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(68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer

BACKGROUND: (68)Ga-labelled prostate specific membrane antigen (PSMA) ligand PET/CT is a promising modality in primary staging (PS) and biochemical relapse (BCR) of prostate cancer (PC). However, pelvic nodes or local recurrences can be difficult to differentiate from radioactive urine. CT urography...

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Autores principales: Iravani, Amir, Hofman, Michael S., Mulcahy, Tony, Williams, Scott, Murphy, Declan, Parameswaran, Bimal K., Hicks, Rodney J.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740783/
https://www.ncbi.nlm.nih.gov/pubmed/29268784
http://dx.doi.org/10.1186/s40644-017-0133-5
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author Iravani, Amir
Hofman, Michael S.
Mulcahy, Tony
Williams, Scott
Murphy, Declan
Parameswaran, Bimal K.
Hicks, Rodney J.
author_facet Iravani, Amir
Hofman, Michael S.
Mulcahy, Tony
Williams, Scott
Murphy, Declan
Parameswaran, Bimal K.
Hicks, Rodney J.
author_sort Iravani, Amir
collection PubMed
description BACKGROUND: (68)Ga-labelled prostate specific membrane antigen (PSMA) ligand PET/CT is a promising modality in primary staging (PS) and biochemical relapse (BCR) of prostate cancer (PC). However, pelvic nodes or local recurrences can be difficult to differentiate from radioactive urine. CT urography (CT-U) is an established method, which allows assessment of urological malignancies. The study presents a novel protocol of (68)Ga-PSMA-11 PET/CT-U in PS and BCR of PC. METHODS: A retrospective review of PSMA PET/CT-U preformed on 57 consecutive patients with prostate cancer. Fifty mL of IV contrast was administered 10 min (range 8–15) before the CT component of a combined PET/CT study, acquired approximately 60 min (range 40–85) after administration of 166 MBq (range 91–246) of (68)Ga-PSMA-11. PET and PET/CT-U were reviewed by two nuclear medicine physicians and CT-U by a radiologist. First, PET images were reviewed independently followed by PET/CT-U images. Foci of activity which could not unequivocally be assessed as disease or urinary activity were recorded. PET/CT-U was considered of potential benefit in final interpretation when the equivocal focal activity in PET images corresponded to opacified ureter, bladder, prostate bed, seminal vesicles, or urethra. Student’s T test and Pearson’s correlation coefficient was used for assessment of variables including lymph node size and standardized uptake value. RESULTS: Overall 50 PSMA PET/CT-U studies were performed for BCR and 7 for PS. Median PSA with BCR and PS were 2.0 ± 11.4 ng/ml (0.06–57.3 ng/ml) and 18 ± 35.3 ng/ml (6.8–100 ng/ml), respectively. The median Gleason-score for both groups was 7 (range 6–10). In BCR group, PSMA PET was reported positive in 36 (72%) patients, CT-U in 11(22%) patients and PET/CT-U in 33 (66%) patients. In PS group, PSMA PET detected the primary site in all seven patients, of which one patient with metastatic nodal disease had negative CT finding. Of 40 equivocal foci (27/57 patients) on PET, 11 foci (10/57 patients, 17.5%) were localized to enhanced urine on PET/CT-U, hence considered of potential benefit in interpretation. Of those, 3 foci (3 patients) were solitary sites of activity on PSMA imaging including two local and one nodal site and 4 foci (3 patients) were in different nodal fields. CONCLUSIONS: PET/CT-U protocol is a practical approach and may assist in interpretation of (68)Ga-PSMA-11 imaging by delineation of the contrast opacified genitourinary system and matching focal PSMA activity with urinary contrast. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40644-017-0133-5) contains supplementary material, which is available to authorized users.
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spelling pubmed-57407832018-01-03 (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer Iravani, Amir Hofman, Michael S. Mulcahy, Tony Williams, Scott Murphy, Declan Parameswaran, Bimal K. Hicks, Rodney J. Cancer Imaging Research Article BACKGROUND: (68)Ga-labelled prostate specific membrane antigen (PSMA) ligand PET/CT is a promising modality in primary staging (PS) and biochemical relapse (BCR) of prostate cancer (PC). However, pelvic nodes or local recurrences can be difficult to differentiate from radioactive urine. CT urography (CT-U) is an established method, which allows assessment of urological malignancies. The study presents a novel protocol of (68)Ga-PSMA-11 PET/CT-U in PS and BCR of PC. METHODS: A retrospective review of PSMA PET/CT-U preformed on 57 consecutive patients with prostate cancer. Fifty mL of IV contrast was administered 10 min (range 8–15) before the CT component of a combined PET/CT study, acquired approximately 60 min (range 40–85) after administration of 166 MBq (range 91–246) of (68)Ga-PSMA-11. PET and PET/CT-U were reviewed by two nuclear medicine physicians and CT-U by a radiologist. First, PET images were reviewed independently followed by PET/CT-U images. Foci of activity which could not unequivocally be assessed as disease or urinary activity were recorded. PET/CT-U was considered of potential benefit in final interpretation when the equivocal focal activity in PET images corresponded to opacified ureter, bladder, prostate bed, seminal vesicles, or urethra. Student’s T test and Pearson’s correlation coefficient was used for assessment of variables including lymph node size and standardized uptake value. RESULTS: Overall 50 PSMA PET/CT-U studies were performed for BCR and 7 for PS. Median PSA with BCR and PS were 2.0 ± 11.4 ng/ml (0.06–57.3 ng/ml) and 18 ± 35.3 ng/ml (6.8–100 ng/ml), respectively. The median Gleason-score for both groups was 7 (range 6–10). In BCR group, PSMA PET was reported positive in 36 (72%) patients, CT-U in 11(22%) patients and PET/CT-U in 33 (66%) patients. In PS group, PSMA PET detected the primary site in all seven patients, of which one patient with metastatic nodal disease had negative CT finding. Of 40 equivocal foci (27/57 patients) on PET, 11 foci (10/57 patients, 17.5%) were localized to enhanced urine on PET/CT-U, hence considered of potential benefit in interpretation. Of those, 3 foci (3 patients) were solitary sites of activity on PSMA imaging including two local and one nodal site and 4 foci (3 patients) were in different nodal fields. CONCLUSIONS: PET/CT-U protocol is a practical approach and may assist in interpretation of (68)Ga-PSMA-11 imaging by delineation of the contrast opacified genitourinary system and matching focal PSMA activity with urinary contrast. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s40644-017-0133-5) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-21 /pmc/articles/PMC5740783/ /pubmed/29268784 http://dx.doi.org/10.1186/s40644-017-0133-5 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Iravani, Amir
Hofman, Michael S.
Mulcahy, Tony
Williams, Scott
Murphy, Declan
Parameswaran, Bimal K.
Hicks, Rodney J.
(68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title_full (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title_fullStr (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title_full_unstemmed (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title_short (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer
title_sort (68)ga psma-11 pet with ct urography protocol in the initial staging and biochemical relapse of prostate cancer
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5740783/
https://www.ncbi.nlm.nih.gov/pubmed/29268784
http://dx.doi.org/10.1186/s40644-017-0133-5
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