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Comparison of hybrid 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT for the detection of bone metastases in prostate cancer patients: Additional value of morphologic information from low dose CT

  • Molecular Imaging
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European Radiology Aims and scope Submit manuscript

Abstract

Purpose

This study compared 68Gallium-prostate-specific-membrane-antigen based Positron-emission-tomography (68Ga-PSMA-PET) and 99metastabletechnetium-3,3-diphospho-1,2-propanedicarbonacid (99mTc-DPD-SPECT) in performing skeletal staging in prostate cancer (PC) patients and evaluated the additional value of the information from low-dose-computed tomography (CT).

Materials and Methods

In this retrospective study, 54 patients who received 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT within 80 days were extracted from our database. Osseous lesions were classified as benign, malignant or equivocal. Lesion, region and patient based analysis was performed with and without CT fusion. The reference standard was generated by defining a best valuable comparator (BVC) containing information from all available data.

Results

In the patient based analysis, accuracies measured as “area-under-the-curve” (AUC) for 68Ga-PSMA-PET, 99mTc-SPECT, 68Ga-PSMA-PET/CT and 99mTc-SPECT/CT were 0.97-0.96, 0.86-0.83, 1.00 and 0.83, respectively (p<0.05) (ranges = optimistic vs. pessimistic view). Region based analysis resulted in the following sensitivities and specificities: 91.8-97.7%, 100-99.5% (PET); 61.2-70.6%, 99.8-98.3% (SPECT); 97.7%, 100% (PET/CT), 69.4% and 98.3% (SPECT/CT) (p<0.05). The amount of correct classifications of equivocal lesions by CT was significantly higher in PET (100%) compared to SPECT (52.4%) (p<0.05).

Conclusion

68Ga-PSMA-PET outperforms 99mTc-DPD-SPECT in detecting bone metastases in PC patients. Additional information from low-dose-CT resulted in a significant reduction in equivocal lesions in both modalities, however 68Ga-PSMA-PET benefited most.

Key Points

• Ga-PSMA-PET outperforms 99m Tc-DPD-SPECT in skeletal staging in prostate cancer patients

• Proportion of equivocal decisions was significantly reduced by CT-fusion in both modalities

• Ga-PSMA-PET benefits more from CT information, compared to 99m Tc-DPD-SPECT

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Abbreviations

PET:

Positron emission tomography

SPECT:

Single photon emission computed tomography

CT:

computed tomography

BVC:

best valuable comparator

BS:

Bone scan

MRI:

Magnetic resonance imaging

PC:

Prostate cancer

Tc-DPD:

99-technetium-3,3-Diphospho-1,2-propanedicarbonacid

PSMA:

Prostate specific membrane antigen

Ga-PSMA-HBED-CC:

prostate specific membrane antigen (PSMA) ligand (Glu-NH-CO-NH-Lys) radio-labelled with 68Gallium-N,N-bis[2-hydroxy-5-(carboxyethyl)benzyl] ethylenediamine-N,N diacetic acid

Ga-PSMA-PET:

68Gallium prostate-specific-membrane-antigen based positron-emission-tomography

DPD:

Diphospho-1,2-propanedicarbonacid

PACS:

Picture archiving and communication system

CI:

confidence interval

PSA:

prostate specific antigen

AUC:

Area under the curve

ROC:

Receiver operating characteristics

HU:

Hounsfield unit

2D:

two dimensional

3D:

three dimensional

MIP:

maximum intensity projection

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Acknowledgements

The author MM is grateful for the financial support from the Deutsche Forschungsgemeinschaft (DFG, 5943/31/41/91).

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Authors and Affiliations

  1. Department of Radiology, Charité, Charitéplatz 1, 10117, Berlin, Germany

    Jan-Carlo Janssen, Sebastian Meißner, Gerd Diederichs, Bernd Hamm & Marcus R. Makowski

  2. Department of Nuclear Medicine, Charité, Charitéplatz 1, 10117, Berlin, Germany

    Nadine Woythal, Vikas Prasad & Winfried Brenner

Authors
  1. Jan-Carlo Janssen
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  2. Sebastian Meißner
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Corresponding author

Correspondence to Jan-Carlo Janssen.

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Guarantor

The scientific guarantor of this publication is Jan-Carlo Janssen.

Conflict of interest

Dr. Hamm declares a relationship with the following companies, including: GE, Guerbet, Siemens, Samsung und Toshiba.

In addition to the author Hamm, no other author has a conflict of interest.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

Daniel Schulze kindly provided statistical advice for this manuscript.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

In this retrospective study, written informed consent was waived by the Institutional Review Board.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Janssen, JC., Meißner, S., Woythal, N. et al. Comparison of hybrid 68Ga-PSMA-PET/CT and 99mTc-DPD-SPECT/CT for the detection of bone metastases in prostate cancer patients: Additional value of morphologic information from low dose CT . Eur Radiol 28, 610–619 (2018). https://doi.org/10.1007/s00330-017-4994-6

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  • DOI: https://doi.org/10.1007/s00330-017-4994-6

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