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. 2015 Dec;1(2):81-84.
doi: 10.18383/j.tom.2015.00169.

Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies

Steven P Rowe  1 , Curtiland Deville  2 , Channing Paller  3 , Steve Y Cho  4 , Elliot K Fishman  1 , Martin G Pomper  5 , Ashley E Ross  6 , Michael A Gorin  6
Affiliations

Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies

Steven P Rowe et al. Tomography. 2015 Dec.

Abstract

Prostate-specific membrane antigen (PSMA)-targeted PET imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this image report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with 18F-DCFPyL, a small molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced CT, bone scan, and pelvic MRI consistent with Paget's disease of bone. The uptake of 18F-DCFPyL in Paget's disease is most likely due to hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's, it is important for nuclear medicine physicians and radiologists interpreting PSMA PET/CT scans to be aware of the potential for this diagnostic pitfall. Correlation to findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

Keywords: DCFPyL; PET/CT; PSMA; Prostate cancer.

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Conflict of interest statement

Conflicts of Interest: M.G.P. is a coinventor of a US patent covering [18F]DCFPyL and as such is entitled to a portion of any licensing fees and royalties generated by this technology. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.

Figures

Figure 1.
Figure 1.
(A) Posterior projection whole-body MDP BS, (B) sagittal CECT image through the sacrum, (C) sagittal T1-weighted noncontrast, nonfat-saturation MRI, (D) sagittal [18F]DCFPyL PET image through the sacrum, and (E) sagittal [18F]DCFPyL PET/CT-fused image through the sacrum demonstrating patient's sacral Paget's disease. Note the thickened trabecular pattern on CECT corresponding to intense MDP uptake, normal high T1 signal upon MRI, and diffuse mild [18F]DCFPyL uptake.
Figure 2.
Figure 2.
(A) Axial T1-weighted postcontrast MRI and (B) axial [18F]DCFPyL PET/CT images through the prostate bed demonstrating the patient's presumed local recurrence as intense radiotracer uptake on PET/CT but with no corresponding abnormality on MRI. The relative radiotracer uptake in the prostate bed lesion is visually and quantitatively higher than the uptake in the sacrum shown in Figure 1D–E.
See this image and copyright information in PMC

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