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Comparative Study
. 2015 Nov;42(12):1794-800.
doi: 10.1007/s00259-015-3106-6. Epub 2015 Jul 11.

PSMA PET/CT with Glu-urea-Lys-(Ahx)-[⁶⁸Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer

Frederik L Giesel  1   2 , H Fiedler  3 , M Stefanova  3 , F Sterzing  4 , M Rius  5   6 , K Kopka  7 , J H Moltz  7 , A Afshar-Oromieh  3 , P L Choyke  8 , U Haberkorn  3   6 , C Kratochwil  3
Affiliations
Comparative Study

PSMA PET/CT with Glu-urea-Lys-(Ahx)-[⁶⁸Ga(HBED-CC)] versus 3D CT volumetric lymph node assessment in recurrent prostate cancer

Frederik L Giesel et al. Eur J Nucl Med Mol Imaging. 2015 Nov.

Abstract

Purpose: PET/CT with the PSMA ligand is a powerful new method for the early detection of nodal metastases in patients with biochemical relapse. The purpose of this retrospective investigation was to evaluate the volume and dimensions of nodes identified by Glu-urea-Lys-(Ahx)-[(68)Ga(HBED-CC)] ((68)Ga-PSMA-11) in the setting of recurrent prostate cancer.

Methods: All PET/CT images were acquired 60 ± 10 min after intravenous injection of (68)Ga-PSMA-11 (mean dose 176 MBq). In 21 patients with recurrent prostate cancer and rising PSA, 49 PSMA-positive lymph nodes were identified. Using semiautomated lymph node segmentation software, node volume and short-axis and long-axis dimensions were measured and compared with the maximum standardized uptake values (SUVmax). Round nodes greater than or equal to 8 mm were considered positive by morphological criteria alone. The percentage of nodes identified by elevated SUVmax but not by conventional morphological criteria was determined.

Results: The mean volume of (68)Ga-PSMA-11-positive nodes was 0.5 ml (range 0.2 - 2.3 ml), and the mean short-axis diameter was 5.8 mm (range 2.4 - 13.3 mm). In 7 patients (33.3 %) with 31 PSMA-positive nodes only 11 (36 %) were morphologically positive based on diameters >8 mm on CT. In the remaining 14 patients (66.7 %), 18 (37 %) of PSMA positive lymph nodes had short-axis diameters <8 mm with a mean short-axis diameter of 5.0 mm (range 2.4 - 7.9 mm). Thus, in this population, (68)Ga-PSMA-11 PET/CT detected nodal recurrence in two-thirds of patients who would have been missed using conventional morphological criteria.

Conclusion: (68)Ga-PSMA-11 PET/CT is more sensitive than CT based 3D volumetric lymph node evaluation in determining the node status of patients with recurrent prostate cancer, and is a promising method of restaging prostate cancers in this setting.

Keywords: 68Ga-PSMA-11 PET/CT; Lymph node evaluation; Lymph node metastasis; Recurrent prostate cancer.

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Figures

Fig. 1
Fig. 1
A 67-year-old patient with recurrent prostate cancer after prostatectomy. a The 68Ga-PSMA PET maximum intensity projection demonstrates multiple positive nodes in the pelvis abdomen, thorax and neck. b–d The CT image (b), PET/CT image (c) and PET image (d) show a single axial slice in the pelvis demonstrating three PSMA-positive nodes (arrows)
Fig. 2
Fig. 2
Image processing of a PSMA-positive node. The node corresponding to the positive 68Ga-PSMA PET images (a, d SUVmax 5.82) is represented on the CT images (b axial, c coronal, and f sagittal planes). It was segmented using Fraunhofer MEVIS software enabling automated quantification of the dimensions (short-axis diameter 4.19 mm, long-axis diameter 6.76 mm). e Volume rendering of the segmented node also provided by the software
Fig. 3
Fig. 3
Volume (a), short-axis diameter (b) and long-axis diameter (c) of PSMA positive lymph nodes indicating that 68Ga-PSMA PET/CT is able to detect many metastatic nodes smaller than the standard size for positive lymph nodes on CT or MRI (diameter >1 cm, volume >0.5 cm3)
Fig. 4
Fig. 4
Morphological distribution of all 49 PSMA-positive lymph nodes in terms of their short-axis diameter (a) and long-axis diameter (c). The relationships between SUVmax and the short axis diameter (b) and long axis diameter (d) of the PSMA-positive lymph nodes are also shown
See this image and copyright information in PMC

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