1
|
Zang J, Yang Y, Chen S, Wang C, Chen S, Hu S, Cai H, Li X, Xu N, Chen X, Zhang J, Miao W. Diagnostic Performance of [ 18F]AlF-Thretide PET/CT in Patients with Newly Diagnosed Prostate Cancer Using Histopathology as Reference Standard. J Nucl Med 2024; 65:1021-1026. [PMID: 38724276 DOI: 10.2967/jnumed.123.266940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/25/2024] [Indexed: 07/03/2024] Open
Abstract
This study aimed to assess the diagnostic value of [18F]AlF-thretide PET/CT in patients with newly diagnosed prostate cancer (PCa). Methods: In total, 49 patients with biopsy-proven PCa were enrolled in this prospective study. All patients underwent [18F]AlF-thretide PET/CT, and the scoring system of the PRIMARY trial was used for PET image analysis. The dosimetry evaluation of [18F]AlF-thretide was performed on 3 patients. Pathologic examination was used as the reference standard to evaluate the location, number, size, and Gleason score of tumors, for comparison with the [18F]AlF-thretide PET/CT results. PSMA expression was evaluated by immunohistochemical staining. Results: All patients tolerated the [18F]AlF-thretide PET/CT well. The total effective dose of [18F]AlF-thretide was 1.16E-02 mSv/MBq. For patient-based analysis of intraprostatic tumors, 46 of 49 (93.9%) patients showed pathologic uptake on [18F]AlF-thretide PET/CT. For lesion-based analysis of intraprostatic tumors, the sensitivity and positive predictive value for [18F]AlF-thretide PET/CT were 58.2% and 90.5%, respectively. Delayed images can detect more lesions than standard images (n = 57 vs. 49, P = 0.005), and the SUVmax and tumor-to-background ratio of the former were higher than those of the latter (SUVmax: 14.5 ± 16.7 vs. 11.4 ± 13.6, P < 0.001; tumor-to-background ratio: 37.1 ± 42.3 vs. 23.1 ± 27.4, P < 0.001). The receiver-operating-characteristic curve analysis showed that the areas under the curve for PRIMARY score-predicted true-positive and false-positive lesions were significantly higher than those for the SUVmax of standard images (P = 0.015) and seemed higher than those for the SUVmax of delayed images (P = 0.257). [18F]AlF-thretide PET/CT showed a higher detection rate than multiparametric MRI for all intraprostatic foci (53.5% vs. 40.8%, P = 0.012) and clinically significant PCa (75.0% vs. 61.4%, P = 0.031). Conclusion: [18F]AlF-thretide PET/CT showed high diagnostic value for patients with primary PCa and can be used as an excellent imaging modality for preoperative evaluation of PCa patients.
Collapse
Affiliation(s)
- Jie Zang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Yun Yang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaoming Chen
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Chao Wang
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shaohao Chen
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Shun Hu
- Department of Pathology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Hai Cai
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaodong Li
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Ning Xu
- Department of Urology, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| | - Xiaoyuan Chen
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Chemical and Biomolecular Engineering and Department of Biomedical Engineering, College of Design and Engineering, National University of Singapore, Singapore, Singapore
- Institute of Molecular and Cell Biology, Agency for Science, Technology, and Research, Proteos, Singapore, Singapore; and
| | - Jingjing Zhang
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore;
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Weibing Miao
- Department of Nuclear Medicine, First Affiliated Hospital, Fujian Medical University, Fuzhou, China;
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of First Affiliated Hospital, Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Precision Medicine for Cancer, First Affiliated Hospital, Fujian Medical University, Fuzhou, China
| |
Collapse
|
2
|
García Vicente AM, Lucas Lucas C, Pérez-Beteta J, Borrelli P, García Zoghby L, Amo-Salas M, Soriano Castrejón ÁM. Analytical performance validation of aPROMISE platform for prostate tumor burden, index and dominant tumor assessment with 18F-DCFPyL PET/CT. A pilot study. Sci Rep 2024; 14:3001. [PMID: 38321201 PMCID: PMC10847509 DOI: 10.1038/s41598-024-53683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 02/03/2024] [Indexed: 02/08/2024] Open
Abstract
To validate the performance of automated Prostate Cancer Molecular Imaging Standardized Evaluation (aPROMISE) in quantifying total prostate disease burden with 18F-DCFPyL PET/CT and to evaluate the interobserver and histopathologic concordance in the establishment of dominant and index tumor. Patients with a recent diagnosis of intermediate/high-risk prostate cancer underwent 18F-DCFPyL-PET/CT for staging purpose. In positive-18F-DCFPyL-PET/CT scans, automated prostate tumor segmentation was performed using aPROMISE software and compared to an in-house semiautomatic-manual guided segmentation procedure. SUV and volume related variables were obtained with two softwares. A blinded evaluation of dominant tumor (DT) and index tumor (IT) location was assessed by both groups of observers. In histopathological analysis, Gleason, International Society of Urological Pathology (ISUP) group, DT and IT location were obtained. We compared all the obtained variables by both software packages using intraclass correlation coefficient (ICC) and Cohen's kappa coefficient (k) for the concordance analysis. Fifty-four patients with a positive 18F-DCFPyL PET/CT were evaluated. The ICC for the SUVmax, SUVpeak, SUVmean, tumor volume (TV) and total lesion activity (TLA) was: 1, 0.833, 0.615, 0.494 and 0.950, respectively (p < 0.001 in all cases). For DT and IT detection, a high agreement was observed between both softwares (k = 0.733; p < 0.001 and k = 0.812; p < 0.001, respectively) although the concordances with histopathology were moderate (p < 0001). The analytical validation of aPROMISE showed a good performance for the SUVmax, TLA, DT and IT definition in comparison to our in-house method, although the concordance was moderate with histopathology for DT and IT.
Collapse
Affiliation(s)
- Ana María García Vicente
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain.
| | | | - Julián Pérez-Beteta
- Mathematical Oncology Laboratory (MOLab), Castilla-La Mancha University, Ciudad Real, Spain
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Pablo Borrelli
- Department of Clinical Physiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laura García Zoghby
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| | - Mariano Amo-Salas
- Department of Mathematics, Castilla-La Mancha University, Ciudad Real, Spain
| | - Ángel María Soriano Castrejón
- Nuclear Medicine Department, Complejo Hospitalario Universitario de Toledo, Avda. Rio Guadiana s/n, 45007, Toledo, Spain
| |
Collapse
|
3
|
Gossili F, Mogensen AW, Konnerup TC, Bouchelouche K, Alberts I, Afshar-Oromieh A, Zacho HD. The diagnostic accuracy of radiolabeled PSMA-ligand PET for tumour staging in newly diagnosed prostate cancer patients compared to histopathology: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging 2023; 51:281-294. [PMID: 37597010 DOI: 10.1007/s00259-023-06392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The current clinical recommendations posit the deployment of specific approved radiolabeled prostate-specific membrane antigen-ligand positron emission tomography (PSMA PET) for detecting metastatic prostate cancer during primary staging. Nevertheless, the precise efficacy of such ligands in localizing intraprostatic tumours (index tumour) and T-staging is not well established. Consequently, the objective of this inquiry is to ascertain the diagnostic accuracy of PSMA-PET in the tumour staging of newly diagnosed prostate cancer by means of a meta-analysis that integrates studies utilizing histological confirmation as the reference standard. METHODS In this study, we conducted a systematic literature search of the PubMed, Embase, Web of Science, and Cochrane Library databases using a predefined collection of search terms. These terms included 'PSMA PET', 'primary staging', and 'prostate cancer'. Subsequently, two independent reviewers evaluated all the studies based on predetermined inclusion criteria, extracted pertinent data, and assessed the quality of evidence. Any disparities were resolved by a third reviewer. A random effects Sidik-Jonkman model was applied to conduct a meta-analysis and estimate the diagnostic accuracy on a per-patient basis, along with 95% confidence intervals. Moreover, an appraisal regarding the likelihood of publication bias and the impact of small-study effects was performed utilizing both Egger's test and a graphical examination of the funnel plot. RESULTS The present analysis comprised a total of twenty-three scientific papers encompassing 969 patients and involved their analysis by both qualitative and quantitative approaches. The results of this study demonstrated that the estimated diagnostic accuracy of PSMA PET/CT and PSMA PET/MRI, for the detection of intraprostatic tumours, regardless of the type of PSMA-ligand, was 86% (95% CI: 76-96%) and 97% (95% CI: 94-100%), respectively. Furthermore, the diagnostic accuracy for the detection of extraprostatic extension (EPE) was 73% (95% CI: 64-82%) and 77% (95% CI: 69-85%), while the diagnostic accuracy for the detection of seminal vesicle involvement (SVI) was 87% (95% CI: 80-93) and 90% (95% CI: 82-99%), respectively. CONCLUSION The present investigation has demonstrated that PSMA PET/MRI surpasses currently recommended multiparametric magnetic resonance imaging (mpMRI) in terms of diagnostic accuracy as inferred from a notable data trajectory, whereas PSMA-PET/CT exhibited comparable diagnostic accuracy for intraprostatic tumour detection and T-staging compared to mpMRI. Nevertheless, the analysis has identified certain potential limitations, such as small-study effects and a potential for publication bias, which may impact the overall conclusions drawn from this study.
Collapse
Affiliation(s)
- Farid Gossili
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | - Anna Winther Mogensen
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Ian Alberts
- Department of Nuclear Medicine. Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ali Afshar-Oromieh
- Department of Nuclear Medicine. Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helle D Zacho
- Department of Nuclear Medicine and Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
4
|
Luo L, Zheng A, Chang R, Li Y, Gao J, Wang Z, Duan X. Evaluating the value of 18F-PSMA-1007 PET/CT in the detection and identification of prostate cancer using histopathology as the standard. Cancer Imaging 2023; 23:108. [PMID: 37924154 PMCID: PMC10623763 DOI: 10.1186/s40644-023-00627-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/19/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Prostate-specific membrane antigen (PSMA) PET/CT is a highly regarded radionuclide imaging modality for prostate cancer (PCa). This study aimed to evaluate the diagnostic performance of 18F-PSMA-1007 PET/CT in detecting intraprostatic lesions of PCa using radical prostatectomy (RP) specimens as a reference standard and to establish an optimal maximum standardized uptake value (SUVmax) cutoff for distinguishing between PCa and non-PCa lesions. METHODS We retrospectively collected 117 patients who underwent 18F-PSMA-1007 PET/CT before RP. The uptake of the index tumor and contralateral non-PCa lesion was assessed. Histopathology of RP specimens was used as the gold standard. Kappa test was used to evaluate the consistency of preoperative PSMA PET/CT staging and postoperative pathological staging. Finally, an SUVmax cutoff value was identified by receiver operating characteristic (ROC) curve analysis to distinguish PCa lesions from non-PCa lesions. A prospective cohort including 76 patients was used to validate the results. RESULTS The detection rate of 18F-PSMA-1007 PET/CT for prostate cancer was 96.6% (113/117). 18F-PSMA-1007 had a sensitivity of 91.2% and a positive predictive value (PPV) of 89.8% for the identification of intraprostatic lesions. The consistency test (Kappa = 0.305) indicated poor agreement between the pathologic T-stage and PSMA PET/CT T-stage. Based on ROC curve analysis, the appropriate SUVmax to diagnose PCa lesions was 8.3 (sensitivity of 71.3% and specificity 96.8%) with an area under the curve (AUC) of 0.93 (P < 0.001). This SUVmax cutoff discriminated PCa lesions from non-PCa lesions with a sensitivity of 74.4%, a specificity of 95.8% in the prospective validation group. CONCLUSIONS 18F-PSMA-1007 PET/CT demonstrated excellent performance in detecting PCa. An optimal SUVmax threshold (8.3) could be utilized to identify lesions of PCa by 18F-PSMA-1007 PET/CT. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04521894, Registered: August 17, 2020.
Collapse
Affiliation(s)
- Liang Luo
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Anqi Zheng
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Ruxi Chang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Yunxuan Li
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Jungang Gao
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China
| | - Zhuonan Wang
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China.
| | - Xiaoyi Duan
- PET/CT Center, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Shaanxi Province, Xi'an, 710061, China.
| |
Collapse
|
5
|
Holzschuh JC, Mix M, Ruf J, Hölscher T, Kotzerke J, Vrachimis A, Doolan P, Ilhan H, Marinescu IM, Spohn SKB, Fechter T, Kuhn D, Bronsert P, Gratzke C, Grosu R, Kamran SC, Heidari P, Ng TSC, Könik A, Grosu AL, Zamboglou C. Deep learning based automated delineation of the intraprostatic gross tumour volume in PSMA-PET for patients with primary prostate cancer. Radiother Oncol 2023; 188:109774. [PMID: 37394103 PMCID: PMC10862258 DOI: 10.1016/j.radonc.2023.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/17/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE With the increased use of focal radiation dose escalation for primary prostate cancer (PCa), accurate delineation of gross tumor volume (GTV) in prostate-specific membrane antigen PET (PSMA-PET) becomes crucial. Manual approaches are time-consuming and observer dependent. The purpose of this study was to create a deep learning model for the accurate delineation of the intraprostatic GTV in PSMA-PET. METHODS A 3D U-Net was trained on 128 different 18F-PSMA-1007 PET images from three different institutions. Testing was done on 52 patients including one independent internal cohort (Freiburg: n = 19) and three independent external cohorts (Dresden: n = 14 18F-PSMA-1007, Boston: Massachusetts General Hospital (MGH): n = 9 18F-DCFPyL-PSMA and Dana-Farber Cancer Institute (DFCI): n = 10 68Ga-PSMA-11). Expert contours were generated in consensus using a validated technique. CNN predictions were compared to expert contours using Dice similarity coefficient (DSC). Co-registered whole-mount histology was used for the internal testing cohort to assess sensitivity/specificity. RESULTS Median DSCs were Freiburg: 0.82 (IQR: 0.73-0.88), Dresden: 0.71 (IQR: 0.53-0.75), MGH: 0.80 (IQR: 0.64-0.83) and DFCI: 0.80 (IQR: 0.67-0.84), respectively. Median sensitivity for CNN and expert contours were 0.88 (IQR: 0.68-0.97) and 0.85 (IQR: 0.75-0.88) (p = 0.40), respectively. GTV volumes did not differ significantly (p > 0.1 for all comparisons). Median specificity of 0.83 (IQR: 0.57-0.97) and 0.88 (IQR: 0.69-0.98) were observed for CNN and expert contours (p = 0.014), respectively. CNN prediction took 3.81 seconds on average per patient. CONCLUSION The CNN was trained and tested on internal and external datasets as well as histopathology reference, achieving a fast GTV segmentation for three PSMA-PET tracers with high diagnostic accuracy comparable to manual experts.
Collapse
Affiliation(s)
- Julius C Holzschuh
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany.
| | - Michael Mix
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, Dresden, Germany
| | - Alexis Vrachimis
- Department of Nuclear Medicine, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Paul Doolan
- Department of Radiation Oncology, German Oncology Center - University Hospital of the European University, Limassol, Cyprus
| | - Harun Ilhan
- Department of Nuclear Medicine, University Hospital - Ludwig-Maximilians-Universität, Munich, Germany
| | - Ioana M Marinescu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Simon K B Spohn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Faculty of Medicine - University of Freiburg, Berta-Ottenstein-Programme, Freiburg, Germany
| | - Tobias Fechter
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Dejan Kuhn
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany; Division of Medical Physics, Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Peter Bronsert
- Department of Pathology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Christian Gratzke
- Department of Urology, Medical Center - University of Freiburg, Freiburg, Germany
| | - Radu Grosu
- Cyber-Physical Systems Division, Institute of Computer Engineering and Faculty of Informatics, Technical University of Vienna, Vienna, Austria; Department of Computer Science, State University of New York at Stony Brook, NY, USA
| | - Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital - Harvard Medical School, Boston, USA
| | - Pedram Heidari
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA
| | - Thomas S C Ng
- Division of Nuclear Medicine and Molecular Imaging, Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, USA; Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Arda Könik
- Joint Program in Nuclear Medicine, Brigham and Women's Hospital - Harvard Medical School, Boston, USA; Department of Imaging, Dana-Farber Cancer Institute - Harvard Medical School, Boston, USA
| | - Anca-Ligia Grosu
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Freiburg, Germany; German Oncology Center, European University of Cyprus, Limassol, Cyprus
| |
Collapse
|
6
|
Wu Y, Sun X, Zhang B, Zhang S, Wang X, Sun Z, Liu R, Zhang M, Hu K. Marriage of radiotracers and total-body PET/CT rapid imaging system: current status and clinical advances. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2023; 13:195-207. [PMID: 38023815 PMCID: PMC10656629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/02/2023] [Indexed: 12/01/2023]
Abstract
Radiotracers and medical imaging equipment are the two main keys to molecular imaging. While radiotracers are of great interest to research and industry, medical imaging equipment technology is blossoming everywhere. Total-body PET/CT (TB-PET/CT) has emerged in response to this trend and is rapidly gaining traction in the fields of clinical oncology, cardiovascular medicine, inflammatory/infectious diseases, and pediatric diseases. In addition, the use of a growing number of radiopharmaceuticals in TB-PET/CT systems has shown promising results. Notably, the distinctive features of TB-PET/CT, such as its ultra-long axial field of view (194 cm), ultra-high sensitivity, and capability for low-dose tracer imaging, have enabled enhanced imaging quality while reducing the radiation dose. The envisioned whole-body dynamic imaging, delayed imaging, personalized disease management, and ultrafast acquisition for motion correction, among others, are achieved. This review highlights two key factors affecting molecular imaging, describing the rapid imaging effects of radiotracers allowed at low doses on TB-PET/CT and the improvements offered compared to conventional PET/CT.
Collapse
Affiliation(s)
- Yuxuan Wu
- Beijing Engineering Research Center of Printed Electronics, School of Printing and Packaging Engineering, Beijing Institute of Graphic CommunicationBeijing 102600, China
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
| | - Xiaona Sun
- Beijing Engineering Research Center of Printed Electronics, School of Printing and Packaging Engineering, Beijing Institute of Graphic CommunicationBeijing 102600, China
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
| | - Boyang Zhang
- Beijing Engineering Research Center of Printed Electronics, School of Printing and Packaging Engineering, Beijing Institute of Graphic CommunicationBeijing 102600, China
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
| | - Siqi Zhang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
| | - Xingkai Wang
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
| | - Zhicheng Sun
- Beijing Engineering Research Center of Printed Electronics, School of Printing and Packaging Engineering, Beijing Institute of Graphic CommunicationBeijing 102600, China
| | - Ruping Liu
- Beijing Engineering Research Center of Printed Electronics, School of Printing and Packaging Engineering, Beijing Institute of Graphic CommunicationBeijing 102600, China
| | - Mingrong Zhang
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and TechnologyChiba 263-8555, Japan
| | - Kuan Hu
- State Key Laboratory of Bioactive Substance and Function of Natural Medicines, Institute of Materia Medica, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing 100050, China
- Department of Advanced Nuclear Medicine Sciences, Institute of Quantum Medical Science, National Institutes for Quantum Science and TechnologyChiba 263-8555, Japan
| |
Collapse
|
7
|
Yu W, Zhao M, Deng Y, Liu S, Du G, Yan B, Zhao Z, Sun N, Guo J. Meta-analysis of 18 F-PSMA-1007 PET/CT, 18 F-FDG PET/CT, and 68Ga-PSMA PET/CT in diagnostic efficacy of prostate Cancer. Cancer Imaging 2023; 23:77. [PMID: 37605288 PMCID: PMC10440897 DOI: 10.1186/s40644-023-00599-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To compare 18 F-PSMA-1007 PET/CT, 18 F-FDG PET/CT and 68Ga-PSMA PET/CT in the diagnostic value of prostate cancer. METHOD The Chinese and foreign databases, such as Pubmed, Cochrane Library, Embase, CNKI, VIP, Wanfang, etc., were systematically searched within the period from the establishment of the database to June 1, 2022. Clinical studies related to the diagnosis of prostate cancer by methods such as 18 F-PSMA-1007 PET/CT, 18 F-FDG PET/CTCT, 68Ga-PSMA PET/CT, were researched. Two (2) investigators independently screened literatures, extracted data, and assessed the risk of bias when these data were included in the studies with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Review Manager5.4, Stata 14.0, and Meta-disc 1.4 software were used for meta-analysis to compare the efficacy of different methods in the diagnose of prostate cancer. RESULTS Twenty-seven (27) studies, including 2891 subjects were included in our study. Meta-analysis results showed that the pooled sensitivities of 18 F-PSMA-1007 PET/CT, 18 F-FDG PET/CT, and 68Ga-PSMA PET/CT were 0.912 (95%CI: 0.883-0.936), 0.748 (95%CI: 0.698-0.795), and 0.916 (95%CI: 0.896-0.934), respectively; the pooled specification were 0.878 (0.844-0.907), 0.639 (95%CI: 0.589-0.687), and 0.734 (95%CI: 0.685-0.779), respectively; the positive likelihood ratios were 6.335 (95%CI: 4.288-9.357), 2.282 (95%CI: 1.497-3.477), and 3.593 (95%CI: 2.986-4.323), respectively; the negative likelihood ratios were 0.878 (95%CI: 0.844-0.907), 0.374 (95%CI: 0.280-0.499), and 0.110 (95%CI: 0.083-0.144), respectively; the diagnostic odds ratios were 65.125 (95%CI: 34.059-124.53), 7.094 (95%CI: 4.091-12.301), and 29.722 (95%CI: 20.141-43.863), respectively; the positive posterior probability was 64%, 38%, and 62%, respectively; the area under the SPOC curve was 0.95 (95%CI: 0.93-0.97), 0.81 (95%CI: 0.78-0.84), and 0.96 (95%CI: 0.92-0.98), respectively. The funnel plots indicated that there was no significant publication bias in the included literatures. CONCLUSION The current evidences showed that 18 F-PSMA-1007 PET/CT and 68Ga-PSMA PET/CT had higher diagnostic efficacy of prostate cancer compared with 18 F-FDG PET/CT, among which 68Ga-PSMA PET/CT was slightly higher in the sensitivity of the diagnosis of prostate cancer, while 18 F-PSMA-1007 PET/CT may have higher efficacy in specificity and confirmed positive rate. Due to the limitations of the quality of the included samples and literatures, the above conclusions should be further validated by expanding the sample size and improving the quality.
Collapse
Affiliation(s)
- Wenxiao Yu
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
- Post-doctoral Research Station, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Ming Zhao
- Graduate School, Beijing University of Chinese Medicine, 11 North Third Ring East Road, Chaoyang, Beijing, China
| | - Yingjun Deng
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Shengjing Liu
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Guanchao Du
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Bin Yan
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Ziwei Zhao
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China
| | - Ning Sun
- Post-doctoral Research Station, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China.
| | - Jun Guo
- Department of Andrology, Xiyuan Hospital of China Academy of Chinese Medical Sciences, No.1, R. Xiyuangcaochang, District Haidian, Beijing, 100091, China.
| |
Collapse
|
8
|
Hvittfeldt E, Bjöersdorff M, Brolin G, Minarik D, Svegborn SL, Oddstig J, Trägårdh E. Biokinetics and dosimetry of 18 F-PSMA-1007 in patients with prostate cancer. Clin Physiol Funct Imaging 2022; 42:443-452. [PMID: 36039853 PMCID: PMC9826386 DOI: 10.1111/cpf.12785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 08/26/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Positron emission tomography-computed tomography (PET-CT) using prostate-specific membrane antigen (PSMA) ligands is a method for imaging prostate cancer. A recent tracer, 18 F-PSMA-1007, offers advantages concerning production and biokinetics compared to the standard tracer (68 Ga-PSMA-11). Until now, radiation dosimetry data for this ligand was limited to the material of three healthy volunteers. The purpose of this study is to study the biokinetics and dosimetry of 18 F-PSMA-1007. METHODS Twelve patients with prostate cancer were injected with 4 MBq/kg 18 F-PSMA-1007. Eight PET-CT scans with concomitant blood sampling were performed up to 330 min after injection. Urine was collected until the following morning. Volumes of interest for radiation-sensitive organs and organs with high uptake of 18 F-PSMA-1007 were drawn in the PET images. A biokinetic compartment model was developed using activity data from PET images and blood and urine samples. Time-activity curves and time-integrated activity coefficients for all delineated organs were calculated. The software IDAC-dose 2.1 was used to calculate the absorbed and effective doses. RESULTS High concentrations of activity were noted in the liver, kidneys, parts of the small intestine, spleen, salivary glands, and lacrimal glands. The elimination through urine was 8% of injected activity in 20 h. The highest absorbed doses coefficients were in the lacrimal glands, kidneys, salivary glands, liver, and spleen (98-66 µGy/MBq). The effective dose coefficient was 25 µSv/MBq. CONCLUSION The effective dose of 18 F-PSMA-1007 is 6.0-8.0 mSv for a typical patient weighing 80 kg injected with 3-4 MBq/kg.
Collapse
Affiliation(s)
- Erland Hvittfeldt
- Department of Clinical Physiology and Nuclear MedicineSkåne University HospitalMalmöSweden,Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden
| | - Mimmi Bjöersdorff
- Department of Clinical Physiology and Nuclear MedicineSkåne University HospitalMalmöSweden,Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden
| | - Gustav Brolin
- Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden,Department of Radiation PhysicsSkåne University HospitalMalmö and LundSweden
| | - David Minarik
- Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden,Department of Radiation PhysicsSkåne University HospitalMalmö and LundSweden
| | - Sigrid L. Svegborn
- Department of Translational MedicineLund UniversityLundSweden,Department of Radiation PhysicsSkåne University HospitalMalmö and LundSweden
| | - Jenny Oddstig
- Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden,Department of Radiation PhysicsSkåne University HospitalMalmö and LundSweden
| | - Elin Trägårdh
- Department of Clinical Physiology and Nuclear MedicineSkåne University HospitalMalmöSweden,Wallenberg Centre for Molecular MedicineLund UniversityLundSweden,Department of Translational MedicineLund UniversityLundSweden
| |
Collapse
|
9
|
Huang YT, Tseng NC, Chen YK, Huang KH, Lin HY, Huang YY, Hwang TIS, Ou YC. The Detection Performance of 18 F-Prostate-Specific Membrane Antigen-1007 PET/CT in Primary Prostate Cancer : A Systemic Review and Meta-analysis. Clin Nucl Med 2022; 47:755-762. [PMID: 35452013 DOI: 10.1097/rlu.0000000000004228] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Multiple tools are now available to determine the requirement for a biopsy to diagnose prostate cancer, and PET/CT with radiolabeled prostate-specific membrane antigen (PSMA)-targeting radiotracers has been recommended for detecting primary prostate cancer. Particularly, the radiotracer 18 F-PSMA-1007 was found to be more favorable for primary tumors compared with other PSMA-targeting radiotracers because of its low clearance via the urinary tract and better image resolution. Thus, we performed a systematic review and meta-analysis to more accurately evaluate the detection performance of 18 F-PSMA-1007 PET/CT in primary prostate cancer patients. METHODS An update on the databases of PubMed/MEDLINE, EMBASE, and Cochrane Library for comprehensive literature search was performed on September 30, 2021. The pooling detection rate was calculated on a per-patient basis. The pooling median of the SUV max was analyzed from the included studies. Furthermore, the positive predictive value of 18 F-PSMA-1007 PET/CT with pathologic lesions was analyzed using the criterion standard. RESULTS Twelve studies (540 patients total) were included in the meta-analysis. The overall pooling detection rate of 18 F-PSMA-1007 per patient was 94%, and the pooling median of SUV max located at the intraprostate tumor was 16 (range, 3.7-77.7). The positive predictive value of 18 F-PSMA-1007 per lesion with histopathological validation was 0.90, detecting regional lymph node metastasis was 0.94, and detecting localized prostatic tumors was 0.84. CONCLUSIONS In the current meta-analysis, we revealed the excellent performance of 18 F-PSMA-1007 to detect localized prostatic tumor lesions and regional lymph node metastasis. Moreover, the uptake of localized tumors in primary prostate cancer was nearly liver uptake and may be considered a suspicious malignancy if it was equal to or greater than the liver uptake.
Collapse
|
10
|
Liu X, Jiang T, Gao C, Liu H, Sun Y, Zou Q, Tang R, Zeng W. Detection rate of fluorine-18 prostate-specific membrane antigen-1007 PET/CT for prostate cancer in primary staging and biochemical recurrence with different serum PSA levels: A systematic review and meta-analysis. Front Oncol 2022; 12:911146. [PMID: 35936732 PMCID: PMC9353183 DOI: 10.3389/fonc.2022.911146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background We performed a systematic review and meta-analysis to evaluate the detection rate (DR) of fluoro-prostate-specific membrane antigen (18F-PSMA-1007) PET/CT in patients with different serum prostate-specific antigen (PSA) levels in the setting of primary staging of prostate cancer (PCa) or biochemically recurring PCa. Methods A comprehensive electronic literature search of the PubMed, Embase, and Cochrane Library databases was conducted in accordance with the PRISMA statement. This study was registered in the PROSPERO database (registration number: CRD42022331595). We calculated the DR of 18F-PSMA-1007 PET/CT in PCa. Results The final analysis included 15 studies that described 1,022 patients and 2,034 lesions with 18F-PSMA-1007 PET/CT in PCa. The DR of 18F-PSMA-1007 PET/CT in patients with PCa in primary staging ranged from 90% to 100%, with a pooled estimate of 94% (95% CI: 92%–96%). The DR of 18F-PSMA-1007 PET/CT in patients with PCa in BCR ranged from 47% to 100%, with a pooled estimate of 86% (95% CI: 76%–95%). The DRs of PSA levels >2.0, 1.1–2.0, 0.51–1.0, and ≤0.5 ng/ml detected by 18F-PSMA-1007 PET/CT in a patient-based analysis were 97% (95% CI: 93%–99%), 95% (95% CI: 88%–99%), 79% (95% CI: 68%–88%), and 68% (95% CI: 58%–78%), respectively. Conclusion This meta-analysis concluded that 18F-PSMA-1007 PET/CT had a high application value for prostate cancer, including primary tumors and biochemical recurrence. The DR of 18F-PSMA-1007 PET/CT was slightly higher in primary prostate tumors than in biochemical recurrence. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier CRD42022331595.
Collapse
Affiliation(s)
- Xue Liu
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Tao Jiang
- Department of Nuclear Medicine, The First People’s Hospital of Huaihua City, Hunan, China
| | - CaiLiang Gao
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - HuiTing Liu
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Yu Sun
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Qiao Zou
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Rui Tang
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
| | - WenBing Zeng
- PET-CT Center, Chongqing University Three Gorges Hospital, Chongqing, China
- *Correspondence: WenBing Zeng,
| |
Collapse
|
11
|
Manafi-Farid R, Ranjbar S, Jamshidi Araghi Z, Pilz J, Schweighofer-Zwink G, Pirich C, Beheshti M. Molecular Imaging in Primary Staging of Prostate Cancer Patients: Current Aspects and Future Trends. Cancers (Basel) 2021; 13:5360. [PMID: 34771523 PMCID: PMC8582501 DOI: 10.3390/cancers13215360] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/17/2021] [Accepted: 10/19/2021] [Indexed: 12/19/2022] Open
Abstract
Accurate primary staging is the cornerstone in all malignancies. Different morphological imaging modalities are employed in the evaluation of prostate cancer (PCa). Regardless of all developments in imaging, invasive histopathologic evaluation is still the standard method for the detection and staging of the primary PCa. Magnetic resonance imaging (MRI) and computed tomography (CT) play crucial roles; however, functional imaging provides additional valuable information, and it is gaining ever-growing acceptance in the management of PCa. Targeted imaging with different radiotracers has remarkably evolved in the past two decades. [111In]In-capromab pendetide scintigraphy was a new approach in the management of PCa. Afterwards, positron emission tomography (PET) tracers such as [11C/18F]choline and [11C]acetate were developed. Nevertheless, none found a role in the primary staging. By introduction of the highly sensitive small molecule prostate-specific membrane antigen (PSMA) PET/CT, as well as recent developments in MRI and hybrid PET/MRI systems, non-invasive staging of PCa is being contemplated. Several studies investigated the role of these sophisticated modalities in the primary staging of PCa, showing promising results. Here, we recapitulate the role of targeted functional imaging. We briefly mention the most popular radiotracers, their diagnostic accuracy in the primary staging of PCa, and impact on patient management.
Collapse
Affiliation(s)
- Reyhaneh Manafi-Farid
- Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran 1411713135, Iran;
| | - Shaghayegh Ranjbar
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Zahra Jamshidi Araghi
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Julia Pilz
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Gregor Schweighofer-Zwink
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Christian Pirich
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| | - Mohsen Beheshti
- Department of Nuclear Medicine, Division of Molecular Imaging and Theranostics, University Hospital Salzburg, Paracelsus Medical University, Muellner Hauptstrasse 48, 5020 Salzburg, Austria; (S.R.); (Z.J.A.); (J.P.); (G.S.-Z.); (C.P.)
| |
Collapse
|