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. 2024 Sep 12;14(1):82.
doi: 10.1186/s13550-024-01148-9.

Potential application of [18F]AlF-PSMA-11 PET/CT in radioiodine refractory thyroid carcinoma

Bliede Van den Broeck  1 , Jens M Debacker  2   3   4 , Wouter Bauters  5 , David Creytens  6   7 , Liesbeth Ferdinande  6   7 , Wouter Huvenne  4   8 , Bruno Lapauw  9   10 , Vanessa Schelfhout  7   11 , Nick Van Laeken  12 , Charlotte Verroken  9
Affiliations

Potential application of [18F]AlF-PSMA-11 PET/CT in radioiodine refractory thyroid carcinoma

Bliede Van den Broeck et al. EJNMMI Res. .

Abstract

Background: Patients diagnosed with radioiodine refractory (RAI-R) thyroid carcinoma (TC) have a significantly worse prognosis than patients with radiosensitive TC. These refractory malignancies are often dedifferentiated, hindering the effectiveness of iodine-based imaging. Additionally, the role of metabolic imaging using [18F]FDG PET/CT is also limited in these cases, making adequate staging of RAI-R TC challenging. Recent case series have shown promising results regarding the role of the prostate-specific membrane antigen (PSMA) in TC. In this study we explored the value of [18F]AlF-PSMA-11 PET/CT in RAI-R TC.

Methods: In this phase II study, lesions detected on [18F]AlF-PSMA-11 PET were compared to findings from [18F]FDG PET/CT. Additionally, the serologic soluble prostate-specific membrane antigen (sPSMA) was measured using ELISA. PSMA-expression on tumor tissue in any available resection specimens was analysed with an immunostainer.

Results: Eight patients were included, with a total of 39 identified lesions based on PET imaging. [18F]AlF-PSMA-11 PET identified 30 of 39 lesions, and [18F]FDG PET identified 33 lesions, leading to a detection rate of 76.9% and 84.6%, respectively. Interestingly, while nine lesions were solely visualized on [18F]FDG, six were uniquely seen on [18F]AlF-PSMA-11 PET. While sPSMA was immeasurable in all female patients, no correlation was found between sPSMA in male patients and disease-related factors. In five out of eight patients immunohistology showed PSMA expression on the primary tumor.

Conclusions: Although not all lesions could be visualized, [18F]PSMA-11 PET identified multiple lesions imperceptible on [18F]FDG PET. These results display the potential additional diagnostic role of PSMA-targeted imaging in patients with RAI-R TC. Trial registration number No. EudraCT 2021-000456-19.

Keywords: PET/CT; PSMA-11; Radio-iodine refractory thyroid carcinoma; Thyroid carcinoma.

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Conflict of interest statement

No conflict of interest.

Figures

Fig. 1
Fig. 1
Example of a lesion that is only visible on PSMA PET (PT1) and a lesion that is only visible on FDG PET (PT 6). A PSMA PET/CT axial fusion images. B FDG PET/CT axial fusion images. C T1 weighted MRI images with gadolinium. D PSMA PET/CT axial fusion images. E FDG PET/CT axial fusion images; A–C shows focal uptake in the cerebellum on PSMA PET (blue arrow), not visible on FDG PET, corresponding with a known metastasis on MRI.; D, E shows intense focal uptake on FDG PET, without uptake on PSMA PET in a known pathologic retropharyngeal lymph node
Fig. 2
Fig. 2
Example of strong PSMA expression in a primary tumor (PT8) and in a brain metastasis (PT7). A Strong PSMA expression (score 2) in thyroid resection specimen of poorly differentiated TC. B Strong PSMA expression (score 2) in brain metastasis of a follicular TC
See this image and copyright information in PMC

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