Fennessy Niall, Lee Jonathan, Shin Jane, Ho Bao, Ali Syed Aman, Paschkewitz Royce, Emmett Louise
Department of Nuclear Medicine, St Vincent's Public Hospital, Sydney, Australia.
University of New South Wales, Sydney, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2017 Dec;61(6):739-744. doi: 10.1111/1754-9485.12625. Epub 2017 Jun 17.
Ga-PSMA positron emission tomography-computed tomography (PET/CT) is useful for both staging and assessment of biochemical relapse in men with prostate cancer. Renal excretion of Ga-PSMA can lead to difficulties in scan interpretation, particularly in the pelvis. We evaluated if intravenous Frusemide at the time of Ga-PSMA injection reduces excreted activity artefact and improves diagnostic certainty.
Sixty-two men with prostate cancer undergoing clinically indicated Ga-PSMA PET/CT were prospectively included, 30 men receiving Frusemide at the time of radiotracer injection. Clinical information and reasons for the scan were documented. Intensity of excreted activity was assessed semi quantitatively for each patient (SUV max). PET/CT images were interpreted by two experienced readers for image quality, and presence/absence of PSMA-positive disease.
Twenty-nine percent (18/62) were staging scans, and 71% (44/62) re-staging. PSMA-positive findings were identified in 95% (59/62). Staging scans had PSMA-positive findings within the prostate in 100% (18/18) and re-staging scans, 50% (22/44) in the prostate fossa, 64% (28/44) in lymph nodes and 21% (9/44) in viscera and bone. Administration of Frusemide had a significant impact on intensity of excreted activity in the ureters and bladder. Impaired image quality was noted in 33% (10/30) of men not given Frusemide, compared to only 3% (1/32) in men given Frusemide (P = 0.002). Reporter confidence on the presence/absence of PSMA avid disease in the prostate fossa improved from 63% (19/30) without Frusemide, to 91% (29/32) with Frusemide (P < 0.015).
Intravenous Frusemide given with Ga-PSMA reduces excretion artefact, and improves diagnostic certainty. Frusemide should be considered for all Ga-PSMA PET/CT imaging protocols.
镓-前列腺特异性膜抗原正电子发射断层扫描-计算机断层扫描（PET/CT）对于前列腺癌男性患者的分期及生化复发评估均有帮助。镓-前列腺特异性膜抗原经肾脏排泄会导致扫描解读困难，尤其是在骨盆部位。我们评估了在注射镓-前列腺特异性膜抗原时静脉注射速尿是否能减少排泄活性伪影并提高诊断确定性。
前瞻性纳入62例接受临床指征性镓-前列腺特异性膜抗原PET/CT检查的前列腺癌男性患者，其中30例患者在注射放射性示踪剂时接受了速尿治疗。记录临床信息及扫描原因。对每位患者排泄活性强度进行半定量评估（SUV最大值）。由两名经验丰富的阅片者解读PET/CT图像，评估图像质量以及是否存在前列腺特异性膜抗原阳性病变。
29%（18/62）为分期扫描，71%（44/62）为再分期扫描。95%（59/62）发现前列腺特异性膜抗原阳性结果。分期扫描中，100%（18/18）在前列腺内发现前列腺特异性膜抗原阳性结果；再分期扫描中，50%（22/44）在前列腺窝、64%（28/44）在淋巴结以及21%（9/44）在内脏和骨骼中发现前列腺特异性膜抗原阳性结果。速尿给药对输尿管和膀胱的排泄活性强度有显著影响。未接受速尿治疗的患者中33%（10/30）图像质量受损，而接受速尿治疗的患者中仅3%（1/32）图像质量受损（P = 0.002）。阅片者对前列腺窝中是否存在前列腺特异性膜抗原高摄取病变的信心从未使用速尿时的63%（19/30）提高到使用速尿时的91%（29/32）（P < 0.015）。
镓-前列腺特异性膜抗原注射时静脉注射速尿可减少排泄伪影并提高诊断确定性。所有镓-前列腺特异性膜抗原PET/CT成像方案均应考虑使用速尿。
