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Effects of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 (HBED-CC) PET/MRI

  • Ali Afshar-Oromieh
  • Maya Wolf
  • Uwe Haberkorn
  • Marc Kachelrieß
  • Regula Gnirs
  • Klaus Kopka
  • Heinz-Peter Schlemmer
  • Martin T. Freitag
Original Article

Abstract

Purpose

PSMA ligand imaging with hybrid PET/MRI scanners could be an integral part of the clinical routine in the future. However, the first study about this novel method revealed a severe photopenic artifact (“halo artifact”) around the urinary bladder causing significantly reduced tumor visibility. The aim of this evaluation was to analyze the role of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 PET/MRI hypothesizing that this influences the appearance.

Methods

Twenty-seven consecutive patients were subjected to 68Ga-PSMA-11 PET/CT (1 h p.i.) followed by PET/MRI (3 h p.i.). PET/MRI was first started with scans of the abdomen to pelvis with arms positioned up above the head. Immediately thereafter, additional scans from the pelvis to abdomen were conducted with arms positioned down beside the trunk. All investigations were first analyzed separately and then compared with respect to tumor detection and tumor uptake (SUV) as well as the presence and intensity of the halo artifact. The Wilcoxon signed rank test was used to determine statistical differences including Bonferroni correction.

Results

The halo was significantly reduced if the arms were elevated. Lesions inside the halo artifact (n = 16) demonstrated significantly increased SUVmean (p = 0.0007) and SUVmax (p = 0.0024) with arms positioned up. The halo appearance and intensity was not dependent on the total activity and activity concentration of the urinary bladder.

Conclusion

Positioning the arms down was shown to be significantly associated with the appearance of the halo artifact in PET/MRI. Positioning the arms up above the head can significantly reduce the halo artifact, thereby detecting more tumor lesions.

Keywords

Prostate cancer PSMA Pet/MRI Halo artifact Prostate-specific membrane antigen 

Notes

Compliance with ethical standards

Conflicts of interest

Ali Afshar-Oromieh has received honoraria from Siemens Healthcare for one educational talk. All other authors declare that they have no conflicts of interest.

Ethical approval

This retrospective study was approved by the local ethics committee (S-485/2012, S-638/2013) and was conducted in agreement with the Declaration of Helsinki. All patients gave written informed consent.

Supplementary material

259_2017_3718_Fig9_ESM.gif (78 kb)
Supplementary Figure 1

The volume of the urinary bladder was measured by drawing a 90% isocontour VOI around the urinary bladder. The software automatically calculated the activity concentration as well. (GIF 77 kb)

259_2017_3718_MOESM1_ESM.tif (622 kb)
High-resolution image (TIFF 621 kb)

References

  1. 1.
    Kosuri S, Akhtar NH, Smith M, Osborne JR, Tagawa ST. Review of salvage therapy for biochemically recurrent prostate cancer: the role of imaging and rationale for systemic salvage targeted anti-prostate-specific membrane antigen radioimmunotherapy. Adv Urol. 2012;2012:921674.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Afshar-Oromieh A, Haberkorn U, Eder M, Eisenhut M, Zechmann CM. [68Ga]gallium-labelled PSMA ligand as superior PET tracer for the diagnosis of prostate cancer: comparison with 18F-FECH. Eur J Nucl Med Mol Imaging. 2012;39:1085–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Afshar-Oromieh A, Malcher A, Eder M, Eisenhut M, Linhart HG, Hadaschik BA, et al. PET imaging with a [68Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:486–95.CrossRefPubMedGoogle Scholar
  4. 4.
    Afshar-Oromieh A, Zechmann CM, Malcher A, Eder M, Eisenhut M, Linhart HG, et al. Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2014;41:11–20.CrossRefPubMedGoogle Scholar
  5. 5.
    Afshar-Oromieh A, Avtzi E, Giesel FL, Holland-Letz T, Linhart HG, Eder M, et al. The diagnostic value of PET/CT imaging with the (68)Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer. Eur J Nucl Med Mol Imaging. 2015;42:197–209.CrossRefPubMedGoogle Scholar
  6. 6.
    Eiber M, Maurer T, Souvatzoglou M, Beer AJ, Ruffani A, Haller B, et al. Evaluation of hybrid 68Ga-PSMA ligand PET/CT in 248 patients with biochemical recurrence after radical prostatectomy. J Nucl Med Off Publ Soc Nucl Med. 2015;56:668–74.Google Scholar
  7. 7.
    Morigi JJ, Stricker PD, van Leeuwen PJ, Tang R, Ho B, Nguyen Q, et al. Prospective comparison of 18F-Fluoromethylcholine versus 68Ga-PSMA PET/CT in prostate cancer patients who have rising PSA after curative treatment and are being considered for targeted therapy. J Nucl Med Off Publ Soc Nucl Med. 2015;56:1185–90.Google Scholar
  8. 8.
    Schwenck J, Rempp H, Reischl G, Kruck S, Stenzl A, Nikolaou K, et al. Comparison of (68)Ga-labelled PSMA-11 and (11)C-choline in the detection of prostate cancer metastases by PET/CT. Eur J Nucl Med Mol Imaging. 2017;44:92–101.CrossRefPubMedGoogle Scholar
  9. 9.
    Roethke MC, Kuru TH, Afshar-Oromieh A, Schlemmer H-P, Hadaschik BA, Fenchel M. Hybrid positron emission tomography-magnetic resonance imaging with gallium 68 prostate-specific membrane antigen tracer: a next step for imaging of recurrent prostate cancer-preliminary results. Eur Urol. 2013;64:862–4.CrossRefPubMedGoogle Scholar
  10. 10.
    Afshar-Oromieh A, Haberkorn U, Schlemmer HP, Fenchel M, Eder M, Eisenhut M, et al. Comparison of PET/CT and PET/MRI hybrid systems using a 68Ga-labelled PSMA ligand for the diagnosis of recurrent prostate cancer: initial experience. Eur J Nucl Med Mol Imaging. 2014;41:887–97.CrossRefPubMedGoogle Scholar
  11. 11.
    Eiber M, Nekolla SG, Maurer T, Weirich G, Wester HJ, Schwaiger M. Ga-PSMA PET/MR with multimodality image analysis for primary prostate cancer. Abdom Imaging [Internet]. Available from: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=25412869.
  12. 12.
    Eiber M, Weirich G, Holzapfel K, Souvatzoglou M, Haller B, Rauscher I, et al. Simultaneous (68)Ga-PSMA HBED-CC PET/MRI improves the localization of primary prostate cancer. Eur Urol. 2016;70:829–36.CrossRefPubMedGoogle Scholar
  13. 13.
    Freitag MT, Radtke JP, Hadaschik BA, Kopp-Schneider A, Eder M, Kopka K, et al. Comparison of hybrid (68)Ga-PSMA PET/MRI and (68)Ga-PSMA PET/CT in the evaluation of lymph node and bone metastases of prostate cancer. Eur J Nucl Med Mol Imaging. 2016;43:70–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Freitag MT, Radtke JP, Afshar-Oromieh A, Roethke MC, Hadaschik BA, Gleave M, et al. Local recurrence of prostate cancer after radical prostatectomy is at risk to be missed in (68)Ga-PSMA-11-PET of PET/CT and PET/MRI: comparison with mpMRI integrated in simultaneous PET/MRI. Eur J Nucl Med Mol Imaging. 2016.Google Scholar
  15. 15.
    Blumhagen JO, Braun H, Ladebeck R, Fenchel M, Faul D, Scheffler K, et al. Field of view extension and truncation correction for MR-based human attenuation correction in simultaneous MR/PET imaging. Med Phys. 2014;41:022303.CrossRefPubMedGoogle Scholar
  16. 16.
    Eder M, Neels O, Müller M, Bauder-Wüst U, Remde Y, Schäfer M, et al. Novel preclinical and radiopharmaceutical aspects of [68Ga]Ga-PSMA-HBED-CC: a new PET tracer for imaging of prostate cancer. Pharm Basel Switz. 2014;7:779–96.Google Scholar
  17. 17.
    Blumhagen JO, Ladebeck R, Fenchel M, Scheffler K. MR-based field-of-view extension in MR/PET: B0 homogenization using gradient enhancement (HUGE). Magn Reson Med. 2013;70:1047–57.CrossRefPubMedGoogle Scholar
  18. 18.
    Afshar-Oromieh A, Hetzheim H, Kübler W, Kratochwil C, Giesel FL, Hope TA, et al. Radiation dosimetry of (68)Ga-PSMA-11 (HBED-CC) and preliminary evaluation of optimal imaging timing. Eur J Nucl Med Mol Imaging. 2016;43:1611–20.CrossRefPubMedGoogle Scholar
  19. 19.
    Afshar-Oromieh A, Sattler LP, Mier W, Hadaschik B, Debus J, Holland-Letz T, et al. The clinical impact of additional late PET/CT imaging with 68Ga-PSMA-11 (HBED-CC) in the diagnosis of prostate cancer. J Nucl Med Off Publ Soc Nucl Med. 2017.Google Scholar
  20. 20.
    Gaertner FC, Beer AJ, Souvatzoglou M, Eiber M, Furst S, Ziegler SI, et al. Evaluation of feasibility and image quality of 68Ga-DOTATOC positron emission tomography/magnetic resonance in comparison with positron emission tomography/computed tomography in patients with neuroendocrine tumors. Investig Radiol. 2013;48:263–72.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of Nuclear MedicineHeidelberg University HospitalHeidelbergGermany
  2. 2.Clinical Cooperation Unit Nuclear MedicineGerman Cancer Research CenterHeidelbergGermany
  3. 3.Department of RadiologyGerman Cancer Research CenterHeidelbergGermany
  4. 4.Department of Medical Physics in RadiologyGerman Cancer Research CenterHeidelbergGermany
  5. 5.Division of Radiopharmaceutical ChemistryGerman Cancer Research CenterHeidelbergGermany

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