Donswijk Maarten L, Wondergem Maurits, de Wit-van der Veen Linda, Bruin Natascha M, van Leeuwen Pim J, van der Poel Henk G, Stokkel Marcel P M, Vogel Wouter V
Department of Nuclear Medicine, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
Department of Radiation Oncology, Antoni van Leeuwenhoek Nederlands Kanker Instituut, Amsterdam, The Netherlands.
EJNMMI Res. 2022 Jul 27;12(1):42. doi: 10.1186/s13550-022-00913-y.
High urinary activity in urinary bladder and ureters may hamper interpretation of prostate cancer and regional nodal metastases in prostate-specific membrane antigen (PSMA) PET/CT. The goal of this study was to assess effects of furosemide and choice of tracer on urinary activity in the bladder and ureters, as well as on occurrence of peri-bladder artefacts in PET/CT.
Four cohorts with a total of 202 men staged with PSMA PET/CT for prostate cancer received either Ga-PSMA-11 as tracer, with (cohort G+) or without 10mg intravenous furosemide (G-) concurrent with tracer, or F-DCFPyL with (F+) or without furosemide (F-). SUVmax of bladder and ureters, presence, type, and severity of peri-bladder artefacts were compared between cohorts. The influence of furosemide and choice of tracer was determined while taking differences in biodistribution time into account.
Median SUVmax bladder was 43,5; 14,8; 61,7 and 22,8 in cohorts G-, G+, F- and F+, respectively, resulting in significant overall (p < 0.001) and between cohort differences (p adjusted < 0.001 to 0.003) except between G- and F+. Median SUVmax ureter was 6.4; 4.5; 8.1 and 6.0 in cohorts G-, G+, F- and F+, respectively, resulting in significant overall (p < 0.001) and between cohort differences for G+ : F- and F- : F+ (p < 0.001, respectively, 0.019). Significant effects of furosemide and choice of tracer on SUVmax bladder (p < 0.001 resp. p = 0.001) and of furosemide on SUVmax ureter (p < 0.001) were found, whereas differences in biodistribution time had not impacted these results significantly. Peri-bladder artefacts were present in 42/202 (21%) patients and were significantly more frequent in the F- cohort, respectively, less frequent in the G+ cohort (p = 0.001 resp. p < 0.001). Peri-bladder artefacts had a direct positive correlation with SUVmax bladder (p = 0.033).
Increased urinary activity and higher incidence of peri-bladder artefacts were found in F-DCFPyL compared to Ga-PSMA-11 PET/CT. Effective reduction of urinary activity may be reached through forced diuresis using 10mg intravenous furosemide, which is especially advantageous in F-DCFPyL PET/CT.
膀胱和输尿管内较高的尿液放射性可能会影响前列腺特异性膜抗原（PSMA）PET/CT对前列腺癌及区域淋巴结转移的诊断。本研究旨在评估呋塞米和示踪剂的选择对膀胱和输尿管内尿液放射性以及PET/CT中膀胱周围伪影发生情况的影响。
四组共202名因前列腺癌接受PSMA PET/CT分期的男性患者，分别接受Ga-PSMA-11作为示踪剂，同时（G+组）或不同时（G-组）静脉注射10mg呋塞米，或F-DCFPyL，同时（F+组）或不同时（F-组）使用呋塞米。比较各组膀胱和输尿管的SUVmax、膀胱周围伪影的存在情况、类型和严重程度。在考虑生物分布时间差异的情况下，确定呋塞米和示踪剂选择的影响。
G-组、G+组、F-组和F+组膀胱SUVmax中位数分别为43.5、14.8、61.7和22.8，总体差异有统计学意义（p < 0.001），组间差异也有统计学意义（校正p < 0.001至0.003），G-组和F+组除外。G-组、G+组、F-组和F+组输尿管SUVmax中位数分别为6.4、4.5、8.1和6.0，总体差异有统计学意义（p < 0.001），G+组与F-组、F-组与F+组间差异有统计学意义（分别为p < 0.001、0.019）。发现呋塞米和示踪剂的选择对膀胱SUVmax有显著影响（分别为p < 0.001、p = 0.001），呋塞米对输尿管SUVmax也有显著影响（p < 0.001），而生物分布时间差异对这些结果无显著影响。42/202（21%）例患者出现膀胱周围伪影，F-组明显更常见，G+组明显更少见（分别为p = 0.001、p < 0.001）。膀胱周围伪影与膀胱SUVmax呈直接正相关（p = 0.033）。
与Ga-PSMA-11 PET/CT相比，F-DCFPyL PET/CT中尿液放射性增加，膀胱周围伪影发生率更高。静脉注射10mg呋塞米进行强制利尿可有效降低尿液放射性，这在F-DCFPyL PET/CT中尤其有利。
