-PSMA-, 18F-FDG+ lesion were analyzed. Results: Although both the detection rate (75.0% vs. 51.8%, P = 0.004) and the number of positive lesions (135 vs. 95) were higher for 68Ga-PSMA PET/CT than for 18F-FDG PET/CT, there were still 13 of 56 (23.2%) patients with at least 1 68Ga-PSMA-, 18F-FDG+ lesion. Prostate-specific antigen (PSA) and the Gleason score were both higher in patients with 68Ga-PSMA-, 18F-FDG+ lesions than in those without (P = 0.04 and P < 0.001, respectively). Multivariate regression analysis showed that the Gleason score (≥8) and PSA (≥7.9 ng/mL) were associated with the detection rate of patients who had 68Ga-PSMA-, 18F-FDG+ lesions (P = 0.01 and P = 0.04, respectively). The incidences of having 68Ga-PSMA-, 18F-FDG+ lesions in low-probability (Gleason score < 8 and PSA < 7.9 ng/mL), medium-probability (Gleason score ≥ 8 and PSA < 7.9 ng/mL or Gleason score < 8 and PSA ≥ 7.9 ng/mL), and high-probability (Gleason score ≥ 8 and PSA ≥ 7.9 ng/mL) groups were 0%, 21.7%, and 61.5%, respectively (P < 0.001). Conclusion: Gleason score and PSA are significant predictors of 68Ga-PSMA-, 18F-FDG+ lesions, and CRPC patients with a high Gleason score and PSA may benefit from additional 18F-FDG PET/CT.
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Affiliation(s)
- Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
| | - Yining Wang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiping Shi
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
| | - Lian Xu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; and
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14
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Aras O, Demirdag C, Kommidi H, Ting R, Sayman HB. Radiopharmaceutical for detecting PSMA - positive metastatic colon cancer: Matched-pair comparison of 18F-BF3-Cy3-ACUPA and 68Ga-PSMA PET/MRI. Nucl Med Rev Cent East Eur 2022; 25:129-130. [PMID: 35699591 PMCID: PMC9878462 DOI: 10.5603/nmr.a2022.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/01/2022] [Indexed: 01/28/2023] Open
Abstract
Prostate-specific membrane antigen (PSMA) - based radiopharmaceuticals are promising for the evaluation of PSMA-positive non-prostate cancers. In this case study, 18F-BF3-Cy3-ACUPA and 68Ga-PSMA positron emission tomography/magnetic resonance imaging (PET/MRI) were compared in a patient with metastatic colon cancer. Both 18F-BF3-Cy3-ACUPA and 68Ga-PSMA PET/MRI showed biopsy-proven metastatic left external iliac adenopathy, highlighting the feasibility of PSMA uptake in PET/MRI of metastatic nodal disease from colon cancer. Along with imaging evaluation, PSMA-based radiopharmaceuticals may also be used as a surrogate imaging tracer for potential theranostic applications using alpha or beta emitters in the context of PSMA-directed radiopharmaceutical therapy in advanced and progressive colorectal cancer.
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Affiliation(s)
- Omer Aras
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA,Corresponding Author Omer Aras, MD, Department of Radiology, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, Suite 1511, New York, NY 10065, T 646.888.4690, or
| | - Cetin Demirdag
- Department of Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Harikrishna Kommidi
- Department of Radiology, Molecular Imaging Innovations Institute (MI3), Weill Cornell Medicine, New York, NY 10065, USA
| | - Richard Ting
- Department of Surgery, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Haluk B Sayman
- Department of Nuclear Medicine, Istanbul University-Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
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15
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Nellaiappan HS, Rajaraman V, Halanaik D, Ananthakrrishnan R. Incidental Detection of Asymptomatic Brain Metastases Due to Carcinoma Prostate in Ga-68 PSMA HBED-CC Positron Emission Tomography-Computed Tomography: Reiterating its Superiority in Assessing Disease Status. Indian J Nucl Med 2022; 37:99-100. [PMID: 35478671 PMCID: PMC9037885 DOI: 10.4103/ijnm.ijnm_100_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 01/15/2022] [Accepted: 01/17/2022] [Indexed: 11/21/2022] Open
Abstract
Brain metastasis originating in adenocarcinoma of the prostate is rare and can be expected in cases of disseminated bone and soft-tissue disease. Asymptomatic brain metastasis is rare at any point of the disease stage. Ga-68 PSMA positron emission tomography-computed tomography (PET-CT) is one of the useful investigations for assessing the disease status in adenocarcinoma of the prostate. We report a case of asymptomatic brain metastases detected in Ga-68 PSMA PET-CT scan.
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Affiliation(s)
- Harihara Sudhan Nellaiappan
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Vishnukumar Rajaraman
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
| | - Dhanapathi Halanaik
- Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India,Address for correspondence: Dr. Dhanapathi Halanaik, Department of Nuclear Medicine, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India. E-mail :
| | - Ramesh Ananthakrrishnan
- Department of Radiodiagnosis, Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry, India
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16
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Aydos U, Çetin S, Akdemir ÜÖ, Budak FÇ, Ateş SG, Koparal MY, Gönül İI, Gülbahar Ö, Sözen S, Atay LÖ. The role of histopathological and biochemical parameters for predicting metastatic disease on 68 Ga-PSMA-11 PET in prostate cancer. Prostate 2021; 81:1337-1348. [PMID: 34516677 DOI: 10.1002/pros.24231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/25/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the role of histopathological and biochemical parameters in the prediction of the presence and number of PSMA positive lesions consistent with the metastatic spread of prostate cancer on 68 Ga-PSMA PET images. METHODS Biochemical, histopathological and imaging data of 302 prostate cancer patients who underwent 68 Ga-PSMA-11 PET/CT or PET/MR imaging for primary staging were retrospectively analyzed. Patients were divided into two groups as "PET positive" and "PET negative" according to the presence of pathologic extraprostatic PSMA involvement. "PET positive" patients were additionally divided into two groups: oligometastatic (1-3 metastatic lesion) and multimetastatic (>3 metastatic lesions). RESULTS The mean age of patients was 66.8 ± 7.6 years. Imaging modality was PET/MR in 223 (73.8%) and PET/CT in 79 (26.2%) of patients. Total PSA, PSA density (PSAD), ALP, and tumor ratio in biopsy specimens were found to be significantly higher in "PET positive" group compared to "PET negative" group and in multimetastatic group compared to oligometastatic group. PET positivity was observed in 3.8% of the low-intermediate risk groups (ISUP 1-3 and total PSA ≤ 20 ng/ml and PSAD < 0.15 ng/ml/cc). This ratio was 46% in the high-risk group (ISUP 4-5 or total PSA > 20 ng/ml or PSAD ≥ 0.15 ng/ml/cc) with a relative risk of 12 (p < .001). The prediction models to predict the PET positivity and the presence of distant metastasis had AUCs of 0.901 and 0.925, respectively; with ALP, total PSA, and tumor ratio in needle biopsy specimen as significant independent predictors (p < .05). CONCLUSIONS In this study, 68 Ga-PSMA-11 PET positivity was significantly higher in the high-risk patient group than in the low-intermediate risk groups. The prediction models used for predicting the PET positivity and the presence of distant metastasis on PET imaging were successful with high discriminatory powers. In addition to total PSA and ISUP GG, ALP and tumor ratio in biopsy specimens can be used to identify high-risk patients.
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Affiliation(s)
- Uğuray Aydos
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Serhat Çetin
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ümit Özgür Akdemir
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Fırat Çağlar Budak
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Seda Gülbahar Ateş
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Murat Yavuz Koparal
- Department of Urology, Recep Tayyip Erdogan University Training and Research Hospital, Rize, Turkey
| | - İpek Işık Gönül
- Department of Pathology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Özlem Gülbahar
- Department of Biochemistry, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sinan Sözen
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Lütfiye Özlem Atay
- Department of Nuclear Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey
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Jiang JY, Liang Yip JW, Kang C, Tran VH, Lee ME, Le K, Mansberg R. Incidental prostate-specific membrane antigen-avid meningioma detected on 68Ga-prostate-specific membrane antigen PET/CT. Radiol Case Rep 2021; 16:3422-3425. [PMID: 34522280 PMCID: PMC8426166 DOI: 10.1016/j.radcr.2021.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 12/01/2022] Open
Abstract
A 70-year-old gentleman with a history of Gleason score 7 (3 + 4) prostate adenocarcinoma was treated with radical prostatectomy with clear surgical margins. Postoperatively his prostate specific antigen was undetectable. However, his prostate specific antigen was slowly rising and he was referred for a 68Galium-Prostate Specific Membrane Antigen (PSMA) PET/CT scan. Findings were suggestive of local prostatic cancer recurrence with no evidence of nodal or distant metastasis. An incidental PSMA avid focus was noted in the left frontal lobe, inseparable from the left frontal bone laterally. Subsequent MRI findings were consistent with meningioma. Meningioma is the most common primary brain tumor and may be a cause of false positive prostate cancer metastasis due to 68Ga-PSMA uptake.
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Affiliation(s)
- James Yuheng Jiang
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Joshua Wei Liang Yip
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia
| | - Christine Kang
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Vu Hoang Tran
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Marco Enoch Lee
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Ken Le
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia
| | - Robert Mansberg
- Department of Nuclear Medicine and PET, Nepean Hospital, Kingswood, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, New South Wales, Sydney, Australia
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Shen K, Liu B, Zhou X, Ji Y, Chen L, Wang Q, Xue W. The Evolving Role of 18F-FDG PET/CT in Diagnosis and Prognosis Prediction in Progressive Prostate Cancer. Front Oncol 2021; 11:683793. [PMID: 34395251 PMCID: PMC8358601 DOI: 10.3389/fonc.2021.683793] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/08/2021] [Indexed: 11/13/2022] Open
Abstract
Positron emission tomography/computed tomography (PET/CT) is widely used in prostate cancer to evaluate the localized tumor burden and detect symptomatic metastatic lesions early. 18F-FDG is the most used tracer for oncologic imaging, but it has limitations in detecting early-stage prostate cancer. 68Ga-PSMA is a new tracer that has high specificity and sensibility in detecting local and metastatic tumors. But with the progression of prostate cancer, the enhancement of glucose metabolism in progressive prostate cancer provides a chance for 18F-FDG. This review focuses on PET/CT in the detection and prognosis of prostate cancer, summarizing the literature on 18F-FDG and 68Ga-PSMA in prostate cancer and highlighting that 18F-FDG has advantages in detecting local recurrence, visceral and lymph node metastases compared to 68Ga-PSMA in partial progressive prostate cancer and castration-resistant prostate cancer patients. We emphasize 18F-FDG PET/CT can compensate for the weakness of 68Ga-PSMA PET/CT in progressive prostate cancer.
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Affiliation(s)
- Kai Shen
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Liu
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiang Zhou
- Department of Nuclear Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyi Ji
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Chen
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qi Wang
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- State Key Laboratory of Oncogenes and Related Genes, Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Abstract
Objective To evaluate the effect that external cooling of the salivary glands (ECSG) has on the uptake of gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as an indirect assessment of the capacity of ECSG to reduce the local dose in lutetium-177-PSMA-617 radioligand therapy. Materials and Methods Ten patients with prostate cancer were submitted to 68Ga-PSMA positron emission tomography/computed tomography with unilateral ECSG. The ECSG was started at 30 min before the injection of the radiotracer and maintained until the end of image acquisition (1 h after injection). Each salivary gland was assessed by determining the maximum, mean, and peak standardized uptake values (SUVmax, SUVmean, and SUVpeak, respectively). The volume of each gland was determined in a volume of interest delineated by a threshold SUVmax of 10%. Paired Student's t-tests were used in order to compare the results. Results In terms of the SUV parameters, there were no statistically significant differences between the cooled and contralateral salivary glands. However, the mean volume was 27% lower in the cooled parotid glands than in the contralateral parotid glands (p = 0.004). Conclusion The use of ECSG does not appear to reduce 68Ga-PSMA uptake by the salivary glands. In addition, there is yet no evidence that ECSG is effective in preventing salivary gland toxicity.
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Affiliation(s)
| | - Nelisa Helena Rocha
- Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira (Icesp), São Paulo, SP, Brazil
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Gündoğan C, Ergül N, Çakır MS, Kılıçkesmez Ö, Gürsu RU, Aksoy T, Çermik TF. 68Ga-PSMA PET/CT Versus 18F-FDG PET/CT for Imaging of Hepatocellular Carcinoma. Mol Imaging Radionucl Ther 2021; 30:79-85. [PMID: 34082503 PMCID: PMC8185475 DOI: 10.4274/mirt.galenos.2021.92053] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objectives: This study aimed to compare the metabolic parameters obtained from 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and gallium-68 (68Ga)-prostate-specific membrane antigen (PSMA) PET/CT and investigate the relationship between serum alpha-fetoprotein and PET scan parameters in patients with hepatocellular carcinoma. Methods: Fourteen patients were recruited after dynamic magnetic resonance imaging (MRI) of the upper abdomen, and 18F-FDG and 68Ga-PSMA PET/CT imaging studies were conducted. Regions of interest (ROIs) were drawn from lesion-free liver tissue, abdominal aorta (A), and right medial gluteal muscle (G) for the background activity. Maximum standard uptake value (SUVmax) of these regions were compared with the SUVmax of primary tumor (T). Results: On visual assessment, five patients (36%) experienced low 18F-FDG uptake in the primary lesion, three patients (21%) experienced moderate uptake, and six patients (43%) experienced high uptake. However, only one patient (7%) showed low 68Ga-PSMA uptake, two patients (14%) showed moderate uptake, and 11 patients (79%) showed high uptake. Four patients with a low 18F-FDG uptake showed high 68Ga-PSMA uptake, while one patient exhibited low uptake with both 18F-FDG and 68Ga-PSMA. The number of lesions on 68Ga-PSMA PET/CT and MRI was significantly higher than 18F-FDG PET/CT (p=0.042 and 0.026, respectively). T/A and T/G values were significantly higher in 68Ga-PSMA than 18F-FDG (p=0.002 and 0.002, respectively). Conclusion: 68Ga-PSMA PET/CT is superior to 18F-FDG PET/CT in the staging of hepatocellular carcinoma. High 68Ga-PSMA uptake could be promising for PSMA-targeted radionuclide treatments.
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Affiliation(s)
- Cihan Gündoğan
- University of Health Sciences Turkey, Gazi Yaşargil Training and Research Hospital, Clinic of Nuclear Medicine, Diyarbakır, Turkey
| | - Nurhan Ergül
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Mehmet Semih Çakır
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Özgür Kılıçkesmez
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Radiology, İstanbul, Turkey
| | - Rıza Umar Gürsu
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Medical Oncology, İstanbul, Turkey
| | - Tamer Aksoy
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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21
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Qin C, Gai Y, Liu Q, Ruan W, Liu F, Hu F, Zhang X, Lan X. Optimized Application of 68Ga-Prostate-Specific Membrane Antigen-617 Whole-Body PET/CT and Pelvic PET/MR in Prostate Cancer Initial Diagnosis and Staging. Front Med (Lausanne) 2021; 8:657619. [PMID: 34055836 PMCID: PMC8155349 DOI: 10.3389/fmed.2021.657619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/19/2021] [Indexed: 01/21/2023] Open
Abstract
Purpose: To analyze 68Ga-PSMA-617 PET/CT or PET/MR and delayed PET/MR images in patients diagnosed with or suspicion of prostate cancer, and to explore the optimal use of PET/CT and PET/MR for initial diagnosis and staging in prostate cancer. Methods: Images from conventional scan by 68Ga-PSMA whole-body PET/CT or PET/MR followed by delayed pelvic PET/MR were retrospectively analyzed. Prostatic 68Ga-PSMA uptake was measured as SUVmax1 (conventional scan 1 h post injection) and SUVmax2 (delayed scan 3 h post injection). Age, PSA levels, and SUVmax were compared between benign and malignant cases. The correlation of SUVmax1 and SUVmax2 was analyzed. Diagnostic performance was evaluated by ROC analysis. Results: Fifty-six patients with 41 prostate cancers and 15 benign prostate lesions were enrolled. Fifty-three patients had paired conventional and delayed scans. Age, tPSA, fPSA levels, and SUVmax were significantly different between benign and malignant cases. A good correlation was found between SUVmax1 and SUVmax2. There was significant difference between SUVmax1 and SUVmax2 in the malignant group (p = 0.001). SUVmax1 had superior diagnostic performance than SUVmax2, SUVmax difference and PSA levels, with a sensitivity of 85.4%, a specificity of 100% and an AUC of 0.956. A combination of SUVmax1 with nodal and/or distant metastases and MR PI-RADS V2 score had a sensitivity and specificity of 100%. Delayed pelvic PET/MR imaging in 33 patients were found to be redundant because these patients had nodal and/or distant metastases which can be easily detected by PET/CT. PET/MR provided incremental value in 8 patients at early-stage prostate cancer based on precise anatomical localization and changes in lesion signal provided by MR. Conclusion: Combined 68Ga-PSMA whole-body PET/CT and pelvic PET/MR can accurately differentiate benign prostate diseases from prostate cancer and accurately stage prostate cancer. Whole-body PET/CT is sufficient for advanced prostate cancer. Pelvic PET/MR contributes to diagnosis and accurate staging in early prostate cancer. Imaging at about 1 h after injection is sufficient in most patients. ClinicalTrials.gov: NCT03756077. Registered 27 November 2018—Retrospectively registered, https://clinicaltrials.gov/show/NCT03756077.
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Affiliation(s)
- Chunxia Qin
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yongkang Gai
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qingyao Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Weiwei Ruan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fang Liu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Fan Hu
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiaoping Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoli Lan
- Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Molecular Imaging, Wuhan, China
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22
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Heuvel JO, de Wit-van der Veen BJ, van der Poel HG, van Leeuwen PJ, Bekers EM, Grootendorst MR, Vyas KN, Slump CH, Stokkel MPM. Cerenkov Luminescence Imaging in Prostate Cancer: Not the Only Light That Shines. J Nucl Med 2021; 63:29-35. [PMID: 33931467 DOI: 10.2967/jnumed.120.260034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intraoperatively during prostatectomy using 68Ga-prostate-specific membrane antigen (68Ga-PSMA-11). This study evaluated the accuracy of CLI compared with histopathology and, as an exploratory objective, investigated the characteristics of the identified chemiluminescence signal. Methods: After intravenous injection of a mean 68Ga-PSMA-11 activity of 69 MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathologic comparison and scored for the likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in 3 radioactive and 3 nonradioactive specimens using CLI. Results: In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1 mm). In 6 hot spots, CLI correctly identified PSMs on histopathology, located at the apex and mid prostate. In all 15 patients, an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in 8 patients. This chemiluminescence signal was also observed in nonradioactive prostate specimens, with a half-life of 48 ± 11 min. The chemiluminescence hampered the visual interpretation of 4 PSMs at the base. Conclusion: CLI was able to correctly identify margin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and mid prostate.
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Affiliation(s)
- Judith Olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands.,Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, The Netherlands; and
| | | | - Kunal N Vyas
- Lightpoint Medical Ltd., Chesham, United Kingdom
| | - Cornelis H Slump
- Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
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23
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Chen R, Wang Y, Zhu Y, Shi Y, Xu L, Huang G, Liu J. The added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in patients with castration-resistant prostate cancer. J Nucl Med 2021:jnumed.121.262250. [PMID: 33893190 DOI: 10.2967/jnumed.121.262250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: The 68Ga-PSMA PET/CT is a commonly used imaging modality in prostate cancers. However, few studies have compared the diagnostic efficiency between 68Ga-PSMA and 18F-FDG PET/CT and evaluated whether a heterogeneous metabolic phenotype (especially PSMA-FDG+ lesions) exists in patients with castration-resistant prostate cancer (CRPC). We determined the added value of 18F-FDG PET/CT compared to 68Ga-PSMA PET/CT in CRPC patients and identified CRPC patients who may benefit from additional 18F-FDG PET/CT. Methods: Data of 56 patients with CRPC who underwent both 68Ga-PSMA and 18F-FDG PET/CT from May 2018 to February 2021 were retrospectively analysed. Patients were classified into two groups with or without PSMA-FDG+ lesions. The differences in patient characteristics between the two groups and predictors of patients who having at least one PSMA-FDG+ lesion were analysed. Results: Although both the detection rate (75.0% vs. 51.8%, P = 0.004) and positive lesion number (135 vs. 95) of 68Ga-PSMA PET/CT were higher than 18F-FDG PET/CT, there were still 13/56 (23.2%) patients with at least one PSMA-FDG+ lesion. The prostate-specific antigen (PSA) and Gleason score were both higher in the patients with PSMA-FDG+ lesions than in those without PSMA-FDG+ lesions (P = 0.04 and P<0.001, respectively). Multivariate regression analysis showed that the Gleason score (≥8) and PSA (≥7.9 ng/mL) were associated with the detection rate of patients who had PSMA-FDG+ lesions (P = 0.01 and P = 0.04, respectively). The incidences of having PSMA-FDG+ lesions in low-probability (Gleason score<8 and PSA<7.9 ng/mL), medium-probability (Gleason score≥8 and PSA<7.9 ng/mL or Gleason score<8 and PSA≥7.9 ng/mL), and high-probability (Gleason score≥8 and PSA≥7.9 ng/mL) groups were 0%, 21.7%, and 61.5%, respectively (P<0.001). Conclusion: Gleason score and PSA are significant predictors for PSMA-FDG+ lesions, and CRPC patients with high Gleason score and PSA may benefit from additional 18F-FDG PET/CT.
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Affiliation(s)
- Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yining Wang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yiping Shi
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Lian Xu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Gang Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jianjun Liu
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University,, China
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24
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Shi Y, Wu JG, Xu L, Zhu Y, Wang Y, Huang G, Liu J, Chen R. The Heterogeneous Metabolic Patterns of Ganglia in 68Ga-PSMA, 11C-choline, and 18F-FDG PET/CT in Prostate Cancer Patients. Front Oncol 2021; 11:666308. [PMID: 33968772 PMCID: PMC8103210 DOI: 10.3389/fonc.2021.666308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose Studies have indicated that PSMA-positive ganglia represent a diagnostic pitfall for nuclear medicine physicians. No studies have described choline and FDG uptake in ganglia, which may be a source of misdiagnosis. Herein, we described the percentage and uptake pattern of 68Ga-PSMA, 11C-choline and 18F-FDG PET/CT in ganglia and evaluated the heterogeneous metabolic patterns of ganglia to differentiate from lymph node metastases (LNM). Methods Thirty-nine patients who underwent 11C-choline PET/CT and 120 patients who underwent 68Ga-PSMA PET/CT and 18F-FDG PET/CT were retrospectively analyzed. The prevalence of PSMA-positive, choline-positive and FDG-positive ganglia was determined, the SUVmax of ganglia in different locations were measured, and the configuration was described. The SUVmax cutoff of PSMA-PET, choline-PET and FDG-PET was determined by ROC curve analysis to differentiate ganglia from LNM. Results 329 PSMA-positive ganglia were identified in 120 patients, 95 choline-positive ganglia were identified in 39 patients, and 39 FDG-positive ganglia were identified in 34 patients. PSMA-positive uptake was observed in 98.3%, 95.8%, and 80.0% of cervical, coeliac, and sacral ganglia, respectively. Choline-positive uptake was observed in 84.6%, 97.4%, and 61.5% of cervical, coeliac, and sacral ganglia, respectively. FDG-positive uptake was observed in 16.7%, 13.3%, and 2.5% of cervical, coeliac, and sacral ganglia, respectively. Cervical and coeliac ganglia had a higher rate of PSMA-positive uptake than sacral ganglia. Choline uptake was highest in coeliac ganglia followed by cervical and sacral ganglia. PSMA, choline or FDG uptake in LNM was all significantly higher than ganglia. ROC curve analysis revealed that at a 4.1 SUVmax cutoff of PSMA-PET, the sensitivity, specificity and accuracy of LNM identification was 88.4%, 97.9% and 96.2%, respectively. ROC curve analysis revealed that at a 2.35 SUVmax cutoff for choline-PET, the sensitivity, specificity, and accuracy of LNM identification was 95.0%, 92.6% and 93.0%, respectively. ROC curve analysis revealed that at a 2.55 SUVmax cutoff for FDG-PET, the sensitivity, specificity, and accuracy of LNM identification was 77.3%, 87.2%, and 81.9%, respectively. PSMA-, Choline- and FDG-positive ganglia are mainly band-shaped; most LNMs exhibited nodular and teardrop-shaped configuration. Conclusion 68Ga-PSMA and 11C-choline uptake in ganglia was common, and FDG-positive ganglia were observed at lower frequency. Using 68Ga-PSMA, 11C-choline and 18F-FDG uptake and anatomic location and configuration, the differentiation of ganglia from adjacent LNM is feasible.
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Affiliation(s)
- Yiping Shi
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Guo Wu
- Department of Nuclear Medicine, Second Affiliated Hospital, Nanchang University, Nanchang, China
| | - Lian Xu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yining Wang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Gan Huang
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jianjun Liu
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruohua Chen
- Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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25
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Has Simsek D, Kuyumcu S, Karadogan S, Oflas M, Isik EG, Ozkan ZG, Paksoy N, Ekmekcioglu O, Ekenel M, Sanli Y. Can PSMA-based tumor burden predict response to docetaxel treatment in metastatic castration-resistant prostate cancer? Ann Nucl Med 2021; 35:680-90. [PMID: 33783752 DOI: 10.1007/s12149-021-01610-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We investigated the role of PSMA-derived tumor burden in predicting docetaxel (DTX) therapy response in metastatic castration-resistant prostate cancer (mCRPC). METHODS Fifty-two mCRPC patients who received at least six cycles of DTX as the first-line treatment following 68Ga-PSMA PET/CT were enrolled in this retrospective study. Total PSMA-derived tumor volume (TV-PSMA) and total lesion PSMA activity (TL-PSMA) were derived from metastatic lesions. A ≥ 50% decline in PSA was defined as a response; a ≥ 25% increase in PSA was defined as progression. Univariate/multivariate logistic and cox regression analyses were performed to predict PSA response, OS, and TTP. RESULTS Twelve (23%) patients had PSA progression after chemotherapy, while 40 patients (77%) achieved a PSA response. On univariate analysis, a significant association was found between TV-PSMA (p = 0.001), TL-PSMA (p = 0.001), pre-PSA (p = 0.012), LDH (p = 0.003), Hg (p = 0.035), and PSA response to DTX. High TV-PSMA (> 107 cm3) (p = 0.04) and high LDH (> 234 U/L) (p = 0.017) were 8.2 times and 12.2 times more likely for DTX failure in multivariate regression analyses. The median TTP was 16 months, and the median OS was not reached. Patients with high TV-PSMA (p = 0.017), high TL-PSMA (> 1013 cm3) (p = 0.042), high age (> 70 years) (p = 0.016), and high LDH (p ≤ 0.001) had significantly shorter OS, while only high TV-PSMA (p = 0.038) and high age (p = 0.006) were significantly related with shorter TTP. High TV-PSMA (p = 0.017) and high age (p = 0.01) were significant predictors for shorter OS, while only high age (p = 0.006) was a significant predictor for shorter TTP in multivariate analysis. CONCLUSION Patients with high TV-PSMA had a significantly higher risk for DTX failure. PSMA-based tumor burden prior to DTX therapy seems to be a reliable predictive tool for survival in mCRPC patients.
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Tuncel M, Telli T, Tuncalı MÇ, Karabulut E. Predictive factors of tumor sink effect: Insights from 177Lu-Prostate-specific membrane antigen therapy. Ann Nucl Med 2021; 35:529-539. [PMID: 33586096 DOI: 10.1007/s12149-021-01593-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 01/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Tumor sink effect (TSE) has been defined as; decreased uptake in healthy tissue with increased tumor sequestration of the radiopharmaceuticals. It enables us to give high tumoral radiation doses while resulting in lower absorbed radiation to critical organs. However, the factors which influence this effect are yet to be defined. In this study, we have investigated the predictive factors of the tumor sink effect in a group of patients who received 177Lu-Prostate-specific membrane antigen (PSMA) therapy due to progressive metastatic castration-resistant prostate cancer (mCRPC). METHODS We have retrospectively analyzed the pre-therapy 68Ga-PSMA positron-emission tomography (PET)-computed tomography (CT) and post-therapy planar whole-body scans of 65 patients who received at least two cycles of 7.4 GBq of 177Lu-PSMA therapy. All patients with mCRPC were referred to our department after multiple treatment lines. Age, previous therapies, International Society of Urological Pathology (ISUP) score, and pre-therapy serum tumor marker levels were recorded. Post 177Lu-PSMA therapy images were analyzed for TSE. 68Ga-PSMA PET-CT images were used for the calculation of SUVmax in malignant and healthy tissues as well as metabolic tumor volume (MTV) and total lesion PSMA index (TLPI). RESULTS Based on the post-therapy scans, TSE was seen in 17/65 (26.2%) patients. In univariate analysis, patients with TSE had higher pre-therapy PSA, PSA velocity, and ALP (p < 0.0001). In relation to PET parameters, patients with TSE had higher 68Ga-PSMA MTV, 68Ga-PSMA TLPI and lower pretherapy renal SUVmax (p < 0.0001)), pretherapy liver SUVmax (p:0.012), pretherapy parotid gland SUVmax (p:0.032), and pretherapy parotid gland SUVmean (p:0.038). In the multivariant analysis, 68Ga-PSMA TLPI, pre-therapy PSA, and PSA velocity were found to be statistically significant. When analyzed according to Youden index, pretherapy PSA level of 133 ng/ml (sensitivity 0.765 and 0.875), PSA velocity of 246 ng/ml/year (sensitivity 0.765 and 0.833), and 68Ga-PSMA TLPI of 2969 g (sensitivity 0.765 and 0.875) was found to be the best cut-off points to predict TSE. CONCLUSION The tumor sink effect was seen in 26.2% of patients. 68Ga- PSMA TLPI, pre-therapy PSA, and PSA velocity was found to be the predictors of TSE. Accurate prediction of TSE may lead to increased tumoral doses while sparing healthy organs. Clinical trials that consider this effect as a part of a dose algorithm may further increase therapeutic efficacy.
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Affiliation(s)
- Murat Tuncel
- Faculty of Medicine, Department of Nuclear Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| | - Tuğçe Telli
- Faculty of Medicine, Department of Nuclear Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Meltem Çağlar Tuncalı
- Faculty of Medicine, Department of Nuclear Medicine, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
| | - Erdem Karabulut
- Faculty of Medicine, Department of Biostatistics, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey
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Kesler M, Druckmann I, Levine C, Kuten J, Yossepowitch O, Even-Sapir E. 68Ga-PSMA-11 PET/CT Follow-Up of Patients with Prostate Cancer with Bone Metastases Who Had Reduced Bone Density after Androgen Deprivation Therapy. Diagnostics (Basel) 2021; 11:diagnostics11020277. [PMID: 33578990 PMCID: PMC7916801 DOI: 10.3390/diagnostics11020277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 11/28/2022] Open
Abstract
Bone metastases from prostate cancer (PCa) often show an increase in density on computed tomography (CT) after successful androgen deprivation therapy (ADT). Density may be reduced, however, as the disease progresses or, contrarily, when disease is no longer active. The current study investigated the role of 68Ga-PSMA-11 positron emission tomography/computed tomography (PET/CT) in differentiating between these two conditions. Methods: The study cohort included 15 PCa patients with sclerotic/blastic bone metastasis in whom reduction in bone density of metastasis was noted on follow-up 68Ga-PSMA-11 PET/CT after ADT. Each patient had two PET/CT scans. Prior to the first scan, six patients were castration naïve and nine patients were already treated. All patients had ADT between the two PET/CT scans. PET parameters (SUVmax and tumor-to-background ratio), and CT parameters (HUmax) were determined and compared for each lesion on both scans. Patient’s response was based on prostate-specific antigen (PSA) levels and appearance of new lesions. The Kolmogorov–Smirnov test was used to evaluate normal distribution of the continuous variables. Results: Post-ADT reduction in bone density was identified in 37 lesions. The mean HUmax was 883.9 ± 175.1 on the first scan and 395.6 ± 157.1 on the second scan (p < 0.001). Twenty-one of the 37 lesions showed no increased tracer uptake on the second PET/CT scan raising the likelihood of a response. The other 16 lesions were associated with increased uptake suggestive of an active resistant disease. Bone density was not different in lesions that no longer showed an increased uptake as compared with those that did. Seven of the study patients responded to therapy, and none of the 16 lesions found in these patients showed increased 68Ga-PSMA-11 uptake. In eight patients with progressive disease, all 12 lesions in five of them showed increased 68Ga-PSMA-11 uptake, there was mixed response in two patients (having two lesions with increased uptake and one without) and although all three lesions no longer showed an increased uptake, new lesions were detected in the eighth patient. Conclusion: A decrease in density of bone lesions may reflect clinical progression, or contrarily, a response to therapy in patients with PCa and skeletal involvement treated with ADT. Uptake of 68Ga-PSMA-11 may separate between these two vastly opposing conditions.
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Affiliation(s)
- Mikhail Kesler
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (M.K.); (C.L.); (J.K.)
| | - Ido Druckmann
- Department of Radiology—Musculoskeletal Imaging Unit, Imaging Division, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
| | - Charles Levine
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (M.K.); (C.L.); (J.K.)
| | - Jonathan Kuten
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (M.K.); (C.L.); (J.K.)
| | - Ofer Yossepowitch
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv 6423906, Israel;
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, 6 Weizmann St., Tel Aviv 6423906, Israel; (M.K.); (C.L.); (J.K.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence:
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Chen R, Wang Y, Shi Y, Zhu Y, Xu L, Huang G, Liu J. Diagnostic value of 18F-FDG PET/CT in patients with biochemical recurrent prostate cancer and negative 68Ga-PSMA PET/CT. Eur J Nucl Med Mol Imaging 2021; 48:2970-7. [PMID: 33528607 DOI: 10.1007/s00259-021-05221-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/25/2021] [Indexed: 01/23/2023]
Abstract
PURPOSE 68Ga-PSMA PET/CT has a high detection rate in prostate cancer patients with biochemical recurrence (BCR). However, few studies have reported other imaging methods for BCR with negative 68Ga-PSMA PET/CT findings. We investigated the value of 18F-FDG compared with 68Ga-PSMA and identified BCR patients with 68Ga-PSMA-negative findings who are most likely to benefit from 18F-FDG PET/CT. METHODS Seventy-two BCR patients with negative 68Ga-PSMA PET/CT findings were retrospectively identified from 510 patients who underwent concomitant 68Ga-PSMA and 18F-FDG PET/CT between June 2018 and August 2020. Patients were categorised into groups with positive or negative 18F-FDG PET/CT findings. Differences in patients' characteristics between these two groups and predictors of positive 18F-FDG findings were analysed. RESULTS The detection rate of 18F-FDG PET/CT was 16.7% (12/72) in BCR patients with 68Ga-PSMA-negative findings. PSA and Gleason score were significantly higher in the 18F-FDG-positive group than in the 18F-FDG-negative group (P < 0.001 and P < 0.001, respectively). A multivariate analysis indicated that PSA (PSA ≥2.3 ng/mL) and Gleason score (Gleason score ≥ 8) correlated with 18F-FDG-positive findings (P < 0.001 and P = 0.015, respectively). The probabilities of 18F-FDG-positive findings in the low-potential (PSA <2.3 ng/mL and Gleason score <8), moderate-potential (PSA <2.3 ng/mL and Gleason score ≥ 8 or PSA ≥2.3 ng/mL and Gleason score <8), and high-potential (PSA ≥2.3 ng/mL and Gleason score ≥ 8) groups were 0%, 11.5%, and 90.0%, respectively (P < 0.001). CONCLUSION PSA level and Gleason score are independent predictors of 18F-FDG-positive findings, and BCR patients with 68Ga-PSMA-negative findings with high PSA and Gleason score are most likely to benefit from 18F-FDG PET/CT.
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Arslan E, Aksoy T, Cin M, Çakır C, Can Trabulus FD, Çermik TF. 68Ga PSMA Uptake at Roux-en-Y Eso-jejunostomy Junction Mimicking the Recurrence of Gastric Carcinoma in PET/CT. Mol Imaging Radionucl Ther 2021; 30:63-66. [PMID: 33586413 PMCID: PMC7885274 DOI: 10.4274/mirt.galenos.2020.86729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
A 67-year-old male patient had undergone total gastrectomy and Roux-en-Y eso-jejunostomy 3 years ago for the treatment of tubular adenocarcinoma located at the corpus of the stomach. The patient was diagnosed with Gleason score 8 (4+4) metastatic prostate cancer during the follow-up period and received hormone therapy. Owing to his elevated prostate-specific antigen levels (77 ng/mL), his clinician referred him gallium-68 (68Ga) prostate-specific membrane antigen 11 (PSMA) positron emission tomography/computed tomography (PET/CT) for restaging. PET/CT showed multiple 68Ga PSMA receptor-positive skeletal lesions and linear PSMA activity at the eso-jejunostomy junction. He was then referred to undergo 18fluorine-fluorodeoxyglucose (18F-FDG) PET/CT to screen for gastric carcinoma recurrence. PET/CT images demonstrated no 18F-FDG avid lesion. However, endoscopy and biopsy performed with samples from the eso-jejunostomy junction revealed superficial benign squamous epithelial fragments.
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Affiliation(s)
- Esra Arslan
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tamer Aksoy
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Merve Cin
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Department of Pathology, İstanbul, Turkey
| | - Coşkun Çakır
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Surgery, Istanbul, Turkey
| | - Fadime Didem Can Trabulus
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Surgery, Istanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health and Sciences Turkey, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Santos A, Mattiolli A, Carvalheira JB, Ferreira U, Camacho M, Silva C, Costa F, Matheus W, Lima M, Etchebehere E. PSMA whole-body tumor burden in primary staging and biochemical recurrence of prostate cancer. Eur J Nucl Med Mol Imaging 2021; 48:493-500. [PMID: 32789680 DOI: 10.1007/s00259-020-04981-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/27/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to evaluate whether 68Ga-PSMA PET/CT whole-body tumor burden (PSMAwbtb) is associated with clinical parameters and laboratory parameters in prostate cancer patients. METHODS We retrospectively evaluated prostate cancer patients submitted to PSMA PET/CT for primary staging purposes or due to biochemical recurrence (BR). PSMAwbtb metrics (total volume of PSMA-avid tumor (PSMA-TV)) and total uptake of PSMA-avid lesions (PSMA-TL) were calculated semi-automatically. Spearman's rank correlations between PSMAwbtb metrics and clinical, laboratory parameters (age, time-to-BR, years of diagnosis of prostate cancer, free and total serum PSA levels, and the Gleason score) and with the highest SUVmax of a lesion (hSUVmax) were analyzed. RESULTS Among the 257 PSMA PET/CT studies, there were 46 scans (17.9%) performed for primary staging and 211 (82.1%) for BR. PSMA-TV and PSMA-TL were calculated for the 157 positive scans (58.8%), which were 43 patients (93.5%) in the primary staging group and 114 patients (54.0%) in the BR group. In the primary staging group, we observed a significant correlation between PSMA-TL and hSUVmax (p = 0.0021). In the BR group, there was a significant direct correlation between PSMA-TL and the variables age (p = 0.0031), total serum PSA values (p = < 0.0001), free serum PSA values (p = < 0.0001), and the hSUVmax (p = < 0.0001). Similar results were obtained for PSMA-TV. CONCLUSION PSMAwbtb has a direct and positive correlation with serum PSA values and age in prostate cancer patients with BR.
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Affiliation(s)
- Allan Santos
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil
| | | | - José Bc Carvalheira
- Division of Oncology of the Department of Internal Medicine, Campinas State University (UNICAMP), Campinas, Brazil
| | - Ubirajara Ferreira
- Division of Urology of the Department of Surgery, Campinas State University (UNICAMP), Campinas, Brazil
| | | | - Cleide Silva
- Department of Biostatistics, Campinas State University (UNICAMP), Campinas, Brazil
| | | | - Wagner Matheus
- Division of Urology of the Department of Surgery, Campinas State University (UNICAMP), Campinas, Brazil
| | - Mariana Lima
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil
| | - Elba Etchebehere
- Medicina Nuclear de Campinas, Campinas, São Paulo, Brazil.
- Division of Nuclear Medicine of the Department of Radiology, Campinas State University (UNICAMP), Rua Vital Brazil 251, Campinas, 13083-888, Brazil.
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Diao W, Cao Y, Su D, Jia Z. Impact of 68 Gallium prostate-specific membrane antigen tracers on the management of patients with prostate cancer who experience biochemical recurrence. BJU Int 2020; 127:153-163. [PMID: 32979229 DOI: 10.1111/bju.15257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the impact of 68 Gallium prostate-specific membrane antigen (68 Ga-PSMA) tracers on the management of prostate cancer (PCa) patients with biochemical recurrence (BCR) by conducting a systematical review and meta-analysis. MATERIALS AND METHODS We performed a literature search of the PubMed, Embase and Web of Science databases up to 29 October 2019. We included studies that reported the proportion of patients whose management changed after 68 Ga-PSMA tracers were used in patients with BCR. We used the Quality Assessment of Diagnostic Accuracy Studies-2 tool to evaluate the quality of the included studies. The proportion of patients with management changes were pooled using a random-effects model. Subgroup analyses and meta-regression analyses were performed to explore the source of heterogeneity. A Sankey diagram was used to show treatment change from before to after the use of 68 Ga-PSMA tracers. RESULTS We included 20 eligible studies (2026 patients). The pooled proportion of patients with management change was 53% (95% confidence interval [CI] 46-60) in patients with BCR and 51% (95% CI, 34-67) in patients with early BCR (prostate-specific antigen [PSA] <0.5 ng/mL). The pooled positron-emission tomography-positive rate in patients with BCR was 68% (95% CI 59-78). Fourteen studies reported management change, with most changes being intermodal in nature (42%, vs 17% intramodal change). CONCLUSIONS The use of 68 Ga-PSMA tracers altered the management of more than half of PCa patients with BCR, including those with early BCR. 68 Ga-PSMA tracers might be used to guide individualized treatment in patients with BCR, particularly those with early BCR.
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Affiliation(s)
- Wei Diao
- Department of Nuclear Medicine, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yuan Cao
- Department of Nuclear Medicine, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Dunyan Su
- Huaxi MR Research Centre, Department of Radiology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Zhiyun Jia
- Department of Nuclear Medicine, and National Clinical Research Center for Geriatrics, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
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Abstract
We have reported here the case of a 69-year-old man who presented with spinal cord compression due to bone metastases as the first manifestation of hepatocellular carcinoma (HCC). For the initial staging, the patient underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) imaging, which demonstrated mild 18F-FDG uptake in the multiple expansile osteolytic bone lesions, but no remarkable atypical 18F-FDG uptake in the liver lesion on low-doses CT. An additional PET/CT scan was performed to evaluate the prostate-specific membrane antigen (PSMA) expression, which has recently been reported to be a potential biological marker in a variety of tumors including HCC. High PSMA uptake was recorded in both the metastatic bone lesions and the primary liver lesion/tumor by the 68Ga-PSMA PET/CT.
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Affiliation(s)
- Seval Erhamamcı
- Başkent University Faculty of Medicine, Ankara; Başkent University İstanbul Hospital, Department of Nuclear Medicine, İstanbul, Turkey
| | - Nesri Aslan
- Neolife Medical Center, Clinic of Nuclear Medicine, İstanbul, Turkey
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Sarikaya I, Alqallaf A, Sarikaya A. Renal Cortical 68Ga-PSMA-11 PET and 99mTc-DMSA Images. J Nucl Med Technol 2020; 49:30-33. [PMID: 32887764 DOI: 10.2967/jnmt.120.248922] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
68Ga-prostate-specific membrane antigen (PSMA) ligands are novel PET radiotracers for prostate cancer. These radiotracers also localize in the normal renal cortex to a high degree and can demonstrate parenchymal defects. We recently started a prospective research study to compare 68Ga-PSMA-11 PET/CT with 99mTc-dimercaptosuccinic acid (DMSA) scan in adults with pyelonephritis. Here, we present a side-by-side comparison of renal cortical PSMA PET/CT and DMSA images of an adult patient with chronic recurring pyelonephritis. Methods: Our prospective study was approved by the Ethical Committees. DMSA images (multiple planar and SPECT) were obtained 3 h after intravenous injection of 111 MBq (3 mCi) of 99mTc-DMSA. On a separate day, we obtained PET/CT images of the kidneys 60 min after intravenous injection of 74 MBq (2 mCi) of 68Ga-PSMA-11 after the patient provided written informed consent. Results: The patient was a 46-y-old woman with history of chronic recurring pyelonephritis. Both DMSA scan and PSMA PET/CT demonstrated slight cortical thinning with mildly reduced uptake in the upper pole of the right kidney, with no significant cortical defects. There was an excellent distribution of activity in the renal cortex and better image resolution with PSMA PET than with DMSA scan. Non-attenuation-corrected PSMA PET images also showed the same findings, with reasonable image quality. Conclusion: In our first case, 68Ga-PSMA-11 PET imaging provided promising results in an adult patient with pyelonephritis. The results of our prospective study on a larger number of adult patients will provide a more accurate comparison of 68Ga-PSMA-11 PET to 99mTc-DMSA scanning in pyelonephritis.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Ahmed Alqallaf
- Department of Medicine, Division of Nephrology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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Medina-Ornelas S, García-Perez F, Estrada-Lobato E, Ochoa-Carrillo F. 68Ga-PSMA PET/CT in the evaluation of locally advanced and metastatic breast cancer, a single center experience. Am J Nucl Med Mol Imaging 2020; 10:135-142. [PMID: 32704404 PMCID: PMC7364382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 05/24/2020] [Indexed: 06/11/2023]
Abstract
Current research indicates that prostate-specific membrane antigen (PSMA) is related to angiogenesis of many solid tumors including breast cancer (BC), our objective is evaluating PSMA expression in primary tumor and metastatic BC by Positron emission tomography/computed tomography (PET/CT). In this retrospective study twenty-one patients with BC included all molecular subtypes, was evaluated with 18F-FDG-PET/CT imaging as stratification and 68Ga-PSMA-PET/CT. Primary sites of BC was identifying in all patients with 18F-FDG-PET/CT. We identified lymph node metastases in 17 patients (81%) and metastatic disease in 15 patients (71%). A total 127 lesions were detected by 18F-FDG-PET/CT, 30 of which were in the breast, 31 axillary lymph-node metastases, 25 mediastinal lymph-node metastases, 15 distant non-bone metastases and 26 bone metastases. 68Ga-PSMA-11-PET/CT showed lower detection-rate (DRs) than did 18F-FDG-PET/CT in all patients with LUM-A and LUM-B HER2. All 18F-FDG PET/CT positive lesions in patients TPN (local, lymph nodes, and metastatic lesions) showed 68Ga-PSMA-PET/CT uptake (P<0.05). Sensitivities and specificities of 99.2% and 93.6% for 18F-FDG-PET/CT and for 68Ga-PSMA-11-PET/CT of 84% and 91.8% (P<0.05). Accuracy measured as AUC was 0.86-0.95 in 18F-FDG-PET/CT and 0.74-0.94 for 68Ga-PSMA-PET/CT (P<0.05). In Patient-Based analysis we found that patients triple-negative subtype (TPN) evaluated with 68Ga-PSMA-PET/CT identified a higher number of positive patients than did LUM A. We conclude that a significate DRs to imaging with 68Ga-PSMA-PET/CT in the staging of locally advanced and metastatic BC with high rates in patients TPN, LUM B HER2+ and HER2 overexpression. We believe that concept of theranostics it may be considered as a potential diagnostic and therapeutic target.
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Affiliation(s)
- Sevastian Medina-Ornelas
- Departament of Nuclear Medicine and Molecular Imaging, Instituto Nacional de CancerologíaMexico City, Mexico
| | - Franciso García-Perez
- Departament of Nuclear Medicine and Molecular Imaging, Instituto Nacional de CancerologíaMexico City, Mexico
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Sanchez S, Currie GM. Topical Sensor for the Assessment of PET Dose Administration: Metric Performance with an Autoinjector. J Nucl Med Technol 2020; 48:363-371. [PMID: 32518121 DOI: 10.2967/jnmt.120.245043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/16/2020] [Indexed: 12/22/2022] Open
Abstract
Extravasation or partial extravasation of the radiopharmaceutical dose in PET can undermine SUV and image quality. A topical sensor has been validated using several metrics to characterize injection quality after manual injection. The performance of these metrics for autoinjector administration has been assessed. Methods: A single PET/CT scanner at a single site was used to characterize injections using an autoinjector with standardized apparatus, flush volume, and infusion rate (1-min infusion followed by 2 syringe flushes) for 18F-FDG, 68Ga-prostate-specific membrane antigen, and 68Ga-DOTATATE. In total, 296 patients with topical application of sensors were retrospectively analyzed using conventional statistical analysis and an artificial neural network. Results: Partial extravasation was noted in 1.3% of studies, with 9.1% (inclusive of partial extravasation) identified to have an injection anomaly (e.g., venous retention). Extravasation was independently predicted by the time that elapsed as the counts recorded by the injection sensor fell from the maximum value to within 200% of the reference sensor counts greater than 1,200 s; as the difference in counts for injection and reference sensors, normalized by dose, from 4 min after injection greater than 25; and as the ratio of the average counts per second recorded by the injection sensor at the end of a monitoring period to those of the reference sensor greater than 2. Conclusion: Extravasation and partial extravasation of PET doses are readily detected and differentiated using time-activity curve metrics. The metrics can provide the insight that could inform image quality or SUV accuracy issues. Further validation of key metrics is recommended in a larger and more diverse cohort.
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Affiliation(s)
- Stephanie Sanchez
- Faculty of Science, Charles Sturt University, Port Macquarie, Australia; and
| | - Geoffrey M Currie
- Faculty of Science, Charles Sturt University, Wagga Wagga, Australia
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36
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Klingenberg S, Jochumsen MR, Ulhøi BP, Fredsøe J, Sørensen KD, Borre M, Bouchelouche K. 68Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer. J Nucl Med 2020; 62:214-220. [PMID: 32444374 DOI: 10.2967/jnumed.120.245605] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
With the largest high-risk prostate cancer (PCa) cohort to date undergoing 68Ga-prostate-specific membrane antigen (PSMA) PET/CT primary staging, we aimed to, first, characterize the metastatic spread of PCa in relation to tumor 68Ga-PSMA uptake and the D'Amico classification and, second, compare 68Ga-PSMA PET/CT findings with radical prostatectomy and pelvic lymph node dissection (PLND) histopathology findings. Methods: The study included 691 consecutive newly diagnosed, biopsy-proven, treatment-naïve, D'Amico high-risk PCa patients primary-staged by 68Ga-PSMA PET/CT. PSMA SUVmax and metastatic findings were compared with prostate-specific antigen level, International Society of Urological Pathology (ISUP) grade, and clinical stage as traditional risk stratification parameters. Moreover, 68Ga-PSMA PET/CT findings were compared with histology findings in radical prostatectomy patients undergoing PLND. Undetected lymph node metastases (LNMs) underwent immunohistochemical PSMA staining. Results: Advanced disease (N1/M1) was observed in 35.3% of patients (244/691) and was associated with increasing prostate-specific antigen level, ISUP grade, and clinical stage. LNMs (N1/M1a) were detected in 31.4% (217/691) and bone metastases (M1b) in 16.8% (116/691). Advanced disease frequencies in patients with ISUP grades 2 and 3 were 10.8% (11/102) and 37.1% (33/89), respectively. Risk of advanced disease for cT2a, cT2b, and cT2c tumors was almost equal (24.2%, 27.9%, and 22.4%, respectively). We observed a weak correlation between SUVmax and biopsy ISUP grade (ρ = 0.21; P < 0.001) and a modest correlation between SUVmax and postprostatectomy ISUP grade (ρ = 0.38; P < 0.001). Sensitivity, specificity, positive and negative predictive value, and accuracy for LNM detection on 68Ga-PSMA PET/CT in the PLND cohort were 30.6%, 96.5%, 68.8%, 84.5%, and 83.1%, respectively. Undetected LNMs either were micrometastases located in the lymph node border or were without PSMA expression. Conclusion: In this high-risk PCa cohort, we identified advanced disease in about one third at diagnosis. ISUP grade was the superior predictor for advanced disease at diagnosis. We found a significant difference in frequency of advanced disease between ISUP grades 2 and 3, as supports the Gleason score 7 subdivision. Interestingly, we observed no significant differences in risk of advanced disease when comparing the different cT2 stages. The undetected LNMs were either PSMA-negative or micrometastases.
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Affiliation(s)
- Søren Klingenberg
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mads R Jochumsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Benedicte P Ulhøi
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Jacob Fredsøe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karina D Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Radzina M, Tirane M, Roznere L, Zemniece L, Dronka L, Kalnina M, Mamis E, Biederer J, Lietuvietis V, Freimanis A, Vjaters E. Accuracy of 68Ga-PSMA-11 PET/CT and multiparametric MRI for the detection of local tumor and lymph node metastases in early biochemical recurrence of prostate cancer. Am J Nucl Med Mol Imaging 2020; 10:106-118. [PMID: 32419979 PMCID: PMC7218697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 04/01/2020] [Indexed: 06/11/2023]
Abstract
Anatomical and functional imaging plays a decisive role for detection and staging, of prostate cancer both primarily and post-treatment. While multiparametric MRI offers anatomic imaging with excellent soft tissue contrast, hybrid imaging based on positron emission tomography in combination with computed tomography (PET/CT) contributes functional imaging capacities. Since 68Ga-PSMA-11 was expected to be more efficient than the prior Choline-based PET radiotracers, it was the aim of the study to evaluate the diagnostic performance of the 68Ga-PSMA-11 PET/CT and multiparametric MRI in patients with recurrent prostate cancer and low PSA levels. 32 out of a cohort of 128 prostate cancer patients with biochemical relapse were referred for 68Ga-PSMA-11 PET/CT, MRI and bone scintigraphy. According to the histopathologically or clinically defined reference standard all results were classified as true positive, false positive, true negative or false negative. Local recurrence was present in 11/32 patients, lymph node metastases - in 13/32 patients and, bone metastases - in 6/32 patients. Against the standard of reference, sensitivity, specificity and accuracy for local recurrence of PET/CT were 63.6 %; 73.7%; 77.8%, respectively. MRI reached 90.9%; 94.7%; 92.3%, respectively. For local lymph node metastases PET/CT - 83.3%; 80.0% and 90.6%, respectively. MRI - 41.7%; 94.4%; 72.0%, respectively. For evaluation of bone metastases in PET/CT - 83.3%; 92.0%; 71.0%, respectively. Bone scintigraphy - 50.0%; 84.0%; 77.4%, respectively. In conclusion, mpMRI offered the better diagnostic accuracy in the detection of local recurrence and while PSMA PET/CT was superior in the detection of distant and lymph node metastases.
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Affiliation(s)
- Maija Radzina
- Riga Stradins University, Radiology Research LaboratoryRiga, Latvia
| | - Mara Tirane
- Riga Stradins University, Radiology Research LaboratoryRiga, Latvia
| | - Lilita Roznere
- Riga Stradins University, Radiology Research LaboratoryRiga, Latvia
| | - Liene Zemniece
- Riga Stradins University, Radiology Research LaboratoryRiga, Latvia
| | - Laura Dronka
- Riga Stradins University, Radiology Research LaboratoryRiga, Latvia
| | - Marika Kalnina
- Riga Stradins University Nuclear Medicine ClinicRiga, Latvia
| | - Edgars Mamis
- Riga Stradins University Nuclear Medicine ClinicRiga, Latvia
| | - Juergen Biederer
- University of LatviaRiga, Latvia
- Department of Diagnostic and Interventional Radiology, University Hospital of HeidelbergHeidelberg, Germany
| | | | - Arvis Freimanis
- Center of Urology, Riga East University HospitalRiga, Latvia
| | - Egils Vjaters
- Center of Urology, Pauls Stradins Clinical University HospitalRiga, Latvia
- University of LatviaRiga, Latvia
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Wielaard J, Habraken JBA, Brinks P, Lavalaye J, Boellaard R. Optimization of injected 68Ga-PSMA activity based on list-mode phantom data and clinical validation. EJNMMI Phys 2020; 7:20. [PMID: 32297142 DOI: 10.1186/s40658-020-00289-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/23/2020] [Indexed: 12/20/2022] Open
Abstract
Optimization of injected gallium-68 (68Ga) activity for 68Ga-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) studies is relevant for image quality, radiation protection, and from an economic point of view. However, no clear guidelines are available for 68Ga-PSMA studies. Therefore, a phantom study is performed to determine the highest coefficient of variation (COV) acceptable for reliable image interpretation and quantification. To evaluate image interpretation, the relationship of COV and contrast-to-noise ratio (CNR) was studied. The CNR should remain larger than five, according to the Rose criterion. To evaluate image quantification, the effect of COV on the percentage difference (PD) between quantification results of two studies was analyzed. Comparison was done by calculating the PD of the SUVmax. The maximum allowable PDSUVmax was set at 20%. The highest COV at which both criteria are still met is defined as COVmax. Of the NEMA Image Quality phantom, a 20 min/bed (2 bed positions) scan was acquired in list-mode PET (Philips Gemini TF PET/CT). The spheres to background activity ratio was approximately 9:1. To obtain images with different COV, lower activity was mimicked by reconstructions with acquisition times of 10 min/bed to 5 s/bed. Pairs of images were obtained by reconstruction of two non-overlapping parts of list-mode data. For the 10-mm diameter sphere, a COV of 25% still meets the criteria of CNRSUVmean ≥ 5 and PDSUVmax ≤ 20%. This phantom scan was acquired with an acquisition time of 116 s and a background activity concentration of 0.71 MBq/kg. Translation to a clinical protocol results in a clinical activity regimen of 3.5 MBq/kg min at injection. To verify this activity regimen, 15 patients (6 MBq/kg min) with a total of 22 lesions are included. Additional reconstructions were made to mimic the proposed activity regimen. Based on the CNRSUVmax, no lesions were missed with this proposed activity regimen. For our institution, a clinical activity regimen of 3.5 MBq/kg min at injection is acceptable, which indicates that activity can be reduced by almost 50% compared with the current code of practice. Our proposed method could be used to obtain an objective activity regimen for other PET/CT systems and tracers.
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Luiting HB, van Leeuwen PJ, Remmers S, Donswijk M, Busstra MB, Bakker IL, Brabander T, Stokkel M, van der Poel HG, Roobol MJ. Optimal Timing of Prostate Specific Membrane Antigen Positron Emission Tomography/Computerized Tomography for Biochemical Recurrence after Radical Prostatectomy. J Urol 2020; 204:503-10. [PMID: 32149575 DOI: 10.1097/JU.0000000000001012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We developed a model predicting the probability of detecting prostate cancer recurrence outside the prostatic fossa on prostate specific membrane antigen positron emission tomography/computerized tomography in patients with biochemical recurrence after radical prostatectomy. MATERIALS AND METHODS We retrospectively included 419 consecutive patients with biochemical recurrence (prostate specific antigen less than 2.0 ng/ml) after radical prostatectomy who underwent 68Ga-prostate specific membrane antigen-11 positron emission tomography/computerized tomography to guide salvage therapy. Patients receiving androgen deprivation therapy between radical prostatectomy and prostate specific membrane antigen positron emission tomography/computerized tomography were excluded from the study. We used multivariable logistic regression to assess predictors for the detection of prostate cancer recurrence outside the prostatic fossa on prostate specific membrane antigen positron emission tomography/computerized tomography. We minimized overfitting of the model and used decision curve analysis to determine clinical utility. RESULTS Median prostate specific antigen at scanning was 0.40 ng/ml (IQR 0.30-0.70). Overall 174 (42%) patients had prostate cancer recurrence outside the prostatic fossa. Prostate specific antigen at time of scanning, and grade group, N stage and surgical margin status at radical prostatectomy specimen were significant predictors for detecting prostate cancer recurrence outside the prostatic fossa. The bootstrapped AUC of this model was 0.75 (IQR 0.73-0.77). The decision curve analysis showed a net benefit by a model based probability from 16%. Limitations include the retrospective design and the missing histological correlation of positive lesions. CONCLUSIONS Next to the prostate specific antigen at time of scanning, grade group, N stage and surgical margin status at radical prostatectomy specimen are significant predictors for detecting prostate cancer recurrence outside the prostatic fossa on prostate specific membrane antigen positron emission tomography/computerized tomography. The presented model is implemented in a dashboard to assist clinicians in determining the optimal time to perform 68Ga-prostate specific membrane antigen-11 positron emission tomography/computerized tomography in patients with biochemical recurrence after radical prostatectomy.
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Calabria F, Pichler R, Leporace M, Wolfsgruber J, Coscarelli P, Dunzinger A, Schillaci O, Cascini GL, Bagnato A. 68Ga/64Cu PSMA Bio-Distribution in Prostate Cancer Patients: Potential Pitfalls for Different Tracers. Curr Radiopharm 2020; 12:238-246. [PMID: 31113354 DOI: 10.2174/1874471012666190515090755] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/20/2019] [Accepted: 04/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND 68Ga-PSMA is a widely useful PET/CT tracer for prostate cancer imaging. Being a transmembrane protein acting as a glutamate carboxypeptidase enzyme, PSMA is highly expressed in prostate cancer cells. PSMA can also be labeled with 64Cu, offering a longer half-life and different resolution imaging. Several studies documented bio-distribution and pitfalls of 68Ga-PSMA as well as of 64Cu- PSMA. No data are reported on differences between these two variants of PSMA. Our aim was to evaluate physiological distribution of these two tracers and to analyze false positive cases. METHODS We examined tracer bio-distribution in prostate cancer patients with negative 68Ga-PSMA PET/CT (n=20) and negative 64Ga-PSMA PET/CT (n=10). A diagnostic pitfall for each tracer was documented. RESULT Bio-distribution of both tracers was similar, with some differences due to renal excretion of 68Ga- PSMA and biliary excretion of 64Cu-PSMA. 68Ga-PSMA uptake was observed in sarcoidosis while 64Cu- PSMA uptake was recorded in pneumonitis. DISCUSSION Both tracers may present similar bio-distribution in the human body, with similar uptake in exocrine glands and high intestinal uptake. Similarly to other tracers, false positive cases cannot be excluded in clinical practice. CONCLUSION The knowledge of difference in bio-distribution between two tracers may help in interpretation of PET data. Diagnostic pitfalls can be documented, due to the possibility of PSMA uptake in inflammation. Our results are preliminary to future studies comparing diagnostic accuracies of 68Ga-PSMA and 64Cu-PSMA.
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Affiliation(s)
- Ferdinando Calabria
- Department of Nuclear Medicine and Theranostics, National Public Hospital "Mariano Santo", 87100, Cosenza, Italy
| | - Robert Pichler
- Institute of Nuclear Medicine, Kepler University Hospital, Neuromed Campus, Wagner-Jauregg Weg 15, A-4021 Linz, Austria
| | - Mario Leporace
- Department of Nuclear Medicine and Theranostics, National Public Hospital "Mariano Santo", 87100, Cosenza, Italy
| | | | | | - Andreas Dunzinger
- Institute of Nuclear Medicine, Kepler University Hospital, Neuromed Campus, Wagner-Jauregg Weg 15, A-4021 Linz, Austria
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University "Tor Vergata", 00133, Rome, Italy.,IRCCS INM Neuromed, 86077, Pozzilli (IS), Italy
| | - Giuseppe Lucio Cascini
- Department of Diagnostic Imaging, Nuclear Medicine Unit, Magna Graecia University, Catanzaro, Italy
| | - Antonio Bagnato
- Department of Nuclear Medicine and Theranostics, National Public Hospital "Mariano Santo", 87100, Cosenza, Italy
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Sanchez S, Currie GM. Topical Sensor for the Assessment of Injection Quality for 18F-FDG, 68Ga-PSMA and 68Ga-DOTATATE Positron Emission Tomography. J Med Imaging Radiat Sci 2020; 51:247-255. [PMID: 32089515 DOI: 10.1016/j.jmir.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/03/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Calculation of the standard uptake value (SUV) and image quality in positron emission tomography (PET) hinges on accurate dose delivery. Extravasation or partial extravasation of the radiopharmaceutical dose can undermine SUV and image quality, and contribute to unnecessary imaging (time and CT dose). Topical sensor characterisation of injections has been reported, with extravasation rates ranging from 9% to 23% for 18F-FDG after manual injection. METHOD A single site, single PET/CT scanner was used to characterise injections using an autoinjector with standardised apparatus, flush volume and infusion rate using 18F-FDG, 68Ga-PSMA and 68Ga-DOTATATE; more reflective of Australian PET facilities. 296 patients with topical application of LARA sensors were retrospectively analysed. RESULTS Only 1.1% of studies showed evidence of partial dose extravasation. In total, 9.1% were identified to have an injection anomaly (including venous retention). No statistically significant differences were noted across the radiopharmaceuticals for demographic data. Although not demonstrating a statistically significant correlation, there was more extravasated doses associated with female patients (P = .334), right side (P = .372), and hand injections (P = .539). Extravasation was independent of dose administered (P = .495), the radiopharmaceutical (P = .887), who injected the dose (P = .343), height (P = .438), weight (P = .607) or age (P = .716). Extravasation was associated with higher glucose levels (P < .001), higher t-half (P = .019) and higher aUCR10, tc50, aUCR1 and c1 (all P < .001). CONCLUSION Topical monitoring and characterisation of PET dose administration is possible and practical with the LARA device. Extravasation and partial extravasation of PET doses are not only readily detected but they are also preventable. The LARA device can provide the insights into variables that could eliminate extravasation as a cause of image quality or SUV accuracy issues.
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Affiliation(s)
- Stephanie Sanchez
- Faculty of Science, Charles Sturt University, Port Macquarie, Australia
| | - Geoffrey M Currie
- Faculty of Science, Charles Sturt University, Wagga Wagga, Australia.
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Lengana T, Lawal IO, Mokoala K, Vorster M, Sathekge MM. 68Ga-PSMA: a One-stop Shop in Radioactive Iodine Refractory Thyroid Cancer? Nucl Med Mol Imaging 2019; 53:442-445. [PMID: 31867081 DOI: 10.1007/s13139-019-00621-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 10/20/2019] [Accepted: 10/23/2019] [Indexed: 01/25/2023] Open
Abstract
We report a case of a 47-year-old female known with metastatic papillary thyroid cancer. Her treatment history included total thyroidectomy and 3 previous radio ablations with a cumulative dose of 950 mCi of 131I. On follow-up, her thyroglobulin levels had demonstrated a rising trend (from 3789.0 to 4240.0 ug/L) despite a 123I whole-body scan demonstrating a reduction in tracer avid lesions. She was suspected of having radio-resistant disease. The patient underwent both 18F-FDG and 68Ga-PSMA PET/CT imaging with both scans demonstrating congruent lesions however with far greater intensity on the 68Ga-PSMA study.
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Affiliation(s)
- Thabo Lengana
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
| | - Ismaheel O Lawal
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
| | - Kgomotso Mokoala
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria & Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001 South Africa
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Bialek EJ, Malkowski B. The "question-mark" MR anatomy of the cervico-thoracic ganglia complex: can it help to avoid mistaking it for a malignant lesion on 68Ga-PSMA-11 PET/MR? Radiol Oncol 2019; 53:407-14. [PMID: 31652125 DOI: 10.2478/raon-2019-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background Detectable uptake of 68Ga-PSMA-ligands in sympathetic ganglia may potentially lead to mistaking them for malignant lesions. Our aim was to investigate the anatomy of cervico-thoracic-ganglia-complex (CTG-C) in the MR part of multimodal 68Ga-PSMA-11 PET/MR imaging, in view of PET factors hindering its proper identification. Patients and methods In 106 patients, 212 sites of the CTG-C were retrospectively reviewed to assess the radiotracer uptake (SUVmax), size, shape, position, symmetry of location and visual uptake intensity. Asymmetry of PSMA-ligand uptake and increased uptake were regarded as risk factors of malignancy. Results In 66.0% left (L) and 53.8% right (R) CTG-C we noticed configurations, resembling the shape of an exclamation-mark, a question-mark, or its part (called “typical”). Tumor-like CTG-C shapes (oval, binodular or longitudinal) were detected in 28.3% L-CTG-C and in 40.6% R-CTG-C. When visual assessment of PET suggested malignancy, the recognition of “typical” shape of underlying CTG-C on MR generated a rise in the accuracy of their proper identification (from 34.4% to 75%, χ2(1) = 70.4; p < 0.001). Recognizing the shape of the CTG-C as “typical” in MR allowed us to classify as “not-suspicious” 61.9% of all CTG-C which were treated as “suspicious” after sole PET assessment. Conclusions The characteristic shape of cervico-thoracic-ganglia-complex (resembling a question-mark, or its part) helps in proper recognition of CTG-C on multimodal whole-body 68Ga-PSMA-ligand PET/MR imaging, when detectable uptake might lead to considering pathology.
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Rousseau C, Le Thiec M, Ferrer L, Rusu D, Rauscher A, Maucherat B, Frindel M, Baumgartner P, Fleury V, Denis A, Morel A, Varmenot N, Debeaupuis E, Campion L, Kraeber-Bodéré F. Preliminary results of a 68 Ga-PSMA PET/CT prospective study in prostate cancer patients with occult recurrence: Diagnostic performance and impact on therapeutic decision-making. Prostate 2019; 79:1514-1522. [PMID: 31421657 DOI: 10.1002/pros.23869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Abstract
BACKGROUND In this prospective study (NCT03443609), we investigated the impact of 68Ga-PSMA-11 PET-CT on the treatment plan and therapeutic response obtained for patients with prostate cancer (PCa) presenting a recurrence with a low rising PSA. METHODS One hundred thirty hormone-naive (PSA < 1.5 ng/mL) patients were enrolled. All patients received radical treatment. PET images were recorded 1 and 2 hours after injection of tracer and interpreted by two independent nuclear physicians. Six months after treatment ended, a PSA assay was requested to evaluate the therapeutic efficacy of the treatment based on PSMA results. RESULTS Data analysis for the first 52 included patients has been completed. 68Ga-PSMA-11-positive lesions were detected in 38/52 (73.1%) patients. Ninety-four lesions were detected as follows, 53/94 in lymph nodes (56.4%), 25/94 in bone (26.6%), and 12/94 into the prostate bed (12.7%). Detection rates were 58%, 81%, and 82% for serum PSA levels lower than 0.25 ng/mL, between 0.25 to ≤ 0.69 ng/mL and 0.70 ng/mL, respectively. As a result of the PSMA PET-CT, therapeutic management changed in 38/52 patients (73.1%). Patients had undetectable serum PSA levels after treatment guided by 68Ga-PSMA-11 PET-CT results in 10/52 (19.2%) cases and with a PSA decrease of over 60% in 18/52 (34.6%) patients. CONCLUSION Whilst our patient population presented a very low PSA level, preliminary results of the 68Ga-PSMA PET-CT study showed recurrence localization in more than half of the patients and this had a major clinical impact, as it resulted in treatment change in more than half of the patients and a significant decrease in PSA levels in a third of patients.
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Affiliation(s)
- Caroline Rousseau
- Department of Nuclear Medicine, ICO Cancer Center
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
| | | | - Ludovic Ferrer
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Physics, ICO Cancer Center
| | - Daniela Rusu
- Department of Nuclear Medicine, ICO Cancer Center
| | | | | | | | | | | | | | - Agnes Morel
- Department of Nuclear Medicine, ICO Cancer Center
| | - Nicolas Varmenot
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Physics, ICO Cancer Center
| | | | - Loic Campion
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
- Department of Biometrics, ICO Cancer Center, Nantes, France
| | - Francoise Kraeber-Bodéré
- Department of Nuclear Medicine, ICO Cancer Center
- CRCINA, University of Nantes, INSERM UMR1232, CNRS-ERL6001
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Aydin AM, Haberal B, Artykov M, Bilen CY, Yazici S. Clinicopathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer following definitive therapy. Ann Nucl Med 2019; 33:326-332. [PMID: 30778860 DOI: 10.1007/s12149-019-01340-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 01/21/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To demonstrate the effect of clinicopathological factors on 68Ga-PSMA-11 PET/CT positivity at the time of biochemical recurrence (BCR) of localized prostate cancer (PCa) following definitive therapy. METHODS We retrospectively reviewed our institutional database for PCa patients who had BCR and subsequently underwent 68Ga-PSMA-11 PET/CT between April 2014 and February 2018. A total of 51 patients who were metastasis-free before PSMA imaging and previously treated with definitive therapy (radical prostatectomy or external beam radiotherapy) for localized disease (pT1c-T3b pN0-1 cM0) were included. RESULTS 37 out of 51 patients (72.5%) had positive 68Ga-PSMA-11 PET/CT scans. Age at diagnosis, Gleason score (GS), D'Amico risk status of PCa, initial PSA level before treatment and PSA doubling time were not associated with PSMA positivity. Pre-scan PSA levels of > 0.2 ng/ml and PSA velocity of ≥ 1 ng/ml/year were significantly associated with increased PSMA positivity, whereas history of androgen deprivation therapy showed a trend towards significance. The optimal cutoffs for distinguishing between positive and negative scans were ≥ 0.71 ng/ml for pre-scan PSA and ≥ 1.22 ng/ml/yr for PSA velocity. In multivariable analysis, log pre-scan PSA and pre-scan PSA level > 0.2 ng/ml remained significant predictors for PSMA positivity, whereas the association of PSA velocity and of ADT was lost. CONCLUSIONS In BCR of localized PCa following definitive therapy, pre-scan PSA was strongly associated with positive 68Ga-PSMA-11 scan, even at PSA levels ranging from 0.2 to 1.0 ng/ml. Therefore, clinical and pathological predictors of positive 68Ga-PSMA-11 PET/CT in PSA-only recurrence of localized prostate cancer need to be further elucidated.
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Affiliation(s)
- Ahmet Murat Aydin
- Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey
| | - Bahadir Haberal
- Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey
| | - Meylis Artykov
- Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey
| | - Cenk Yucel Bilen
- Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey
| | - Sertac Yazici
- Department of Urology, School of Medicine, Hacettepe University, Sihhiye, Ankara, 06100, Turkey.
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Keidar Z, Gill R, Goshen E, Israel O, Davidson T, Morgulis M, Pirmisashvili N, Ben-Haim S. 68Ga-PSMA PET/CT in prostate cancer patients - patterns of disease, benign findings and pitfalls. Cancer Imaging 2018; 18:39. [PMID: 30382889 PMCID: PMC6211573 DOI: 10.1186/s40644-018-0175-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/22/2018] [Indexed: 12/11/2022] Open
Abstract
Background 68Ga-PSMA PET/CT has an important role in assessment of prostate cancer patients with biochemical recurrence and is evolving in staging high- and intermediate risk disease. The aim of present study was to describe the metastatic patterns and frequency of involved sites of prostate cancer and to assess the incidence of benign Ga68-PSMA avid PET/CT findings in a large patient population. Methods 68Ga-PSMA PET/CT studies performed in two tertiary medical centers over a period of 24 months were retrospectively reviewed. The incidence and location of pathological 68Ga-PSMA avid foci, suspicious to represent malignancy, as well as those of unexpected benign foci of increased 68Ga-PSMA activity were documented and analyzed. Results There were 445 68Ga-PSMA studies in 438 men (mean age 72.4, range 51–92 years) with prostate cancer referred for biochemical failure (n = 270, 61%), staging high-risk disease (n = 112, 25%), response assessment (n = 30, 7%), follow-up (n = 22, 5%) and suspected bone metastases (n = 11, 2%). 68Ga-PSMA avid disease sites were observed in 319 studies (72%), in 181 studies (67%) for biochemical recurrence, 94 studies for staging (84%) (p < 0.05), in 22 studies for response assessment (73%), 10 follow up studies (45%) and in five patients with suspected bone metastases (45%). 68Ga-PSMA avid lesions were most commonly detected in the prostate (n = 193, 43%), loco-regional spread (n = 51, 11%), abdomino-pelvic nodes (n = 129, 29%) and distant metastases (n = 158, 36%), including bone metastases (n = 11, 25%), distant lymphadenopathy (n = 29, 7%) and other organs (n = 18, 4%). Distant 68Ga-PSMA-avid metastases were commonly seen in patients with biochemical recurrence (14/21 lesions), but were not seen in patient referred for staging (p < 0.013). There were 96 non-malignant 68Ga-PSMA avid foci in 81 studies, most common in reactive lymph nodes (n = 36, 38%), nonmalignant bone lesions (n = 21, 22%), thyroid nodules (n = 9, 9%), ganglions (n = 9, 9%) and lung findings (n = 8, 8%). Conclusion The distribution of 68Ga-PSMA avid metastatic lesions is similar to data previously reported mainly from autopsy with comparable detection rates, indicating 68Ga-PSMA PET/CT is an accurate detection tool in patients with metastatic prostate cancer. If confirmed by further prospective studies 68Ga-PSMA PET/CT should be included in the guidelines to evaluate disease extent in these patients.
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Affiliation(s)
- Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel. .,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Ronit Gill
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Elinor Goshen
- Department of Nuclear Medicine, Wolfson Medical Center, Holon, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel.,The Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Tima Davidson
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Maryna Morgulis
- Department of Nuclear Medicine, Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Simona Ben-Haim
- Department of Medical Biophysics and Nuclear Medicine, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel.,University College London and UCL Hospitals, NHS Trust, London, UK
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Khurshid Z, Ahmadzadehfar H, Gaertner FC, Papp L, Zsóter N, Essler M, Bundschuh RA. Role of textural heterogeneity parameters in patient selection for 177Lu-PSMA therapy via response prediction. Oncotarget 2018; 9:33312-33321. [PMID: 30279962 PMCID: PMC6161784 DOI: 10.18632/oncotarget.26051] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 08/06/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose Prostate cancer is most common tumor in men causing significant patient mortality and morbidity. In newer diagnostic/therapeutic agents PSMA linked ones are specifically important. Analysis of textural heterogeneity parameters is associated with determination of innately aggressive and therapy resistant cell lines thus emphasizing their importance in therapy planning. The objective of current study was to assess predictive ability of tumor textural heterogeneity parameters from baseline 68Ga-PSMA PET prior to 177Lu-PSMA therapy. Results Entropy showed a negative correlation (rs = −0.327, p = 0.006, AUC = 0.695) and homogeneity showed a positive correlation (rs = 0.315, p = 0.008, AUC = 0.683) with change in pre and post therapy PSA levels. Conclusions Study showed potential for response prediction through baseline PET scan using textural features. It suggested that increase in heterogeneity of PSMA expression seems to be associated with an increased response to PSMA radionuclide therapy. Materials and Methods Retrospective analysis of 70 patients was performed. All patients had metastatic prostate cancer and were planned to undergo 177Lu-PSMA therapy. Pre-therapeutic 68Ga- PSMA PET scans were used for analysis. 3D volumes (VOIs) of 3 lesions each in bones and lymph nodes were manually delineated in static PET images. Five PET based textural heterogeneity parameters (COV, entropy, homogeneity, contrast, size variation) were determined. Results obtained were then compared with clinical parameters including pre and post therapy PSA, alkaline phosphate, bone specific alkaline phosphate levels and ECOG criteria. Spearman correlation was used to determine statistical dependence among variables. ROC analysis was performed to estimate the optimal cutoff value and AUC.
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Affiliation(s)
- Zain Khurshid
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - László Papp
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | | | - Markus Essler
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
| | - Ralph A Bundschuh
- Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
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Giovacchini G, Giovannini E, Riondato M, Ciarmiello A. PET/CT With 68Ga-PSMA in Prostate Cancer: Radiopharmaceutical Background and Clinical Implications. Curr Radiopharm 2018; 11:4-13. [PMID: 29090673 DOI: 10.2174/1874471010666171101121803] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 10/18/2017] [Accepted: 10/20/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE In the last twenty years, positron emission tomography / computed tomography (PET/CT) with radiolabeled choline, represented the most powerful imaging modality for prostate cancer (PCa). However, the low positive detection rate of the technique for PSA < 1 ng/ml prompted the development of other tracers for imaging PCa. METHODS We performed a critical review of 68Ga-PSMA, a receptor ligand tracer, which has been identified as the most promising radiopharmaceutical for imaging PCa. RESULTS The most promising feature of this radiopharmaceutical is the high positive detection rate for prostate specific antigen (PSA) levels < 1 ng/ml or less (i.e., PSA < 0.5 ng/ml). 68Ga-PSMA detection rate is also sensitive to PSA kinetics, expressed either as PSA doubling time or PSA velocity. There are initial results indicating that 68Ga-PSMA may significantly affect the clinical management of PCa patients, even though the additional advantages in comparison to radiolabeled choline need to be further supported in future perspective studies. Other clinical implications, such as whether 68Ga-PSMA PET/CT predicts PCa-specific survival, have not yet been investigated. Numerous clinical studies have been published, some of them with histopathological verification so that despite the recent introduction in the clinical field reliable estimation of sensitivity and specificity of 68Ga-PSMA PET/CT have been obtained through meta-analyses. Most clinical studies with PET/CT with 68Ga-PSMA are retrospective, single-institutional studies and in many cases include heterogeneous patient cohorts. Thus, multidisciplinary, well-throughout prospective trials are needed to better define the clinical implications of 68Ga- PSMA PET/CT in PCa patients. The increasing availability of positron emission tomography / magnetic resonance (PET/MR) hybrid devices promotes the use of this radiopharmaceutical especially at initial staging when identification of tumor localization and of extra-prostatic disease represent clinically relevant questions. PSMA cold ligands can also be labeled with beta emitters with good chemical stability so that 68Ga-PSMA PET/CT can be used to guide radiometabolic therapy of advanced metastatic PCa patients through 177Lu-labeled PSMA ligands. CONCLUSION PSMA labeled ligands appear very promising for diagnosis and treatment of PCa.
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Affiliation(s)
| | | | - Mattia Riondato
- Nuclear Medicine Department, S. Andrea Hospital, La Spezia, Italy
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ter Voert EEGW, Muehlematter UJ, Delso G, Pizzuto DA, Müller J, Nagel HW, Burger IA. Quantitative performance and optimal regularization parameter in block sequential regularized expectation maximization reconstructions in clinical 68Ga-PSMA PET/MR. EJNMMI Res 2018; 8:70. [PMID: 30054750 PMCID: PMC6063806 DOI: 10.1186/s13550-018-0414-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 06/27/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In contrast to ordered subset expectation maximization (OSEM), block sequential regularized expectation maximization (BSREM) positron emission tomography (PET) reconstruction algorithms can run until full convergence while controlling image quality and noise. Recent studies with BSREM and 18F-FDG PET reported higher signal-to-noise ratios and higher standardized uptake values (SUV). In this study, we investigate the optimal regularization parameter (β) for clinical 68Ga-PSMA PET/MR reconstructions in the pelvic region applying time-of-flight (TOF) BSREM in comparison to TOF OSEM. Two-minute emission data from the pelvic region of 25 patients who underwent 68Ga-PSMA PET/MR were retrospectively reconstructed. Reference OSEM reconstructions had 28 subsets and 2 iterations. BSREM reconstructions were performed with 15 β values between 150 and 1200. Regions of interest (ROIs) were drawn around lesions and in uniform background. Background SUVmean (average) and SUVstd (standard deviation), and lesion SUVmax (average of 5 hottest voxels) were calculated. Differences were analyzed using the Wilcoxon matched pairs signed-rank test. RESULTS A total of 40 lesions were identified in the pelvic region. Background noise (SUVstd) and lesions SUVmax decreased with increasing β. Image reconstructions with β values lower than 400 have higher (p < 0.01) background noise, compared to the reference OSEM reconstructions, and are therefore less useful. Lesions with low activity on images reconstructed with β values higher than 600 have a lower (p < 0.05) SUVmax compared to the reference. These reconstructions are likely visually appealing due to the lower background noise, but the lower SUVmax could possibly render small low-uptake lesions invisible. CONCLUSIONS In our study, we showed that PET images reconstructed with TOF BSREM in combination with the 68Ga-PSMA tracer result in lower background noise and higher SUVmax values in lesions compared to TOF OSEM. Our study indicates that a β value between 400 and 550 might be the optimal compromise between high SUVmax and low background noise.
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Affiliation(s)
- Edwin E. G. W. ter Voert
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
- University of Zurich, Rämistrasse 71, CH-8006 Zurich, Switzerland
| | - Urs J. Muehlematter
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Gaspar Delso
- GE Healthcare, 3000 N Grandview Blvd, Waukesha, WI 53188 USA
| | - Daniele A. Pizzuto
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Julian Müller
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Hannes W. Nagel
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
| | - Irene A. Burger
- Department of Nuclear Medicine, University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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Perveen G, Arora G, Damle NA, Prabhu M, Arora S, Tripathi M, Bal C, Kumar P, Kumar R, Singh P, Das CJ, Passah A. Can Early Dynamic Positron Emission Tomography/Computed Tomography Obviate the Need for Postdiuresis Image in 68Ga-PSMA-HBED-CC Scan for Evaluation of Prostate Adenocarcinoma? Indian J Nucl Med 2018; 33:202-208. [PMID: 29962715 PMCID: PMC6011556 DOI: 10.4103/ijnm.ijnm_32_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Forced diuresis technique is often adopted to wash out the high amount of urinary radioactivity that masks the foci of abnormal uptake in the pelvic region on 68Ga-PSMA-HBED-CC positron emission tomography/computed tomography (PET/CT) scan in prostate cancer (PC) patients. However, this method is time-consuming, makes the patient non/less compliant, and is not feasible in patients with renal dysfunction. We hypothesized that early dynamic imaging can obviate the need for a postdiuresis view as the urinary activity is expected to be low at the time. MATERIALS AND METHODS A total of 20 biopsy-proven PC patients who were referred to our department for a 68Ga-PSMA PET/CT for staging/restaging were prospectively studied. Dynamic PET/CT was done with on table intravenous (i.v.) injection of 2-3 mCi (74-111 MBq) of the radiotracer. Dynamic images were acquired over the pelvis with a frame time of 1 min for 10 min. Static images of 2 min/bed position were acquired between 45 and 60 min p.i. The patients were then administered i.v. furosemide and encouraged water intake and frequent urination. A static view of pelvic region was acquired at 5 min/bed at 120 min p.i. A three-dimensional volume of interest (3D-VOI) was plotted on the primary lesion, bladder, involved nodes if any, pelvic bones at involved and uninvolved sites, gluteal muscles, and artery. The sentence seems fine. This was to generate the Time activity curve for analysis. RESULTS Nine patients were referred for staging and 11 for restaging. Mean age of 20 patients was 64.6 years, and median prostate-specific antigen level was 21.4 ng/ml (range: 0.05-2180). Prostatic lesion was present in 20 patients, nodal involvement in 8, and bone involvement in 10 patients. Median maximum standardized uptake value (SUVmax) of the prostatic lesion (P) showed an ascending trend: 5.31 at 5 min, 10.65 at 60 min, and 10.52 at 120 min p.i. At the same time, median SUVmax of the bladder (B) also progressed steeply and then decreased postdiuresis: 1.01 at 5 min, 24.6 at 60 min, and 6.88 at 120 min. Despite forced diuresis, the bladder activity remained higher than that during early dynamic imaging. Median prostate-to-bladder (P/B) ratio was highest during early dynamic imaging at 5 min p.i. was 5.17, while at 60 min, P/B ratio was 0.42 (P = 0.002) and, at 120 min, it was 1.27 (P = 0.009). Further, all the nodal and bone lesions were clearly visualized on early dynamic images. CONCLUSION The study results suggest that early dynamic imaging performs better than a postdiuresis view in terms of delineation of prostatic and regional lesions on 68Ga-PSMA scan. Further, it saves time and the patients are more compliant to this technique.
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Affiliation(s)
| | | | | | | | - Saurabh Arora
- Department of Nuclear Medicine, AIIMS, New Delhi, India
| | | | | | - Praveen Kumar
- Department of Nuclear Medicine, AIIMS, New Delhi, India
| | - Rajeev Kumar
- Department of Nuclear Medicine, AIIMS, New Delhi, India
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