European Radiology

, Volume 28, Issue 2, pp 610–619 | Cite as

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

  • Jan-Carlo JanssenEmail author
  • Sebastian Meißner
  • Nadine Woythal
  • Vikas Prasad
  • Winfried Brenner
  • Gerd Diederichs
  • Bernd Hamm
  • Marcus R. Makowski
Molecular Imaging



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.

Key Points

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


Prostatic neoplasms Positron emission tomography computed tomography Single photon emission computed tomography Neoplasm metastasis Bone tissue PSMA 



Positron emission tomography


Single photon emission computed tomography


computed tomography


best valuable comparator


Bone scan


Magnetic resonance imaging


Prostate cancer




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


confidence interval


prostate specific antigen


Area under the curve


Receiver operating characteristics


Hounsfield unit


two dimensional


three dimensional


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.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

In this retrospective study, written informed consent was waived by the Institutional Review Board.


• retrospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  1. 1.Department of RadiologyCharitéBerlinGermany
  2. 2.Department of Nuclear MedicineCharitéBerlinGermany

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