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Fragoso Costa P, Jentzen W, SÜßELBECK F, Fendler WP, Rischpler C, Herrmann K, Conti M, Kersting D, Weber M. Reduction of emission time for [68Ga]Ga-PSMA PET/CT using the digital biograph vision: a phantom study. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2023; 67:57-68. [PMID: 34309334 DOI: 10.23736/s1824-4785.21.03300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this phantom study was to optimize the [68Ga]Ga-PSMA PET/CT examination in terms of scan time duration and image reconstruction parameters, in combination with PSF and TOF modelling, in a digital Biograph Vision PET/CT scanner. METHODS Three types of phantoms were used: 1) soft-tissue tumor phantom consisting of six spheres mounted in a torso phantom; 2) bone-lung tumor phantom; 3) resolution phantom. Phantom inserts were filled with activity concentrations (ACs) that were derived from clinical data. Phantom data were acquired in list-mode at one bed position. Images with emission data ranging from 30 to 210 s in 30-s increments were reconstructed from a reference image acquired with 3.5-min emission. Iterative image reconstruction (OSEM), point-spread-function (PSF) and time-of-flight (TOF) options were applied using different iterations, Gaussian filters, and voxel sizes. The criteria for image quality was lesion detectability and lesion quantification, evaluated as contrast-to-noise ratio (CNR) and maximum AC (peak AC), respectively. A threshold value of CNR above 6 and percentage maximum AC (peak AC) deviation range of ±20% of the reference image were considered acceptable. The proposed single-bed scan time reduction was projected to a whole-body examination (patient validation scan) using the continuous-bed-motion mode. RESULTS Sphere and background ACs of 20 kBq/mL and 1 kBq/mL were selected, respectively. The optimized single-bed scan time was approximately 60 s using OSEM-TOF or OSEM-TOF+PSF (four iterations, 4.0-mm Gaussian filter and almost isotropic voxel size of 3.0-mm side length), resulting in a PET spatial resolution of 6.3 mm for OSEM-TOF and 5.5 mm for OSEM-TOF+PSF. In the patient validation, the maximum percentage difference in lesion quantification between standard and optimized protocol (whole-body scan time of 15 vs. 5 min) was below 19%. CONCLUSIONS A reduction of single-bed and whole-body scan time for [68Ga]Ga-PSMA PET/CT compared to current recommended clinical acquisition protocols is postulated. Clinical studies are warranted to validate the applicability of this protocol.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany -
| | - Walter Jentzen
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Finja SÜßELBECK
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | | | - David Kersting
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, Essen University Hospital, Duisburg-Essen University, Essen, Germany
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García Cañamaque L, Field CA, Furtado FS, Plaza DE Las Heras I, Husseini JS, Balza R, Jarraya M, Catalano OA, Mitjavila Casanovas M. Contribution of positron emission tomography/magnetic resonance imaging in musculoskeletal malignancies. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:3-14. [PMID: 34881853 DOI: 10.23736/s1824-4785.21.03432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Positron emission tomography/computed tomography (PET/CT) is a promising hybrid imaging technique for evaluating musculoskeletal malignancies. Both technologies, independently are useful for evaluating this type of tumors. PET/MR has great potential combining metabolic and functional imaging PET with soft tissue contrast and multiparametric sequences of MR. In this paper we review the existing literature and discuss the different protocols, new available radiotracers to conclude with the scarce evidence available the most useful/probable indications of the PET MR for the for musculoskeletal malignancies.
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Affiliation(s)
- Lina García Cañamaque
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain -
| | - Caroline A Field
- Department of Nuclear Medicine, Madrid Sanchinarro University Hospital, Madrid, Spain
| | - Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Mohamed Jarraya
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Reduced Acquisition Time per Bed Position for PET/MRI Using 68Ga-RM2 or 68Ga-PSMA-11 in Patients With Prostate Cancer: A Retrospective Analysis. AJR Am J Roentgenol 2021; 218:333-340. [PMID: 34406051 DOI: 10.2214/ajr.21.25961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND. Growing clinical adoption of PET/MRI for prostate cancer (PC) evaluation has increased interest in reducing PET/MRI scanning times. Reducing acquisition time per bed position below current times of at least 5 minutes would allow shorter examination lengths. OBJECTIVE. The purpose of this study was to evaluate the effect of different reduced PET acquisition times in patients with PC who underwent 68Ga-PSMA-11 or 68Ga-RM2 PET/MRI using highly sensitive silicon photomultiplier-based PET detectors. METHODS. This study involved retrospective review of men with PC who underwent PET/MRI as part of one of two prospective trials. Fifty men (mean [± SD] age, 69.9 ± 6.8 years) who underwent 68Ga-RM2 PET/MRI and 50 men (mean age, 66.6 ± 5.7 years) who underwent 68Ga-PSMA-11 PET/MRI were included. PET/MRI used a time-of-flight-enabled system with silicon photomultiplier-based detectors. The acquisition time was 4 minutes per bed position. PET data were reconstructed using acquisition times of 30 seconds, 1 minute, 2 minutes, 3 minutes, and 4 minutes. Three readers independently assessed image quality for each reconstruction using a 5-point Likert scale (with 1 denoting nondiagnostic and 5 indicating excellent quality). One reader measured SUVmax for up to six lesions per patient. Two readers independently assessed lesion conspicuity using a a 3-point Likert scale (with 1 indicating that lesions were not visualized and 3 denoting that they were definitely visualized). RESULTS. Mean image quality across readers at 30 seconds, 1 minutes, 2 minutes, 3 minutes, and 4 minutes was, for 68Ga-RM2 PET/MRI, from 1.0 ± 0.2 to 1.7 ± 0.7, 2.0 ± 0.3 to 2.6 ± 0.8, 3.1 ± 0.5 to 3.9 ± 0.8, 4.6 ± 0.6 to 4.7 ± 0.6, and 4.8 ± 0.4 to 4.8 ± 0.5, respectively, and for 68Ga-PSMA-11 PET/MRI it was from 1.2 ± 0.4 to 1.8 ± 0.6, 2.2 ± 0.4 to 2.8 ± 0.7, 3.6 ± 0.6 to 4.1± 0.8, 4.8 ± 0.4 to 4.9 ± 0.4, and 4.9 ± 0.3 to 5.0 ± 0.2, respectively. The mean lesion SUVmax for 68Ga-RM2 PET/MRI was 11.1 ± 12.4, 10.2 ± 11.7, 9.6 ± 11.3, 9.5 ± 11.6, and 9.4 ± 11.6, respectively, and for 68Ga-PSMA-11 PET/MRI it was 14.7 ± 8.2, 12.9 ± 7.4, 12.1 ± 7.8, 11.7 ± 7.9, and 11.6 ± 7.9, respectively. Mean lesion conspicuity (reader 1/reader 2) was, for 68Ga-RM2 PET/MRI, 2.4 ± 0.5/2.7 ± 0.5, 2.9 ± 0.3/2.9 ± 0.3, 3.0 ± 0.0/3.0 ± 0.0, 3.0 ± 0.0/3.0 ± 0.0, and 3.0 ± 0.0/3.0 ± 0.0, respectively, and for 68Ga-PSMA-11 PET/MRI it was 2.6 ± 0.5/2.8 ± 0.4, 3.0 ± 0.2/2.9 ± 0.3, 3.0 ± 0.1/3.0 ± 0.2, 3.0 ± 0.0/3.0 ± 0.0, and 3.0 ± 0.0/3.0 ± 0.0, respectively. CONCLUSION. Our data support routine 3-minute acquisitions, which provided results very similar to those for 4-minute acquisitions. Two-minute acquisitions, although they lowered quality somewhat, provided acceptable performance and warrant consideration. CLINICAL IMPACT. When PC is evaluated using modern PET/MRI equipment, time per bed position may be reduced compared with historically used times. TRIAL REGISTRATION. ClinicalTrials.gov NCT02624518 and NCT02678351.
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Evangelista L, Zattoni F, Cassarino G, Artioli P, Cecchin D, Dal Moro F, Zucchetta P. PET/MRI in prostate cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2020; 48:859-873. [PMID: 32901351 PMCID: PMC8036222 DOI: 10.1007/s00259-020-05025-0] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 08/31/2020] [Indexed: 12/16/2022]
Abstract
Aim In recent years, the clinical availability of scanners for integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) has enabled the practical potential of multimodal, combined metabolic-receptor, anatomical, and functional imaging to be explored. The present systematic review and meta-analysis summarize the diagnostic information provided by PET/MRI in patients with prostate cancer (PCa). Materials and methods A literature search was conducted in three different databases. The terms used were “choline” or “prostate-specific membrane antigen - PSMA” AND “prostate cancer” or “prostate” AND “PET/MRI” or “PET MRI” or “PET-MRI” or “positron emission tomography/magnetic resonance imaging.” All relevant records identified were combined, and the full texts were retrieved. Reports were excluded if (1) they did not consider hybrid PET/MRI; or (2) the sample size was < 10 patients; or (3) the raw data were not enough to enable the completion of a 2 × 2 contingency table. Results Fifty articles were eligible for systematic review, and 23 for meta-analysis. The pooled data concerned 2104 patients. Initial disease staging was the main indication for PET/MRI in 24 studies. Radiolabeled PSMA was the tracer most frequently used. In primary tumors, the pooled sensitivity for the patient-based analysis was 94.9%. At restaging, the pooled detection rate was 80.9% and was higher for radiolabeled PSMA than for choline (81.8% and 77.3%, respectively). Conclusions PET/MRI proved highly sensitive in detecting primary PCa, with a high detection rate for recurrent disease, particularly when radiolabeled PSMA was used. Electronic supplementary material The online version of this article (10.1007/s00259-020-05025-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy.
| | - Fabio Zattoni
- Urology Unit, Department of Medicine, Udine University Hospital, Udine, Italy
| | - Gianluca Cassarino
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Paolo Artioli
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
| | - Fabrizio Dal Moro
- Urology Unit, Department of Medicine, Udine University Hospital, Udine, Italy.,Urology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine, Padova University Hospital, Via Giustiniani 2, Padova, Italy
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Murthy V, Smith RL, Tao DH, Lawhn-Heath CA, Korenchan DE, Larson PEZ, Flavell RR, Hope TA. 68Ga-PSMA-11 PET/MRI: determining ideal acquisition times to reduce noise and increase image quality. EJNMMI Phys 2020; 7:54. [PMID: 32844310 PMCID: PMC7447708 DOI: 10.1186/s40658-020-00322-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/12/2020] [Indexed: 12/21/2022] Open
Abstract
Background In this study, we investigate the impact of increased PET acquisition time per bed position on lesion detectability, standard uptake value, and image noise in 68Ga-PSMA-11 PET/MRI scans. Methods Scans of twenty patients were analyzed in this study. Patients were injected with 68Ga-PSMA-11 (mean, 5.50 ± 1.49 mCi) and imaged on a 3.0 T time-of-flight PET/MRI. PET images were retrospectively reconstructed using 0.5, 1, 2, 4, 7, and 10 min of PET data. Lesion detectability was evaluated on a 5-point Likert Scale for each lesion in each reconstruction. Quantitative analysis was performed measuring image noise and lesion uptake. Results A total of 55 lesions were identified, and lesion detectability increased from 2.07 ± 1.14 for 0.5 min to 4.93 ± 0.26 for 10 min (p < 0.001), with no significant difference detected between 7 and 10 min of scan time. Average SUVmax decreased from 9.89 ± 6.62 for 0.5 min to 8.64 ± 6.81 for 10 min. Noise decreased from 0.72 ± 0.22 for 0.5 min to 0.31 ± 0.12 for 10 min (p < 0.001) and were nearly equivalent between 7 and 10 min. Pairwise interaction terms between size, SUVmax, and scan time were all found to be significant, although the interaction term between SUVmax and scan time was found to be the most significant. Conclusions Increased acquisition duration improves image quality by increasing detectability and reducing noise. In patients with biochemical recurrence, increased acquisition time up to 7 min improves lesion detection.
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Affiliation(s)
- Vishnu Murthy
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Raven L Smith
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dora H Tao
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Courtney A Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Dave E Korenchan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Peder E Z Larson
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Robert R Flavell
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA. .,UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA. .,Department of Radiology, San Francisco VA Medical Center, San Francisco, CA, USA.
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Rezaei S, Ghafarian P, Bakhshayesh-Karam M, Uribe CF, Rahmim A, Sarkar S, Ay MR. The impact of iterative reconstruction protocol, signal-to-background ratio and background activity on measurement of PET spatial resolution. Jpn J Radiol 2020; 38:231-239. [PMID: 31894449 DOI: 10.1007/s11604-019-00914-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 12/19/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The present study aims to assess the impact of acquisition time, different iterative reconstruction protocols as well as image context (including contrast levels and background activities) on the measured spatial resolution in PET images. METHODS Discovery 690 PET/CT scanner was used to quantify spatial resolutions in terms of full width half maximum (FWHM) as derived (i) directly from capillary tubes embedded in air and (ii) indirectly from 10 mm-diameter sphere of the NEMA phantom. Different signal-to-background ratios (SBRs), background activity levels and acquisition times were applied. The emission data were reconstructed using iterative reconstruction protocols. Various combinations of iterations and subsets (it × sub) were evaluated. RESULTS For capillary tubes, improved FWHM values were obtained for higher it × sub, with improved performance for PSF algorithms relative to non-PSF algorithms. For the NEMA phantom, by increasing acquisition times from 1 to 5 min, intrinsic FWHM for reconstructions with it × sub 32 (54) was improved by 15.3% (13.2%), 15.1% (13.8%), 14.5% (12.8%) and 13.7% (12.7%) for OSEM, OSEM + PSF, OSEM + TOF and OSEM + PSF + TOF, respectively. Furthermore, for all reconstruction protocols, the FWHM improved with more impact for higher it × sub. CONCLUSION Our results indicate that PET spatial resolution is greatly affected by SBR, background activity and the choice of the reconstruction protocols.
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Affiliation(s)
- Sahar Rezaei
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran
| | - Pardis Ghafarian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, 19569-44413, Tehran, Iran. .,PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Mehrdad Bakhshayesh-Karam
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, 19569-44413, Tehran, Iran.,PET/CT and Cyclotron Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Carlos F Uribe
- Department of Functional Imaging, BC Cancer, Vancouver, BC, Canada
| | - Arman Rahmim
- Departments of Radiology and Physics, University of British Columbia, Vancouver, Canada.,Department of Integrative Oncology, BC Cancer Research Centre, Vancouver, Canada
| | - Saeed Sarkar
- Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Ay
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran.,Research Center for Molecular and Cellular Imaging (RCMCI), Tehran University of Medical Sciences, Tehran, Iran
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Contribution of 5th minute and 2nd hour images to standard imaging in ( 68Ga)PSMA 11 PET/CT. Ann Nucl Med 2019; 34:163-173. [PMID: 31808135 DOI: 10.1007/s12149-019-01428-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/28/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole body Gallium68-prostate-specific membrane antigen-HBED-CC [(68Ga)PSMA 11] Positron Emission Tomography/Computed Tomography (PET/CT) images to 1st hour imaging in patients with prostate cancer (PCa). MATERIALS AND METHODS A total of 63 patients diagnosed with PCa who underwent (68Ga)PSMA 11 PET/CT between April 2019 and June 2019 and who had 5th minute and 1st and 2nd hour images were included in the study. Early (5th minute) pelvic region and 1st and 2nd hour full body images were obtained from all patients. The regions of interest (ROI) were drawn from the background tissues and the physiological uptake sites in a way to include the same lesions from primary and metastatic lesions in all three imagings, and SUVmax values, and tumor-background ratio (TBR) were calculated. RESULTS The mean age of the patients was 69.81 ± 8.78 (min/max: 51/91) years. In the 5th minute images, prostate gland and bed were easier to evaluate, because of low bladder activity. However, lymph node evaluation was more difficult due to high vascular activity. In the prostate gland, lymph nodes and bone metastases, both SUVmax values and TBR rates increased with time from the 5th minute (p < 0.001). At the 2nd hour, some lesions became more visible, while decreased activity was observed in some lesions. However, none of the patients required a change in the stage or treatment. CONCLUSION In conclusion, the 5th minute pelvic images in (68Ga)PSMA 11 PET/CT were helpful in visual evaluation of the prostate gland and bed, while 2nd hour images showed high SUVmax and TBR rates in malignant lesions. As the SUVmax values of benign lesions were found to be lower in the 2nd hour, when compared to the 1st hour, it was thought that the 2nd hour imaging could be used in the additional imaging for suspicious lesions without the need for very long waiting times.
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Rauscher I, Fendler WP, Hope TA, Quon A, Nekolla SG, Calais J, Richter A, Haller B, Herrmann K, Weber WA, Czernin J, Eiber M. Can the Injected Dose Be Reduced in 68Ga-PSMA-11 PET/CT While Maintaining High Image Quality for Lesion Detection? J Nucl Med 2019; 61:189-193. [PMID: 31324710 DOI: 10.2967/jnumed.119.227207] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 07/15/2019] [Indexed: 01/14/2023] Open
Abstract
Our purpose was to define a clinically useful lower limit of injected dose for 68Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT imaging of prostate cancer. Methods: 68Ga-PSMA-11 PET/CT was performed on 11 patients. PET was acquired in list mode and reconstructed using a 3-min full acquisition, a 2-min acquisition, and a 1-min acquisition to generate images obtained with three thirds (standard dose), two thirds (low dose), and one third (very low dose) of the injected dose, respectively. Overall image quality (5-point scale) was assessed, and the detectability of PSMA-positive lesions was determined by 3 readers and compared with the reference standard. Results: Image quality declined with decreasing dose (mean score of 4.1 ± 0.4 for the standard dose, 3.4 ± 0.7 for the low dose, and 1.9 ± 0.4 for the very low dose; all P < 0.05). Readers 1, 2, and 3 correctly identified the lesions (n = 21) at a rate of 100%, 100%, and 95% with the standard dose; 95%, 81%, and 90% with the low dose; and 71%, 76%, and 59% with the very low dose, respectively. Conclusion: 68Ga-PSMA-11 dose reduction is not feasible without a negative impact on image quality and lesion detectability.
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Affiliation(s)
- Isabel Rauscher
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
| | - Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California; and
| | - Andrew Quon
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
| | - Stephan G Nekolla
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jeremie Calais
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
| | - Antonia Richter
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Haller
- Institute of Medical Informatics, Statistics and Epidemiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany.,Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
| | - Wolfgang A Weber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johannes Czernin
- Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, California
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10
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Lindemann ME, Guberina N, Wetter A, Fendler WP, Jakoby B, Quick HH. Improving 68Ga-PSMA PET/MRI of the Prostate with Unrenormalized Absolute Scatter Correction. J Nucl Med 2019; 60:1642-1648. [DOI: 10.2967/jnumed.118.224139] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 03/18/2019] [Indexed: 12/18/2022] Open
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11
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Kuo HT, Pan J, Zhang Z, Lau J, Merkens H, Zhang C, Colpo N, Lin KS, Bénard F. Effects of Linker Modification on Tumor-to-Kidney Contrast of 68Ga-Labeled PSMA-Targeted Imaging Probes. Mol Pharm 2018; 15:3502-3511. [DOI: 10.1021/acs.molpharmaceut.8b00499] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Hsiou-Ting Kuo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Jinhe Pan
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Zhengxing Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Joseph Lau
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Helen Merkens
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Chengcheng Zhang
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Nadine Colpo
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
| | - Kuo-Shyan Lin
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - François Bénard
- Department of Molecular Oncology, BC Cancer, Vancouver, BC V5Z 1L3, Canada
- Department of Functional Imaging, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Department of Radiology, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
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12
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Clinical Evaluation of 68Ga-PSMA-II and 68Ga-RM2 PET Images Reconstructed With an Improved Scatter Correction Algorithm. AJR Am J Roentgenol 2018; 211:655-660. [PMID: 29873506 DOI: 10.2214/ajr.17.19356] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Gallium-68-labeled radiopharmaceuticals pose a challenge for scatter estimation because their targeted nature can produce high contrast in these regions of the kidneys and bladder. Even small errors in the scatter estimate can result in washout artifacts. Administration of diuretics can reduce these artifacts, but they may result in adverse events. Here, we investigated the ability of algorithmic modifications to mitigate washout artifacts and eliminate the need for diuretics or other interventions. MATERIALS AND METHODS The model-based scatter algorithm was modified to account for PET/MRI scanner geometry and challenges of non-FDG tracers. Fifty-three clinical 68Ga-RM2 and 68Ga-PSMA-11 whole-body images were reconstructed using the baseline scatter algorithm. For comparison, reconstruction was also processed with modified sampling in the single-scatter estimation and with an offset in the scatter tail-scaling process. None of the patients received furosemide to attempt to decrease the accumulation of radiopharmaceuticals in the bladder. The images were scored independently by three blinded reviewers using the 5-point Likert scale. RESULTS The scatter algorithm improvements significantly decreased or completely eliminated the washout artifacts. When comparing the baseline and most improved algorithm, the image quality increased and image artifacts were reduced for both 68Ga-RM2 and for 68Ga-PSMA-11 in the kidneys and bladder regions. CONCLUSION Image reconstruction with the improved scatter correction algorithm mitigated washout artifacts and recovered diagnostic image quality in 68Ga PET, indicating that the use of diuretics may be avoided.
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13
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Lückerath K, Stuparu AD, Wei L, Kim W, Radu CG, Mona CE, Calais J, Rettig M, Reiter RE, Czernin J, Slavik R, Herrmann K, Eiber M, Fendler WP. Detection Threshold and Reproducibility of 68Ga-PSMA11 PET/CT in a Mouse Model of Prostate Cancer. J Nucl Med 2018; 59:1392-1397. [PMID: 29602819 DOI: 10.2967/jnumed.118.207704] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 03/19/2018] [Indexed: 12/22/2022] Open
Abstract
To improve prostate-specific membrane antigen (PSMA)-targeted theranostic approaches, robust murine models of prostate cancer are needed. However, important characteristics of preclinical PSMA imaging-that is, the reproducibility of the imaging signal and the relationship between quantitative cell surface PSMA expression and lesion detectability with small-animal PET/CT-have not been defined yet. Methods: Murine prostate cancer RM1 sublines (ras myc transformed cells of C57BL/6 prostate origin) expressing varying levels of human PSMA were injected into the shoulder of C57BL/6 mice on day 0. 68Ga-PSMA11 PET/CT was performed on days 7 and 8 and interpreted by 2 masked readers to determine interday and interreader reproducibility. PSMA expression was quantified on days 7 and 8 by flow cytometry of fine-needle aspiration tumor biopsy samples. Cell surface PSMA expression was correlated with PET signal. The threshold for PET positivity was based on the clinical Prostate Cancer Molecular Imaging Standardized Evaluation (PROMISE) criteria. Results: The maximum and average percentages of injected 68Ga-PSMA11 activity per gram of tissue (%IA/g) correlated nearly perfectly as determined by 2 independent readers and on 2 separate days (intraclass correlation coefficient, 1.00/0.89 and 0.95/0.88, respectively). The number of PSMA molecules per cell increased from the RM1-yellow fluorescent protein subline (PSMA-; 2,000/cell) to the RM1-low subline (PSMA+; 17,000/cell), the RM1-medium subline (PSMA++; 22,000/cell), and the RM1-PGLS subline (PSMA-positive, green fluorescent protein-positive, and luciferase-positive; PSMA+++; 45,000/cell). Expression levels correlated with the visual positivity rate on 68Ga-PSMA11 PET and with the PSMA PET %IA/g. The PSMA threshold for PET positivity was approximately 20,000 per cell. Signal correlation was close at lower PSMA levels (RM1-low to RM1-medium; 10-23 %IA/g) but was lost at higher PSMA levels (RM1-medium to RM1-PGLS; 23-27 %IA/g). Conclusion: The in vivo relationship between 68Ga-PSMA11 PET/CT and PSMA expression level in a murine model of prostate cancer was robust for lower cell surface PSMA expression levels (≤22,000/cell). Thus, preclinical 68Ga-PSMA11 PET/CT can be used as an imaging biomarker to test PSMA-targeted interventions in murine models.
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Affiliation(s)
- Katharina Lückerath
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Andreea D Stuparu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Liu Wei
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Woosuk Kim
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Caius G Radu
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Christine E Mona
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeremie Calais
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Matthew Rettig
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Robert E Reiter
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Johannes Czernin
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Roger Slavik
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Ken Herrmann
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany; and
| | - Matthias Eiber
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California.,Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Wolfgang P Fendler
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, California
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14
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Pizzuto DA, Müller J, Mühlematter U, Rupp NJ, Töpfer A, Mortezavi A, Nagel H, Kranzbühler B, Eberli D, Burger IA. The central zone has increased 68Ga-PSMA-11 uptake: “Mickey Mouse ears” can be hot on 68Ga-PSMA-11 PET. Eur J Nucl Med Mol Imaging 2018. [DOI: 10.1007/s00259-018-3979-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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15
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Virgolini I, Decristoforo C, Haug A, Fanti S, Uprimny C. Current status of theranostics in prostate cancer. Eur J Nucl Med Mol Imaging 2018; 45:471-495. [PMID: 29282518 PMCID: PMC5787224 DOI: 10.1007/s00259-017-3882-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 11/07/2017] [Indexed: 12/25/2022]
Abstract
The aim of this review is to report on the current status of prostate-specific membrane antigen (PSMA)-directed theranostics in prostate cancer (PC) patients. The value of 68Ga-PSMA-directed PET imaging as a diagnostic procedure for primary and recurrent PC as well as the role of evolving PSMA radioligand therapy (PRLT) in castration-resistant (CR)PC is assessed. The most eminent data from mostly retrospective studies currently available on theranostics of prostate cancer are discussed. The current knowledge on 68Ga-PSMA PET/CT implicates that primary staging with PET/CT is meaningful in patients with high-risk PC and that the combination with pelvic multi parametric (mp)MR (or PET/mpMR) reaches the highest impact on patient management. There may be a place for 68Ga-PSMA PET/CT in intermediate-risk PC patients as well, however, only a few data are available at the moment. In secondary staging for local recurrence, 68Ga-PSMA PET/mpMR is superior to PET/CT, whereas for distant recurrence, PET/CT has equivalent results and is faster and cheaper compared to PET/mpMR. 68Ga-PSMA PET/CT is superior to 18F / 11Choline PET/CT in primary staging as well as in secondary staging. In patients with biochemical relapse, PET/CT positivity is directly associated with prostate-specific antigen (PSA) increase and amounts to roughly 50% when PSA is raised to ≤0.5 ng/ml and to ≥90% above 1 ng/ml. Significant clinical results have so far been achieved with the subsequent use of radiolabeled PSMA ligands in the treatment of CRPC. Accumulated activities of 30 to 50 GBq of 177Lu-PSMA ligands seem to be clinically safe with biochemical response and PERCIST/RECIST response in around 75% of patients along with xerostomia in 5-10% of patients as the only notable side effect. On the basis of the current literature, we conclude that PSMA-directed theranostics do have a major clinical impact in diagnosis and therapy of PC patients. We recommend that 68Ga-PSMA PET/CT should be performed in primary staging together with pelvic mpMR in high-risk patients and in all patients for secondary staging, and that PSMA-directed therapy is a potent strategy in CRPC patients when other treatment options have failed. The combination of PSMA-directed therapy with existing therapy modalities (such as 223Ra-chloride or androgen deprivation therapy) has to be explored, and prospective clinical multicenter trials with theranostics are warranted.
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Affiliation(s)
- Irene Virgolini
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
| | - Clemens Decristoforo
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Alexander Haug
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 18-20 Währinger Gürtel, 1090, Vienna, Austria
| | - Stefano Fanti
- Nuclear Medicine Unit, University of Bologna, S. Orsola Hospital Bologna, Massarenti 9, 40138, Bologna, Italy
| | - Christian Uprimny
- Department of Nuclear Medicine, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
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16
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Optimal time-point for 68Ga-PSMA-11 PET/CT imaging in assessment of prostate cancer: feasibility of sterile cold-kit tracer preparation? Eur J Nucl Med Mol Imaging 2018; 45:1188-1196. [DOI: 10.1007/s00259-018-3970-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
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17
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Albisinni S, Aoun F, Marcelis Q, Jungels C, Al-Hajj Obeid W, Zanaty M, Tubaro A, Roumeguere T, De Nunzio C. Innovations in imaging modalities for recurrent and metastatic prostate cancer: a systematic review. MINERVA UROL NEFROL 2018; 70:347-360. [PMID: 29388415 DOI: 10.23736/s0393-2249.18.03059-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The last decade has witnessed tremendous changes in the management of advanced and metastatic castration resistant prostate cancer. In the current systematic review, we analyze novel imaging techniques in the setting of recurrent and metastatic prostate cancer (PCa), exploring available data and highlighting future exams which could enter clinical practice in the upcoming years. EVIDENCE ACQUISITION The National Library of Medicine Database was searched for relevant articles published between January 2012 and August 2017. A wide search was performed including the combination of following words: "Prostate" AND "Cancer" AND ("Metastatic" OR "Recurrent") AND "imaging" AND ("MRI" OR "PET"). The selection procedure followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) principles and is presented using a PRISMA flow chart. EVIDENCE SYNTHESIS Novel imaging techniques, as multiparametric magnetic resonance imaging (MRI), whole-body MRI and Choline and prostate-specific membrane antigen (PSMA) PET imaging techniques are currently revolutioning the treatment planning in patients with advanced and metastatic PCa, allowing a better characterization of the disease. Multiparametric MRI performs well in the detection of local recurrences, with sensitivity rates of 67-98% and overall diagnostic accuracy of 83-93%, depending on the type of magnetic field strength (1.5 vs. 3T). Whole body MRI instead shows a high specificity (>95%) for bone metastases. PET imaging, and in particular PSMA PET/CT, showed promising results in the detection of both local and distant recurrences, even for low PSA values (<0.5 ng/mL). Sensitivity varies from 77-98% depending on PSA value and PSA velocity. CONCLUSIONS Whole body-MRI, NaF PET, Choline-PET/CT and PSMA PET/CT are flourishing techniques which find great application in the field of recurrent and metastatic PCa, in the effort to reduce treatment of "PSA only" and rather focus our therapies on clinical tumor entities. Standardization is urgently needed to allow adequate comparison of results and diffusion on a large scale.
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Affiliation(s)
- Simone Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium -
| | - Fouad Aoun
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Quentin Marcelis
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Claude Jungels
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Walid Al-Hajj Obeid
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.,Urology Department, Saint George Hospital University Medical Center, Beyrouth, Liban
| | - Marc Zanaty
- Urology Department, Hôtel Dieu de France, Université Saint Joseph, Beyrouth, Liban
| | - Andrea Tubaro
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
| | - Thierry Roumeguere
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Cosimo De Nunzio
- Urology Department, Sant'Andrea Hospital, Università degli Studi di Roma La Sapienza, Rome, Italy
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18
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Domachevsky L, Bernstine H, Goldberg N, Nidam M, Stern D, Sosna J, Groshar D. Early 68GA-PSMA PET/MRI acquisition: assessment of lesion detectability and PET metrics in patients with prostate cancer undergoing same-day late PET/CT. Clin Radiol 2017; 72:944-950. [DOI: 10.1016/j.crad.2017.06.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/07/2017] [Accepted: 06/12/2017] [Indexed: 11/28/2022]
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19
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Clinical performance of 68Ga-PSMA-11 PET/MRI for the detection of recurrent prostate cancer following radical prostatectomy. Eur J Nucl Med Mol Imaging 2017; 45:20-30. [PMID: 29032394 DOI: 10.1007/s00259-017-3850-x] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 10/04/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE Sensitive visualization of recurrent prostate cancer foci is a challenge in patients with early biochemical recurrence (EBR). The recently established 68Ga-PSMA-11 PET/CT has significantly improved the detection rate with published values of up to 55% for patients with a serum PSA concentration between 0.2-0.5 ng/mL. The increased soft tissue contrast in the pelvis using simultaneous 68Ga-PSMA-11 PET/MRI might further improve the detection rate in patients with EBR and low PSA values over PET/CT. METHODS We retrospectively analyzed a cohort of 56 consecutive patients who underwent a 68Ga-PSMA-11 PET/MRI for biochemical recurrence in our institution between April and December 2016 with three readers. Median PSA level was 0.99 ng/mL (interquartile range: 3.1 ng/mL). Detection of PSMA-positive lesions within the prostate fossa, local and distant lymph nodes, bones, or visceral organs was recorded. Agreement among observers was evaluated with Fleiss's kappa (k). RESULTS Overall, in 44 of 56 patients (78.6%) PSMA-positive lesions were detected. In four of nine patients (44.4%) with a PSA < 0.2 ng/mL, suspicious lesions were detected (two pelvic and one paraaortic lymph nodes, and two bone metastases). In eight of 11 patients (72.7%) with a PSA between 0.2 and < 0.5 ng/mL, suspicious lesions were detected (two local recurrences, six lymph nodes, and one bone metastasis). Five out of 20 patients with a PSA < 0.5 ng/mL had extrapelvic disease. In 12 of 15 patients (80.0%) with a PSA between 0.5 and < 2.0 ng/mL, suspicious lesions were detected (four local recurrences, nine lymph nodes, and four bone metastases). In 20 of 21 patients (95.2%) with a PSA >2.0 ng/mL, suspicious lesions were detected. The overall interreader agreement for cancer detection was excellent (κ = 0.796, CI 0.645-0.947). CONCLUSIONS Our data show that 68Ga-PSMA-11 PET/MRI has a high detection rate for recurrent prostate cancer even at very low PSA levels <0.5 ng/mL. Furthermore, even at those low levels extrapelvic disease can be localized in 25% of the cases and local recurrence alone is seen only in 10%.
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20
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Heußer T, Mann P, Rank CM, Schäfer M, Dimitrakopoulou-Strauss A, Schlemmer HP, Hadaschik BA, Kopka K, Bachert P, Kachelrieß M, Freitag MT. Investigation of the halo-artifact in 68Ga-PSMA-11-PET/MRI. PLoS One 2017; 12:e0183329. [PMID: 28817656 PMCID: PMC5560715 DOI: 10.1371/journal.pone.0183329] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/02/2017] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES Combined positron emission tomography (PET) and magnetic resonance imaging (MRI) targeting the prostate-specific membrane antigen (PSMA) with a 68Ga-labelled PSMA-analog (68Ga-PSMA-11) is discussed as a promising diagnostic method for patients with suspicion or history of prostate cancer. One potential drawback of this method are severe photopenic (halo-) artifacts surrounding the bladder and the kidneys in the scatter-corrected PET images, which have been reported to occur frequently in clinical practice. The goal of this work was to investigate the occurrence and impact of these artifacts and, secondly, to evaluate variants of the standard scatter correction method with regard to halo-artifact suppression. METHODS Experiments using a dedicated pelvis phantom were conducted to investigate whether the halo-artifact is modality-, tracer-, and/or concentration-dependent. Furthermore, 31 patients with history of prostate cancer were selected from an ongoing 68Ga-PSMA-11-PET/MRI study. For each patient, PET raw data were reconstructed employing six different variants of PET scatter correction: absolute scatter scaling, relative scatter scaling, and relative scatter scaling combined with prompt gamma correction, each of which was combined with a maximum scatter fraction (MaxSF) of MaxSF = 75% or MaxSF = 40%. Evaluation of the reconstructed images with regard to halo-artifact suppression was performed both quantitatively using statistical analysis and qualitatively by two independent readers. RESULTS The phantom experiments did not reveal any modality-dependency (PET/MRI vs. PET/CT) or tracer-dependency (68Ga vs. 18F-FDG). Patient- and phantom-based data indicated that halo-artifacts derive from high organ-to-background activity ratios (OBR) between bladder/kidneys and surrounding soft tissue, with a positive correlation between OBR and halo size. Comparing different variants of scatter correction, reducing the maximum scatter fraction from the default value MaxSF = 75% to MaxSF = 40% was found to efficiently suppress halo-artifacts in both phantom and patient data. In 1 of 31 patients, reducing the maximum scatter fraction provided new PET-based information changing the patient's diagnosis. CONCLUSION Halo-artifacts are particularly observed for 68Ga-PSMA-11-PET/MRI due to 1) the biodistribution of the PSMA-11-tracer resulting in large OBRs for bladder and kidneys and 2) inaccurate scatter correction methods currently used in clinical routine, which tend to overestimate the scatter contribution. If not compensated for, 68Ga-PSMA-11 uptake pathologies may be masked by halo-artifacts leading to false-negative diagnoses. Reducing the maximum scatter fraction was found to efficiently suppress halo-artifacts.
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Affiliation(s)
- Thorsten Heußer
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Philipp Mann
- Applied Medical Radiation Physics, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Christopher M. Rank
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin Schäfer
- Divison of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | | | | | - Klaus Kopka
- Divison of Radiopharmaceutical Chemistry, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Peter Bachert
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Marc Kachelrieß
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Martin T. Freitag
- Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Calabria F, Chiaravalloti A, Cicciò C, Gangemi V, Gullà D, Rocca F, Gallo G, Cascini GL, Schillaci O. PET/CT with 18 F–choline: Physiological whole bio-distribution in male and female subjects and diagnostic pitfalls on 1000 prostate cancer patients. Nucl Med Biol 2017; 51:40-54. [DOI: 10.1016/j.nucmedbio.2017.04.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 03/07/2017] [Accepted: 04/10/2017] [Indexed: 12/24/2022]
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Noto B, Büther F, Auf der Springe K, Avramovic N, Heindel W, Schäfers M, Allkemper T, Stegger L. Impact of PET acquisition durations on image quality and lesion detectability in whole-body 68Ga-PSMA PET-MRI. EJNMMI Res 2017; 7:12. [PMID: 28168589 PMCID: PMC5293699 DOI: 10.1186/s13550-017-0261-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 01/21/2017] [Indexed: 01/09/2023] Open
Abstract
Background While 68Ga-PSMA PET-MRI might be superior to PET-CT with regard to soft tissue assessment in prostate cancer evaluation, it is also known to potentially introduce additional PET image artefacts. Therefore, the impact of PET acquisition duration and attenuation data on artefact occurrence, lesion detectability, and quantification was investigated. To this end, whole-body PET list mode data from 12 patients with prostate cancer were acquired 1 h after injection of 2 MBq/kg [68Ga]HBED-CC-PSMA on a hybrid PET-MRI system. List mode data were further transformed into data sets representing 300, 180, 90, and 30 s acquisition duration per bed position. Standard attenuation and scatter corrections were performed based on MRI-derived attenuation maps, complemented by emission-based attenuation data in areas not covered by MRI. A total of 288 image data sets were reconstructed with varying acquisition durations for emission and attenuation data with and without scatter and prompt gamma correction, and further analysed regarding image quality and diagnostic performance. Results Decreased PET acquisition durations resulted in a significantly increased incidence of halo artefacts around kidneys and bladder, decreased lesion detectability and lower SUV as well as markedly lower arm attenuation values: Halo artefacts were present in 5 out of 12 cases at 300-s duration, in 6 at 180 s, in 10 at 90 s, and in 11 cases at 30 s. Using attenuation data of the 300 s scans restored artefact occurrence to the original 300-s level. Prompt gamma correction only led to small improvements in terms of artefact occurrence and size. Of the 141 detected lesions in the 300-s images one lesion was not detected at 180 s, 28 at 90 s, and 64 at 30 s. Using the 300-s attenuation map decreased non-detectability of lesions to zero at 180 s, 9 at 90 s, and 52 at 30 s. Attenuation maps at 90 and 30 s demonstrated markedly lower mean arm attenuation values (0.002 cm-1) than those at 300 s (0.084 cm-1), and 180 s (0.062 cm-1). Conclusions Short acquisition durations of less than 3 minutes per bed position result in unacceptable image artefacts and decreased diagnostic performance in current whole-body 68Ga-PSMA PET-MRI and should be avoided. Increased image noise and imperfections in generated attenuation maps were identified as a paramount cause for image degradation. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0261-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Noto
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Florian Büther
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany. .,European Institute for Molecular Imaging, University of Münster, Münster, Germany.
| | | | - Nemanja Avramovic
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
| | - Walter Heindel
- Institute for Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany.,European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Thomas Allkemper
- Institute for Clinical Radiology, University Hospital Münster, Münster, Germany
| | - Lars Stegger
- Department of Nuclear Medicine, University Hospital Münster, Albert-Schweitzer-Campus 1, 48149, Münster, Germany
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Berliner C, Tienken M, Frenzel T, Kobayashi Y, Helberg A, Kirchner U, Klutmann S, Beyersdorff D, Budäus L, Wester HJ, Mester J, Bannas P. Detection rate of PET/CT in patients with biochemical relapse of prostate cancer using [68Ga]PSMA I&T and comparison with published data of [68Ga]PSMA HBED-CC. Eur J Nucl Med Mol Imaging 2016; 44:670-677. [DOI: 10.1007/s00259-016-3572-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022]
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