Clinical imaging · 2025
The role of PSMA PET/CT in identifying benign and malignant intracranial lesions in patients with prostate cancer.
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Deffler Caitlin, Sedeh Ashkan Eighaei, Leitman Ellen, Ng Thomas S C, Chow David Z, Mahmood Umar, Heidari Pedram, Mercaldo Nathaniel, Esfahani Shadi A
Аннотация
PURPOSE: To evaluate the ability of prostate-specific membrane antigen (PSMA) PET/CT to detect and characterize intracranial lesions in patients with prostate cancer (PCa), using brain MRI as a gold standard method.
METHODS: In this retrospective single-center study, standard-of-care 18F-piflufolastat and 68Ga-gozetotide PSMA PET/CT scans for PCa patients were reviewed from August 2021 to February 2023. Patients with a brain MRI taken within 6 months of their PSMA PET/CT were enrolled. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PSMA PET/CT were calculated for the detection of brain metastases. Lesion uptake and patients' clinical information, including prostate-specific antigen (PSA) were compared between metastatic and non-metastatic brain lesions.
RESULTS: Of 1482 reviewed PCa patients, 141 with available brain MRI within six months of PSMA PET/CT were included. The estimated incidence rate of brain metastasis was 1.1 % (17/1482; Exact 95 % CI: 0.7-1.83), using brain MRI. PSMA PET/CT had a sensitivity of 81.2 % (95 % CI: 54.4-96.0), a specificity of 93.6 % (95 % CI: 87.8-97.2), a PPV of 61.9 % (95 % CI: 44.4-76.8), and an NPV of 97.5 % (95 % CI: 93.3-99.1) for detecting at least one metastatic PCa lesion as confirmed by MRI. Although not statistically significant, the mean SUVmax was higher in patients with intracranial PCa metastasis than those with other etiologies (fold change: 2.88, 95 % CI: 0.88, 9.43, p = 0.077), and a similar pattern was shown for mean PSA (fold-change: 17.2, 95 % CI: 0.95-312.6, p = 0.054).
CONCLUSION: Intracranial uptake on PSMA PET/CT may require further clinical and imaging correlation for accurate characterization.
METHODS: In this retrospective single-center study, standard-of-care 18F-piflufolastat and 68Ga-gozetotide PSMA PET/CT scans for PCa patients were reviewed from August 2021 to February 2023. Patients with a brain MRI taken within 6 months of their PSMA PET/CT were enrolled. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of PSMA PET/CT were calculated for the detection of brain metastases. Lesion uptake and patients' clinical information, including prostate-specific antigen (PSA) were compared between metastatic and non-metastatic brain lesions.
RESULTS: Of 1482 reviewed PCa patients, 141 with available brain MRI within six months of PSMA PET/CT were included. The estimated incidence rate of brain metastasis was 1.1 % (17/1482; Exact 95 % CI: 0.7-1.83), using brain MRI. PSMA PET/CT had a sensitivity of 81.2 % (95 % CI: 54.4-96.0), a specificity of 93.6 % (95 % CI: 87.8-97.2), a PPV of 61.9 % (95 % CI: 44.4-76.8), and an NPV of 97.5 % (95 % CI: 93.3-99.1) for detecting at least one metastatic PCa lesion as confirmed by MRI. Although not statistically significant, the mean SUVmax was higher in patients with intracranial PCa metastasis than those with other etiologies (fold change: 2.88, 95 % CI: 0.88, 9.43, p = 0.077), and a similar pattern was shown for mean PSA (fold-change: 17.2, 95 % CI: 0.95-312.6, p = 0.054).
CONCLUSION: Intracranial uptake on PSMA PET/CT may require further clinical and imaging correlation for accurate characterization.