Digital versus analogue PET in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer: a matched-pair comparison

Alberts, Ian; Prenosil, George; Sachpekidis, Christos; Weitzel, Thilo; Shi, Kuangyu; Rominger, Axel; Afshar‐Oromieh, Ali

doi:10.1007/s00259-019-04630-y

Cited by 61 publications

(51 citation statements)

References 32 publications

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“…In addition, state-of-the-art digital systems often include longer axial coverage, smaller crystals, and more advanced electronics, which lead to higher sensitivity, higher spatial resolution, and shorter deadtime. These improved performance characteristics have been confirmed by a number of publications [1,2], which correspond to improvements in image quality and lesion detection [2][3][4][5][6].…”

Section: Introductionmentioning

confidence: 60%

“…As described in the introduction, digital PET/CT represents a step forward in molecular imaging, with increasing numbers of publications confirming the favourable performance characteristics for such scans in comparison to previous-generation analogue systems [ 1 , 16 ], including increased lesion detection and sensitivity [ 1 , 3 , 4 , 13 , 17 ]. Previous authors have reported head-to-head studies comparing digital and analogue systems, showing both improved image quality and upstaging of individuals [ 10 ], as well as improved recovery (as shown by higher SUV values) and lesion sharpness [ 3 , 6 ]. Traditionally, shorter list-mode acquisitions have been associated with decreased lesion detection, as most recently shown for [ 68 Ga]Ga-PSMA-11 PET/CT by Rauscher et al (using an analogue scanner) [ 18 ] with 1 min/bp reconstructions (equivalent to 1/3 rd of the standard) associated with reduced detection of up to 36% of lesions.…”

Section: Discussionmentioning

confidence: 99%

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Digital PET/CT allows for shorter acquisition protocols or reduced radiopharmaceutical dose in [18F]-FDG PET/CT

et al. 2021

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Purpose To establish the feasibility of shorter acquisition times (and by analogy, applied activity) on tumour detection and lesion contrast in digital PET/CT. Methods Twenty-one randomly selected patients who underwent oncological [18F]-FDG PET/CT on a digital PET/CT were retrospectively evaluated. Scan data were anonymously obtained and reconstructed in list-mode acquisition for a standard 2 min/bed position (bp), 1 min/bp and 30 s/bp (100%, 50% and 25% time or applied activity, respectively). Scans were randomized and read by two nuclear medicine physicians in a consensus read. Readers were blind to clinical details. Scans were evaluated for the number of pathological lesions detected. Measured uptake for lesions was evaluated by maximum and mean standardized uptake value (SUVmax and SUVmean, respectively) and tumour-to-backround ratio (TBR) were compared. Agreement between the three acquisitions was compared by Krippendorf’s alpha. Results Overall n = 100 lesions were identified in the 2 min and 1 min/bp acquisitions and n = 98 lesions in the 30 s/bp acquisitions. Agreement between the three acquisitions with respect to lesion number and tumour-to-background ratio showed almost perfect agreement (K’s α = 0.999). SUVmax, SUVmean and TBR likewise showed > 98% agreement, with longer acquisitions being associated with slightly higher mean TBR (2 min/bp 7.94 ± 4.41 versus 30 s/bp 7.84 ± 4.22, p < 0.05). Conclusion Shorter acquisition times have traditionally been associated with reduced lesion detectability or the requirement for larger amounts of radiotracer activity. These data confirm that this is not the case for new-generation digital PET scanners, where the known higher sensitivity results in clinically adequate images for shorter acquisitions. Only a small variation in the semi-quantitative parameters SUVmax, SUVmean and TBR was seen, confirming that either reduction of acquisition time or (by analogy) applied activity can be reduced as much as 75% in digital PET/CT without apparent clinical detriment.

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Section: Introductionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Digital PET/CT allows for shorter acquisition protocols or reduced radiopharmaceutical dose in [18F]-FDG PET/CT

et al. 2021

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“…1 illustrates, we are still a long way from demonstrating higher lesion counts as proof of a true benefit to patient outcomes. • Spatial resolution and contrast recovery [42,[98][99][100] • Noise/background variability [42,99,100] • Lesion detection [101] Patients Level 1:…”

Section: Prostate Cancermentioning

confidence: 99%

Moving the goalposts while scoring―the dilemma posed by new PET technologies

Rogasch

Boellaard

Pike

et al. 2021

Eur J Nucl Med Mol Imaging

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“…Several studies have shown improvements in lesion detection with digital scanners compared to analog systems for 18 F-FDG PET, possibly also leading to higher detectability of UBUs using [ 18 F]-PSMA-1007 [26,27]. This was suggested by Alberts et al, who reported a higher detection rate of both prostate cancer lesions and benign PSMA-avid lesions with digital than with analog systems [28]. It can therefore be assumed that, with more installations of high-end digital PET systems, the frequency of UBU in 18 F-PSMA-1007 imaging will become even more challenging.…”

Section: Discussionmentioning

confidence: 97%

Focal Unspecific Bone Uptake on [18F]-psma-1007 Pet: A Multicenter Retrospective Evaluation of the Distribution, Frequency, and Quantitative Parameters of a Potential Pitfall in Prostate Cancer Imaging

Grünig

Maurer

Thali

et al. 2021

Preprint

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PurposeImproved logistics and availability led to a rapid increase in the use of [18F]-PSMA-1007 for prostate cancer PET imaging. Initial data suggests increased uptake in benign lesions compared to [68Ga]-PSMA-11, and clinical observations found increased unspecific bone uptake (UBU). We therefore investigate the frequency and characteristics of UBU in [18F]-PSMA-1007 PET.MethodsWe retrospectively analyzed [18F]-PSMA-1007 PET scans from four centers for the presence of UBU, defined as a focal mild-to-moderate uptake (SUVmax < 10.0) not obviously related to a benign or malignant cause. If present, up to three leading UBUs were quantified (SUVmax), localized, and correlated to clinical parameters, such as age, PSA, injected dose, Gleason-score, tumor size (T1–T4), and type of PET scanner (analog vs. digital). Additionally, clinical and imaging follow-up results and therapeutic impact were evaluated.ResultsUBUs were identified in 179 out of 348 patients (65.2%). The most frequent localizations were ribs (57.5%) and pelvis (24.8%). The frequency of UBUs was not associated with PSA, Gleason-score, tumor size, age, or the injected [18F]-PSMA-1007 dose. UBUs were significantly more frequent in images obtained with digital scanners (70.1%) than analog scanners (p=.0001). In 80 out of 179 patients (44.7%), the interpretation of UBUs was critical for therapeutic management and therefore considered clinically relevant. For 65 UBUs, follow-ups were available: three biopsies, three radiotherapies with PSA follow-up, and 59 cases with imaging. After follow-up UBUs were still considered unclear in 28 of 65 patients (43.1%), benign in 28 (43.1%), and malignant in nine (13.8%) patients.ConclusionUBUs occur in two-thirds of patients imaged with [18F]-PSMA-1007 PET/CT and are significantly more frequent on digital PET scanners than analog scanners. UBUs should be interpreted carefully to avoid over-staging.

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Digital versus analogue PET in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer: a matched-pair comparison

Cited by 61 publications

References 32 publications

Digital PET/CT allows for shorter acquisition protocols or reduced radiopharmaceutical dose in [18F]-FDG PET/CT

Digital PET/CT allows for shorter acquisition protocols or reduced radiopharmaceutical dose in [18F]-FDG PET/CT

Moving the goalposts while scoring―the dilemma posed by new PET technologies

Focal Unspecific Bone Uptake on [18F]-psma-1007 Pet: A Multicenter Retrospective Evaluation of the Distribution, Frequency, and Quantitative Parameters of a Potential Pitfall in Prostate Cancer Imaging

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