Department of Radiology & Nuclear Medicine, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands.
Department of Urology, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, The Netherlands.
J Nucl Med. 2019 Aug;60(8):1111-1117. doi: 10.2967/jnumed.118.222505. Epub 2019 Jan 10.
PET is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include Ga-prostate-specific membrane antigen HBED-CC (Ga-PSMA), F-DCFPyL, F-fluoromethylcholine (F-FCH), and F-dihydrotestosterone (F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, because malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. A total of 232 PCa PET/CT scans from multiple hospitals was analyzed, including 87 Ga-PSMA scans, 50 F-DCFPyL scans, 68 F-FCH scans, and 27 F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow, and muscle using several SUVs (SUV, SUV, SUV). Variability in uptake between patients was analyzed using the coefficient of variation (COV%). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based quality control for future PET acquisitions. For Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV, 19.9%), which was significantly more stable than all other tissues (COV, 29.8%-35.2%; = 0.001-0.024). For F-DCFPyL, the lowest variability was observed in the blood pool and liver (COV, 14.4% and 21.7%, respectively; = 0.001-0.003). The least variable F-FCH uptake was observed in the liver, blood pool, and bone marrow (COV, 16.8%-24.2%; = 0.001-0.012). For F-FDHT, low uptake variability was observed in all tissues, except the lung (COV, 14.6%-23.6%; = 0.001-0.040). The different SUV types had limited effect on variability (COVs within 3 percentage points). In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for Ga-PSMA and F-DCFPyL and the liver for F-FCH and F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based quality control.
正电子发射断层扫描（PET）越来越多地用于前列腺癌（PCa）的诊断。重要的 PCa 放射性示踪剂包括 Ga-前列腺特异性膜抗原 HBED-CC（Ga-PSMA）、F-DCFPyL、F-氟甲基胆碱（F-FCH）和 F-二氢睾酮（F-FDHT）。了解健康组织中示踪剂摄取的变异性对于准确的 PET 解读很重要，因为只有当病变的摄取与背景形成对比时，才怀疑为恶性肿瘤。因此，本研究旨在定量分析健康组织中 PCa 示踪剂的摄取变异性，并确定用于 PET 解读的稳定参考区域。
本研究分析了来自多家医院的 232 例 PCa PET/CT 扫描，包括 87 例 Ga-PSMA 扫描、50 例 F-DCFPyL 扫描、68 例 F-FCH 扫描和 27 例 F-FDHT 扫描。使用多个 SUV（SUV、SUV、SUV）评估血液池、肺、肝、骨髓和肌肉中的示踪剂摄取。使用变异系数（COV%）分析患者之间摄取的变异性。对于所有示踪剂，计算了 SUV 参考范围（95%百分位数），这些参考范围可作为未来 PET 采集的基于图像的质量控制。
对于 Ga-PSMA，血液池中的摄取变异性最低（COV，19.9%），与其他所有组织相比（COV，29.8%-35.2%；=0.001-0.024）更为稳定。对于 F-DCFPyL，血液池和肝脏中的摄取变异性最低（COV，分别为 14.4%和 21.7%；=0.001-0.003）。F-FCH 摄取的变异性最低，见于肝脏、血液池和骨髓（COV，16.8%-24.2%；=0.001-0.012）。对于 F-FDHT，除了肺（COV，14.6%-23.6%；=0.001-0.040）外，所有组织的摄取变异性均较低。不同的 SUV 类型对变异性的影响有限（差异在 3 个百分点以内）。
在这项多中心分析中，确定了具有有限摄取变异性的健康组织，这些组织可作为 PCa PET 解读的参考区域。这些参考区域包括 Ga-PSMA 和 F-DCFPyL 的血液池以及 F-FCH 和 F-FDHT 的肝脏。本研究还提供了健康组织 SUV 参考范围，可作为基于图像的质量控制应用。
