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The potential role of osteoporosis in unspecific [18F]PSMA-1007 bone uptake

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

Unspecific bone uptake is one of the main limitations of PET imaging with some PSMA-targeting radiopharmaceuticals, especially with [18F]PSMA-1007. We explored the potential association between osteoporosis and the occurrence of unspecific [18F]PSMA-1007 bone uptake investigating markers which might correlate with bone mineral density.

Materials and methods

We retrospectively analyzed treatment-naïve patients with a confirmed diagnosis of prostate adenocarcinoma who underwent staging [18F]PSMA-1007 positron emission tomography (PET). Qualitative image analysis was performed independently by three experienced nuclear medicine physicians. Patients were divided in two groups according to the presence/absence of unspecific bone uptake. Clinical information, blood count parameters (assessed within 3 months to the PET scan), body mass index (BMI), and bone density as estimated by computed tomography were collected. The Kruskal–Wallis and t-test were used to compare parameters.

Results

We analyzed 77 patients: 29 of them (38%) had unspecific bone uptake at [18F]PSMA-1007 PET, most commonly in the pelvic bones (69%) and ribs (62%). We did not find any significant difference in clinical parameters in the two groups. In patients with unspecific bone uptake, white blood cell, and neutrophil counts were significantly higher; in the same group, we observed lower values of BMI and bone density, although not statistically different.

Conclusions

We observed unspecific bone uptake on [18F]PSMA-1007 PET in more than 1/3 of patients. In this exploratory analysis, we found a significant correlation between blood count parameters and unspecific [18F]PSMA-1007 bone uptake. We may speculate that [18F]PSMA-1007 unspecific bone uptake could be associated with osteoporosis. This hypothesis needs to be further investigated in larger populations and exploring more specific markers of osteoporosis.

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Data availability

The manuscript represents valid work, and neither this manuscript nor one with substantially similar content under the same authorship has been published or is being considered for publication elsewhere. Arturo Chiti had full access to all the data in the study and takes responsibility for the data integrity and the accuracy of the data analysis. Raw data are available on specific request to the corresponding author.

Code availability

This is not applicable.

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Funding

F.G. is supported by the Investigator Grant 2020-23596 funded by AIRC (Italian Association for Cancer Research) won by A.C.

Author information

Author notes

  1. Martina Sollini and Arturo Chiti contributed equally to the present work.

Authors and Affiliations

  1. Nuclear Medicine Department, IRCCS San Raffaele Scientific Institute, Milan, Italy

    Gaia Ninatti, Cristiano Pini, Samuele Ghezzo, Paola Mapelli, Maria Picchio, Lidija Antunovic & Arturo Chiti

  2. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Gaia Ninatti, Cristiano Pini & Claudio Landoni

  3. Vita-Salute San Raffaele University, Milan, Italy

    Fabrizia Gelardi, Samuele Ghezzo, Paola Mapelli, Maria Picchio, Alberto Briganti, Francesco Montorsi & Arturo Chiti

  4. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy

    Fabrizia Gelardi & Martina Sollini

  5. Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele, Milan, Italy

    Alberto Briganti & Francesco Montorsi

  6. Nuclear Medicine Department, IRCCS Monza, San Gerardo Hospital, Monza, Italy

    Claudio Landoni

  7. Nuclear Medicine–IRCCS Humanitas Research Hospital, Rozzano, Italy

    Martina Sollini

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Contributions

M.S. and A.C. conceptualized the study. A.C., F.G., and M.S. designed the study. C.P., F.G, G.N., and S.G. performed patient selection and collected clinical data. A.C., F.G., and L.A. analyzed the images. G.N. performed data analysis. A.B., A.C., C.L., F.G., F.M., M.P., M.S., and P.M. critically interpreted the results. C.P., F.G., G.N., and M.S. drafted the paper. All authors critically revised the paper and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Cristiano Pini.

Ethics declarations

Ethics approval

The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. The Ethics Committee of the IRCCS S. Raffaele Hospital approved the study, with the authorization number 81/INT/2022.

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A specific informed consent was waived because of the observational and retrospective study design.

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This is not applicable.

Competing interests

Prof. Chiti reports personal fees from AAA, Blue Earth Diagnostics and General Electric Healthcare, outside the submitted work. The other authors do not report any conflict of interest.

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Ninatti, G., Pini, C., Gelardi, F. et al. The potential role of osteoporosis in unspecific [18F]PSMA-1007 bone uptake. Eur J Nucl Med Mol Imaging 51, 304–311 (2023). https://doi.org/10.1007/s00259-023-06424-9

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