Comparison of hybrid 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT for the detection of bone metastases in prostate cancer patients: Additional value of morphologic information from low dose CT
- 787 Downloads
This study compared 68Gallium-prostate-specific-membrane-antigen based Positron-emission-tomography (68Ga-PSMA-PET) and 99metastabletechnetium-3,3-diphospho-1,2-propanedicarbonacid (99mTc-DPD-SPECT) in performing skeletal staging in prostate cancer (PC) patients and evaluated the additional value of the information from low-dose-computed tomography (CT).
Materials and Methods
In this retrospective study, 54 patients who received 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT within 80 days were extracted from our database. Osseous lesions were classified as benign, malignant or equivocal. Lesion, region and patient based analysis was performed with and without CT fusion. The reference standard was generated by defining a best valuable comparator (BVC) containing information from all available data.
In the patient based analysis, accuracies measured as “area-under-the-curve” (AUC) for 68Ga-PSMA-PET, 99mTc-SPECT, 68Ga-PSMA-PET/CT and 99mTc-SPECT/CT were 0.97-0.96, 0.86-0.83, 1.00 and 0.83, respectively (p<0.05) (ranges = optimistic vs. pessimistic view). Region based analysis resulted in the following sensitivities and specificities: 91.8-97.7%, 100-99.5% (PET); 61.2-70.6%, 99.8-98.3% (SPECT); 97.7%, 100% (PET/CT), 69.4% and 98.3% (SPECT/CT) (p<0.05). The amount of correct classifications of equivocal lesions by CT was significantly higher in PET (100%) compared to SPECT (52.4%) (p<0.05).
68Ga-PSMA-PET outperforms 99mTc-DPD-SPECT in detecting bone metastases in PC patients. Additional information from low-dose-CT resulted in a significant reduction in equivocal lesions in both modalities, however 68Ga-PSMA-PET benefited most.
• Ga-PSMA-PET outperforms 99m Tc-DPD-SPECT in skeletal staging in prostate cancer patients
• Proportion of equivocal decisions was significantly reduced by CT-fusion in both modalities
• Ga-PSMA-PET benefits more from CT information, compared to 99m Tc-DPD-SPECT
KeywordsProstatic neoplasms Positron emission tomography computed tomography Single photon emission computed tomography Neoplasm metastasis Bone tissue PSMA
Positron emission tomography
Single photon emission computed tomography
best valuable comparator
Magnetic resonance imaging
Prostate specific membrane antigen
prostate specific membrane antigen (PSMA) ligand (Glu-NH-CO-NH-Lys) radio-labelled with 68Gallium-N,N-bis[2-hydroxy-5-(carboxyethyl)benzyl] ethylenediamine-N,N diacetic acid
68Gallium prostate-specific-membrane-antigen based positron-emission-tomography
Picture archiving and communication system
prostate specific antigen
Area under the curve
Receiver operating characteristics
maximum intensity projection
The author MM is grateful for the financial support from the Deutsche Forschungsgemeinschaft (DFG, 5943/31/41/91).
Compliance with ethical standards
The scientific guarantor of this publication is Jan-Carlo Janssen.
Conflict of interest
Dr. Hamm declares a relationship with the following companies, including: GE, Guerbet, Siemens, Samsung und Toshiba.
In addition to the author Hamm, no other author has a conflict of interest.
The authors state that this work has not received any funding.
Statistics and biometry
Daniel Schulze kindly provided statistical advice for this manuscript.
Institutional Review Board approval was obtained.
In this retrospective study, written informed consent was waived by the Institutional Review Board.
• diagnostic study
• performed at one institution
- 8.Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I (2006) The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med 47:287–297PubMedGoogle Scholar
- 21.Lecouvet FE, El Mouedden J, Collette L et al (2012) Can whole-body magnetic resonance imaging with diffusion-weighted imaging replace Tc 99m bone scanning and computed tomography for single-step detection of metastases in patients with high-risk prostate cancer? Eur Urol 62:68–75CrossRefPubMedGoogle Scholar
- 26.Jambor I, Kuisma A, Ramadan S et al (2016) Prospective evaluation of planar bone scintigraphy, SPECT, SPECT/CT, 18F-NaF PET/CT and whole body 1.5T MRI, including DWI, for the detection of bone metastases in high risk breast and prostate cancer patients: SKELETA clinical trial. Acta Oncol 55:59–67CrossRefPubMedGoogle Scholar
- 29.Francis MDHP, Tofe AJ (1981) Controversial mechanism of technetium-99m deposition on bone. J Nucl Med 22:72Google Scholar
- 34.Lecouvet FE, Geukens D, Stainier A et al (2007) Magnetic resonance imaging of the axial skeleton for detecting bone metastases in patients with high-risk prostate cancer: diagnostic and cost-effectiveness and comparison with current detection strategies. J Clin Oncol 25:3281–3287CrossRefPubMedGoogle Scholar