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

Giesel FL, Fiedler H, Stefanova M, Sterzing F, Rius M, Kopka K, Moltz JH, Afshar-Oromieh A, Choyke PL, Haberkorn U, Kratochwil C - Eur. J. Nucl. Med. Mol. Imaging (2015)

Bottom Line: 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.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany. frederik@egiesel.com.

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.

No MeSH data available.


Related in: MedlinePlus

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
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Fig2: 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

Mentions: The pelvic lymph nodes are a common site of recurrent prostate cancer after surgery or radiation. Evidence based largely on the levels of prostate-specific antigen (PSA) in biochemical recurrence indicate that the sooner treatment, typically consisting of radiation and androgen deprivation therapy (ADT), is instituted after detection, the better is survival [1]. This increases the importance of early detection and localization of recurrent disease, whether in the lymph nodes or in the prostatic bed (Figs. 1, 2, 3 and 4).Fig. 1


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

Giesel FL, Fiedler H, Stefanova M, Sterzing F, Rius M, Kopka K, Moltz JH, Afshar-Oromieh A, Choyke PL, Haberkorn U, Kratochwil C - Eur. J. Nucl. Med. Mol. Imaging (2015)

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
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Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4589548&req=5

Fig2: 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
Mentions: The pelvic lymph nodes are a common site of recurrent prostate cancer after surgery or radiation. Evidence based largely on the levels of prostate-specific antigen (PSA) in biochemical recurrence indicate that the sooner treatment, typically consisting of radiation and androgen deprivation therapy (ADT), is instituted after detection, the better is survival [1]. This increases the importance of early detection and localization of recurrent disease, whether in the lymph nodes or in the prostatic bed (Figs. 1, 2, 3 and 4).Fig. 1

Bottom Line: 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.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).

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, INF 400, University Hospital Heidelberg, University of Heidelberg, 69120, Heidelberg, Germany. frederik@egiesel.com.

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.

No MeSH data available.


Related in: MedlinePlus