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Biphasic 68Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma

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

Abstract

Purpose

Binding of 68Ga-PSMA-HBED-CC (68Ga-PSMA) at prostate cancer (PC) cells increases over time. A biphasic protocol may help separating benign from tumor lesions. The aim of this study was the retrospective evaluation of a diagnostic incremental value of a dual-time point (biphasic) 68Ga-PSMA-PET/CT in patients with prostate cancer.

Methods

Retrospective analysis of 35 consecutive patients (49–78 years, median 71) with newly diagnosed PC (12/35) or recurrence of PC (23/35). PET/CT (Gemini TF16, Philips) was acquired 1 h and 3 h p. i. of 140–392 MBq (300 MBq median) 68Ga-PSMA, followed by a diagnostic contrast CT. PET findings were correlated with histology or unequivocal CT findings. Semiquantitative PET data (SUVmax, SUV mean) were acquired and target-to-background-ratios (T/B-ratio) were calculated for benign and malign lesions for both time points. Size of lymph nodes (LN) on diagnostic CT was recorded. Statistical analysis was performed for assessment of significant changes of semiquantitative PET-parameters over time and for correlation of size and uptake of lymph nodes.

Results

One hundred and four lesions were evaluated. Sixty lesions were referenced by histology or unequivocal CT findings, including eight (13.3 %) histopathologically benign lymph nodes, 12 (20 %) histopathologically lymph node metastases, 12 (20 %) primary tumors, three (5 %) local recurrences, and 25 (41.7 %) bone metastases. Forty-four lesions were axillary LN with normal CT-appearance. Benign lesions had significantly lower SUVmax and T/B-ratios compared with malignant findings. Malign lesions showed a significant increase of both parameters over time compared to benign findings. There was no correlation between LN size and SUVmax. The sensitivity, specificity, the positive predictive value and negative predictive value of PET/CT regarding pelvic LN was 94 %, 99 %, 89 %, and 99.5 %, respectively.

Conclusions

In contrast to benign tissues, the uptake of proven tumor lesions increases on 68Ga-PSMA-PET/CT over time. A biphasic PET-study may lead to a better detection of tumor lesions in unequivocal findings.

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Authors and Affiliations

  1. Department of Nuclear Medicine, University Medical Center Goettingen, Robert-Koch-Str. 40, D-37075, Goettingen, Germany

    Carsten-Oliver Sahlmann, Birgit Meller, Caroline Bouter & Johannes Meller

  2. Department of Diagnostic and Interventional Radiology, University Medical Center Goettingen, Goettingen, Germany

    Christian Oliver Ritter & Joachim Lotz

  3. Department of Urology, University Medical Center Goettingen, Goettingen, Germany

    Lutz Trojan & Sameh Hijazi

  4. Department of Pathology, University Medical Center Goettingen, Goettingen, Germany

    Philipp Ströbel

Authors
  1. Carsten-Oliver Sahlmann
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  2. Birgit Meller
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  3. Caroline Bouter
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  4. Christian Oliver Ritter
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  5. Philipp Ströbel
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  6. Joachim Lotz
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  7. Lutz Trojan
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  8. Johannes Meller
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  9. Sameh Hijazi
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Correspondence to Carsten-Oliver Sahlmann.

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Conflicts of interest

Carsten-Oliver Sahlmann declares that he has no conflict of interest. Birgit Meller declares that she has no conflict of interest. Caroline Bouter declares that she has no conflict of interest. Christian Oliver Ritter declares that he has no conflict of interest. Philipp Ströbel declares that he has no conflict of interest. Joachim Lotz declares that he has no conflict of interest. Lutz Trojan declares that he has no conflict of interest. Johannes Meller declares that he has no conflict of interest. Sameh Hijazi declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Sahlmann, CO., Meller, B., Bouter, C. et al. Biphasic 68Ga-PSMA-HBED-CC-PET/CT in patients with recurrent and high-risk prostate carcinoma. Eur J Nucl Med Mol Imaging 43, 898–905 (2016). https://doi.org/10.1007/s00259-015-3251-y

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  • DOI: https://doi.org/10.1007/s00259-015-3251-y

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