Repeatability of <sup>68</sup>Ga-PSMA-HBED-CC PET/CT-derived total molecular tumor volume

Seifert, Robert; Sandach, Patrick; Kersting, David; Fendler, Wolfgang P.; Hadaschik, Boris; Herrmann, Ken; Sunderland, John; Pollard, Janet H.

doi:10.2967/jnumed.121.262528

Cited by 8 publications

(5 citation statements)

References 31 publications

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“…A 6-tier image scoring system referred to as Pro-PET score has been proposed, although there has been no external validation (22). There are also proposed semiautomated algorithms that can facilitate quantification of total tumor burden on either PSMA PET/CT or 18 F-FDG PET/CT (23)(24)(25).…”

Section: Pros and Cons Of 18 F-fdg Pet/ct Inclusion In Psma Rltmentioning

confidence: 99%

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC

Jadvar

2021

J Nucl Med

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Metastatic castration resistant prostate cancer (mCRPC) is incurable. The expression of the transmembrane protein prostate-specific membrane antigen (PSMA) is markedly increased in most mCRPC lesions. PSMA has been recognized as a viable biologic target for imaging and radionuclide therapy (theranostics) in mCRPC. The PET agents 68 Ga-PSMA-11 and 18 F-DCFPyL have recently been approved for imaging evaluation of patients with suspected metastasis who are candidates for initial definitive therapy and patients with suspected recurrence based on elevated serum prostate-specific antigen level. Radioligand therapy (RLT) with 177 Lu-PSMA-617 ( 177 Lu-vipivotide tetraxetan, Pluvicto, Novartis/AAA) was approved on March 23, 2022, based on the favorable results of the VISION trial. It has been recognized that PET imaging of PSMA expression and glucose metabolism (with 18 F-FDG) provides a more comprehensive assessment of the tumor burden and heterogeneity. However, there are many unresolved issues that surround whether or not imaging with 18 F-FDG PET is advantageous in the clinical setting of PSMA RLT in mCRPR.

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Section: Pros and Cons Of 18 F-fdg Pet/ct Inclusion In Psma Rltmentioning

confidence: 99%

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC

Jadvar

2021

J Nucl Med

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“…Despite, the degree of variation as observed in this study ( Table 3 ) may be less significant in clinical context when coexisted with inter-patient and intra-patient variability in PSMA biodistribution ( 24 , 25 ). Notwithstanding, the repeatability of PSMA PET/CT was proven and shown to be similar to 18FDG PET/CT that has been extensively used clinically with confidence ( 26 , 27 ). The effect of lesion contouring using common segmentation methods on volumetric parameters with such variation in SUVmax and image appearance is the main concern of this study.…”

Section: Discussionmentioning

confidence: 86%

Reliability of gradient-based segmentation for measuring metabolic parameters influenced by uptake time on 18F-PSMA-1007 PET/CT for prostate cancer

Lau

Chen

et al. 2022

Front. Oncol.

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PurposeTo determine an optimal setting for functional contouring and quantification of prostate cancer lesions with minimal variation by evaluating metabolic parameters on 18F-PSMA-1007 PET/CT measured by threshold-based and gradient-based methods under the influence of varying uptake time.Methods and materialsDual time point PET/CT was chosen to mimic varying uptake time in clinical setting. Positive lesions of patients who presented with newly diagnosed disease or biochemical recurrence after total prostatectomy were reviewed retrospectively. Gradient-based and threshold-based tools at 40%, 50% and 60% of lesion SUVmax (MIM 6.9) were used to create contours on PET. Contouring was considered completed if the target lesion, with its hottest voxel, was delineated from background tissues and nearby lesions under criteria specific to their operations. The changes in functional tumour volume (FTV) and metabolic tumour burden (MTB, defined as the product of SUVmean and FTV) were analysed. Lesion uptake patterns (increase/decrease/stable) were determined by the percentage change in tumour SUVmax at ±10% limit.ResultsA total of 275 lesions (135 intra-prostatic lesions, 65 lymph nodes, 45 bone lesions and 30 soft tissue lesions in pelvic region) in 68 patients were included. Mean uptake time of early and delayed imaging were 94 and 144 minutes respectively. Threshold-based method using 40% to 60% delineated only 85 (31%), 110 (40%) and 137 (50%) of lesions which all were contoured by gradient-based method. Although the overall percentage change using threshold at 50% was the smallest among other threshold levels in FTV measurement, it was still larger than gradient-based method (median: 50%=-7.6% vs gradient=0%). The overall percentage increase in MTB of gradient-based method (median: 6.3%) was compatible with the increase in tumour SUVmax. Only a small proportion of intra-prostatic lesions (<2%), LN (<4%), bone lesions (0%) and soft tissue lesions (<4%) demonstrated decrease uptake patterns.ConclusionsWith a high completion rate, gradient-based method is reliable for prostate cancer lesion contouring on 18F-PSMA-1007 PET/CT. Under the influence of varying uptake time, it has smaller variation than threshold-based method for measuring volumetric parameters. Therefore, gradient-based method is recommended for tumour delineation and quantification on 18F-PSMA-1007 PET/CT.

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“…RCs for SUV max and SUV mean were 31% and 24.4%, respectively. Seifert et al [ 2 ] reported RCs of lesion SUV max and SUV mean of 34.% and 32.7%, respectively, using 68 Ga-PSMA-HBED-CC PET-CT scan. Future work is needed to determine whether the described Gen-PET methods would be within reliability metrics for response assessment criteria, such as PERCIST [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

“…PET-CT is a standard imaging modality in oncology for initial diagnosis [1][2][3]. Furthermore, follow-up PET-CTs can help to evaluate quantitative treatment response both clinically and in research/clinical trials [4].…”

Section: Introductionmentioning

confidence: 99%

Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN

Ma,

Mena,

Lindenberg

et al. 2024

Oncotarget

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Purpose: Sequential PET/CT studies oncology patients can undergo during their treatment follow-up course is limited by radiation dosage. We propose an artificial intelligence (AI) tool to produce attenuation-corrected PET (AC-PET) images from non-attenuation-corrected PET (NAC-PET) images to reduce need for low-dose CT scans. Methods: A deep learning algorithm based on 2D Pix-2-Pix generative adversarial network (GAN) architecture was developed from paired AC-PET and NAC-PET images. 18 F-DCFPyL PSMA PET-CT studies from 302 prostate cancer patients, split into training, validation, and testing cohorts ( n = 183, 60, 59, respectively). Models were trained with two normalization strategies: Standard Uptake Value (SUV)-based and SUV-Nyul-based. Scan-level performance was evaluated by normalized mean square error (NMSE), mean absolute error (MAE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR). Lesion-level analysis was performed in regions-of-interest prospectively from nuclear medicine physicians. SUV metrics were evaluated using intraclass correlation coefficient (ICC), repeatability coefficient (RC), and linear mixed-effects modeling. Results: Median NMSE, MAE, SSIM, and PSNR were 13.26%, 3.59%, 0.891, and 26.82, respectively, in the independent test cohort. ICC for SUV max and SUV mean were 0.88 and 0.89, which indicated a high correlation between original and AI-generated quantitative imaging markers. Lesion location, density (Hounsfield units), and lesion uptake were all shown to impact relative error in generated SUV metrics (all p < 0.05). Conclusion: The Pix-2-Pix GAN model for generating AC-PET demonstrates SUV metrics that highly correlate with original images. AI-generated PET images show clinical potential for reducing the need for CT scans for attenuation correction while preserving quantitative markers and image quality.

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Repeatability of ⁶⁸Ga-PSMA-HBED-CC PET/CT-derived total molecular tumor volume

Cited by 8 publications

References 31 publications

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC

Reliability of gradient-based segmentation for measuring metabolic parameters influenced by uptake time on 18F-PSMA-1007 PET/CT for prostate cancer

Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN

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Repeatability of 68Ga-PSMA-HBED-CC PET/CT-derived total molecular tumor volume

Cited by 8 publications

References 31 publications

The VISION Forward: Recognition and Implication of PSMA−/18F-FDG+ mCRPC

The VISION Forward: Recognition and Implication of PSMA−/18F-FDG+ mCRPC

Reliability of gradient-based segmentation for measuring metabolic parameters influenced by uptake time on 18F-PSMA-1007 PET/CT for prostate cancer

Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN

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Repeatability of ⁶⁸Ga-PSMA-HBED-CC PET/CT-derived total molecular tumor volume

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC

The VISION Forward: Recognition and Implication of PSMA−/¹⁸F-FDG+ mCRPC