{"title":"Tc-99m PSMA SSPECT/CT 对生化复发性前列腺癌的诊断性能与 Ga-68 PSMA PET/CT 的比较分析：一项单中心前瞻性研究。","authors":"Manish Ora, Vivek Kumar Saini, Manish Dixit, Uday Pratap Singh, Sanjay Gambhir","doi":"10.4103/ijnm.ijnm_8_24","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Biochemical recurrence (BCR) after initial management of Prostate Carcinoma (PC) is frequent. Subsequent interventions rely on disease burden and metastasis distribution. <sup>68</sup>Ga prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is an excellent imaging modality in BCR. However, <sup>68</sup>Ga is radionuclide generator produced and has restricted availability. <sup>99</sup>mTc-labeled PSMA could be a potential cost-effective alternative. We compared the performance of <sup>99m</sup>Tc-PSMA single-photon emission CT (SPECT)/CT and <sup>68</sup>Ga-PSMA PET/CT in BCR with a serum prostate surface antigen (PSA) level of <20 ng/mL.</p><p><strong>Materials and methods: </strong>The prospective study included 25 patients with BCR and at least one lesion on a <sup>68</sup>Ga-PSMA PET/CT. All patients underwent 99 mTc-PSMA SPECT/CT, and disease distribution and metastatic burden were compared with <sup>68</sup>Ga-PSMA PET/CT. The maximum standard uptake value (SUVmax) and the tumor-to-background ratio (TBR) were computed and analyzed.</p><p><strong>Results: </strong>The mean age and serum PSA (SPSA) were 69.72 ± 6.69 years and 5.65 ± 6.07 ng/mL. Eleven patients (44%) had SPSA ≤2 ng/mL. Recurrent sites were noted in the prostate (19, 76%), prostatic bed (3, 12%), and pelvis lymph nodes (LNs) (13, 52%). Distant metastasis to bones (13, 52%), lungs (5, 20%), and retroperitoneal LNs (2, 8%) were noted. Both modalities were concordant for the recurrent disease at the prostate, prostatic bed, bone, and lung lesions. <sup>99m</sup>Tc-PSMA could localize pelvis LNs in most patients (10/13, 76.9%). The site-specific sensitivity and specificity between the two modalities were not significantly different (<i>P</i> > 0.05). TBR shows excellent correlation with SUVmax (0.783, <i>P</i> < 0.001). Four (16%) patients were understaged with <sup>99m</sup>Tc-PSMA due to the nonvisualization of the subcentimeter size LNs. No patient with systemic metastases was understaged.</p><p><strong>Conclusions: </strong><sup>99m</sup>Tc-PSMA SPECT/CT has good concordance with <sup>68</sup>Ga-PSMA PET/CT in BCR, even at low PSA levels. However, it may miss a few subcentimeter LNs due to lower resolution. <sup>99m</sup>Tc-PSMA SPECT/CT could be a simple, cost-effective, and readily available imaging alternative to PET/CT.</p>","PeriodicalId":45830,"journal":{"name":"Indian Journal of Nuclear Medicine","volume":"39 3","pages":"170-176"},"PeriodicalIF":0.4000,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404733/pdf/","citationCount":"0","resultStr":"{\"title\":\"An Analysis of the Diagnostic Performance of Tc-99m PSMA SSPECT/CT in Biochemically Recurrent Prostate Cancer Compared with Ga-68 PSMA PET/CT: A Single-center, Prospective Study.\",\"authors\":\"Manish Ora, Vivek Kumar Saini, Manish Dixit, Uday Pratap Singh, Sanjay Gambhir\",\"doi\":\"10.4103/ijnm.ijnm_8_24\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Biochemical recurrence (BCR) after initial management of Prostate Carcinoma (PC) is frequent. Subsequent interventions rely on disease burden and metastasis distribution. <sup>68</sup>Ga prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is an excellent imaging modality in BCR. However, <sup>68</sup>Ga is radionuclide generator produced and has restricted availability. <sup>99</sup>mTc-labeled PSMA could be a potential cost-effective alternative. We compared the performance of <sup>99m</sup>Tc-PSMA single-photon emission CT (SPECT)/CT and <sup>68</sup>Ga-PSMA PET/CT in BCR with a serum prostate surface antigen (PSA) level of <20 ng/mL.</p><p><strong>Materials and methods: </strong>The prospective study included 25 patients with BCR and at least one lesion on a <sup>68</sup>Ga-PSMA PET/CT. All patients underwent 99 mTc-PSMA SPECT/CT, and disease distribution and metastatic burden were compared with <sup>68</sup>Ga-PSMA PET/CT. The maximum standard uptake value (SUVmax) and the tumor-to-background ratio (TBR) were computed and analyzed.</p><p><strong>Results: </strong>The mean age and serum PSA (SPSA) were 69.72 ± 6.69 years and 5.65 ± 6.07 ng/mL. Eleven patients (44%) had SPSA ≤2 ng/mL. Recurrent sites were noted in the prostate (19, 76%), prostatic bed (3, 12%), and pelvis lymph nodes (LNs) (13, 52%). Distant metastasis to bones (13, 52%), lungs (5, 20%), and retroperitoneal LNs (2, 8%) were noted. Both modalities were concordant for the recurrent disease at the prostate, prostatic bed, bone, and lung lesions. <sup>99m</sup>Tc-PSMA could localize pelvis LNs in most patients (10/13, 76.9%). The site-specific sensitivity and specificity between the two modalities were not significantly different (<i>P</i> > 0.05). TBR shows excellent correlation with SUVmax (0.783, <i>P</i> < 0.001). Four (16%) patients were understaged with <sup>99m</sup>Tc-PSMA due to the nonvisualization of the subcentimeter size LNs. No patient with systemic metastases was understaged.</p><p><strong>Conclusions: </strong><sup>99m</sup>Tc-PSMA SPECT/CT has good concordance with <sup>68</sup>Ga-PSMA PET/CT in BCR, even at low PSA levels. However, it may miss a few subcentimeter LNs due to lower resolution. <sup>99m</sup>Tc-PSMA SPECT/CT could be a simple, cost-effective, and readily available imaging alternative to PET/CT.</p>\",\"PeriodicalId\":45830,\"journal\":{\"name\":\"Indian Journal of Nuclear Medicine\",\"volume\":\"39 3\",\"pages\":\"170-176\"},\"PeriodicalIF\":0.4000,\"publicationDate\":\"2024-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11404733/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Indian Journal of Nuclear Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.4103/ijnm.ijnm_8_24\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Journal of Nuclear Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/ijnm.ijnm_8_24","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/17 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
An Analysis of the Diagnostic Performance of Tc-99m PSMA SSPECT/CT in Biochemically Recurrent Prostate Cancer Compared with Ga-68 PSMA PET/CT: A Single-center, Prospective Study.
Objective: Biochemical recurrence (BCR) after initial management of Prostate Carcinoma (PC) is frequent. Subsequent interventions rely on disease burden and metastasis distribution. 68Ga prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is an excellent imaging modality in BCR. However, 68Ga is radionuclide generator produced and has restricted availability. 99mTc-labeled PSMA could be a potential cost-effective alternative. We compared the performance of 99mTc-PSMA single-photon emission CT (SPECT)/CT and 68Ga-PSMA PET/CT in BCR with a serum prostate surface antigen (PSA) level of <20 ng/mL.
Materials and methods: The prospective study included 25 patients with BCR and at least one lesion on a 68Ga-PSMA PET/CT. All patients underwent 99 mTc-PSMA SPECT/CT, and disease distribution and metastatic burden were compared with 68Ga-PSMA PET/CT. The maximum standard uptake value (SUVmax) and the tumor-to-background ratio (TBR) were computed and analyzed.
Results: The mean age and serum PSA (SPSA) were 69.72 ± 6.69 years and 5.65 ± 6.07 ng/mL. Eleven patients (44%) had SPSA ≤2 ng/mL. Recurrent sites were noted in the prostate (19, 76%), prostatic bed (3, 12%), and pelvis lymph nodes (LNs) (13, 52%). Distant metastasis to bones (13, 52%), lungs (5, 20%), and retroperitoneal LNs (2, 8%) were noted. Both modalities were concordant for the recurrent disease at the prostate, prostatic bed, bone, and lung lesions. 99mTc-PSMA could localize pelvis LNs in most patients (10/13, 76.9%). The site-specific sensitivity and specificity between the two modalities were not significantly different (P > 0.05). TBR shows excellent correlation with SUVmax (0.783, P < 0.001). Four (16%) patients were understaged with 99mTc-PSMA due to the nonvisualization of the subcentimeter size LNs. No patient with systemic metastases was understaged.
Conclusions: 99mTc-PSMA SPECT/CT has good concordance with 68Ga-PSMA PET/CT in BCR, even at low PSA levels. However, it may miss a few subcentimeter LNs due to lower resolution. 99mTc-PSMA SPECT/CT could be a simple, cost-effective, and readily available imaging alternative to PET/CT.
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