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Letter to the Editor: 68Ga-PSMA-11 for renal cortical PET imaging

Dear Editor,

I read with interest the systematic review by Amoabeng et al. that was published in recent issue of Clinical and Translational Imaging [1]. This article reviewed the utilization of positron emission tomography (PET) studies in the evaluation of renal health and diseases. However, the review did not include the use of 68Ga—prostate specific membrane antigen (PSMA)-11 PET for renal cortical imaging. 68Ga-PSMA-11 demonstrates high physiological uptake in the renal parenchyma [2]. PSMA, also known as glutamate carboxypeptidase II or folate hydrolase, is a Type II transmembrane protein which is mainly found in prostate tissue and overexpressed in prostate cancer, various other malignancies and also in extraprostatic normal tissues such as kidneys [3]. In immunohistochemical analysis, detectable PSMA levels were identified in the brush borders and apical cytoplasm of a subset of proximal renal tubules where it is responsible for the reuptake of folates via epithelial brush cells [3, 4]. In a prospective study, we compared 68Ga-PSMA-11 PET to 99mTc-dimercaptosuccinic acid (DMSA) scan in adult patients with pyelonephritis. Our study was interrupted by Covid-19 pandemic but we were able to obtain renal PSMA PET and DMSA images in 2 adult patients with pyelonephritis [5, 6]. In our cases, renal PSMA PET provided superior image resolution over DMSA scan and demonstrated the scar formation from pyelonephritis. We used low doses of 68Ga-PSMA-11 which was 48–74 MBq (1.3–2 mCi) and longer acquisition time (6–10 min/bed). Non-attenuation corrected PSMA PET also provided high resolution images of the kidneys. Estimated effective doses of 111 MBq (3 mCi) of 99mTc-DMSA and 37 MBq (1 mCi) of 68Ga-PSMA-11 seems comparable [5, 6]. We also assessed the correlation between 68 Ga-PSMA-11 renal PET parameters and renal function tests in patients with prostate cancers [7]. Based on our results renal 68Ga-PSMA-11 uptake appeared to be correlating with renal function tests.

68Ga-PSMA-11 seems to be a potential alternative to 99mTc-DMSA but further work, such as learning the mechanism of uptake, physiologic meaning of uptake, biodistribution in children, determining the optimal injected activity and imaging time, and investigating the dosimetry, is required before its use as a renal cortical tracer can be supported.

References

  1. Amoabeng KA, Laurila S, Juárez-Orozco LE et al (2021) The utilization of positron emission tomography in the evaluation of renal health and disease. Clin Transl Imaging. https://doi.org/10.1007/s40336-021-00469-2

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Correspondence to Ismet Sarikaya.

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Sarikaya, I. Letter to the Editor: 68Ga-PSMA-11 for renal cortical PET imaging. Clin Transl Imaging 10, 321–322 (2022). https://doi.org/10.1007/s40336-021-00475-4

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  • DOI: https://doi.org/10.1007/s40336-021-00475-4