Department of Nuclear Medicine, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.
Department of Surgery, Netherlands Cancer Institute-Antoni Van Leeuwenhoek Hospital, Plesmanlaan 121, NL-1066 CX, Amsterdam, The Netherlands.
Eur Radiol. 2023 May;33(5):3377-3385. doi: 10.1007/s00330-023-09492-5. Epub 2023 Mar 9.
To investigate the incidences of prostate-specific membrane antigen (PSMA) thyroid incidentaloma (PTI) using different methods to define PTI, to compare the incidence of PTI among different PSMA PET tracers, and to evaluate the clinical consequences of PTI.
PSMA PET/CT scans in consecutive patients with primary prostate cancer were analyzed for the presence of PTI using a structured visual (SV) analysis reporting any elevated thyroidal uptake; a semi-quantitative (SQ) analysis using a SUVmax thyroid/bloodpool (t/b) ratio ≥ 2.0 as cutoff; and an analysis of PTI incidence in the clinical reports (RV analysis).
A total of 502 patients were included. The incidence of PTIs was 22% in the SV analysis, 7% in the SQ analysis, and 2% in the RV analysis. PTI incidences differed significantly from 29 to 64% (SQ, resp. SV analysis) for [F]PSMA-1007, 7 to 23% for [Ga]PSMA-11, 2 to 8% for [F]DCFPyL, and to 0% for [F]PSMA-JK-7. The majority of PTI in the SV and SQ analyses consisted of diffuse (72-83%) and/or only slightly elevated thyroidal uptake (70%). Inter-observer agreement in the SV analysis was substantial (kappa = 0.76-0.78). During follow-up (median 16.8 months), there were no thyroid-related adverse events except in three patients.
The incidence of PTI varies greatly among different PSMA PET tracers and is strongly dependent on the analysis method applied. PTI may safely be restricted to focal thyroidal uptake with a SUVmax t/b ratio ≥ 2.0. The clinical pursuit of a PTI must be weighed up to the expected outcome of the underlying disease.
• Thyroid incidentalomas (PTIs) are recognized in PSMA PET/CT. • Incidence of PTI varies greatly among PET tracers and analysis methods. • Incidence of thyroid-related adverse events in PTI cases is low.
使用不同方法定义 PSMA 甲状腺意外瘤（PTI），以研究前列腺特异性膜抗原（PSMA）甲状腺意外瘤（PTI）的发生率，比较不同 PSMA PET 示踪剂的 PTI 发生率，并评估 PTI 的临床后果。
对连续原发性前列腺癌患者的 PSMA PET/CT 扫描进行分析，使用结构视觉（SV）分析报告任何升高的甲状腺摄取；使用 SUVmax 甲状腺/血池（t/b）比值≥2.0 作为截断值的半定量（SQ）分析；以及在临床报告中分析 PTI 的发生率（RV 分析）。
共纳入 502 例患者。SV 分析、SQ 分析和 RV 分析中 PTI 的发生率分别为 22%、7%和 2%。PTI 发生率在[F]PSMA-1007 中从 29%到 64%（SQ，分别为 SV 分析）、[Ga]PSMA-11 中从 7%到 23%、[F]DCFPyL 中从 2%到 8%、[F]PSMA-JK-7 中为 0%，差异有统计学意义。SV 和 SQ 分析中大多数 PTI 由弥漫性（72-83%）和/或仅轻度升高的甲状腺摄取组成（70%）。SV 分析中的观察者间一致性较高（kappa=0.76-0.78）。在随访期间（中位 16.8 个月），除了 3 例患者外，没有与甲状腺相关的不良事件。
不同 PSMA PET 示踪剂的 PTI 发生率差异很大，且强烈依赖于应用的分析方法。PTI 可安全限制为具有 SUVmax t/b 比值≥2.0 的局灶性甲状腺摄取。PTI 的临床随访必须权衡潜在疾病的预期结果。
PSMA PET/CT 可识别甲状腺意外瘤（PTI）。
PTI 在不同示踪剂和分析方法中的发生率差异很大。
PTI 病例中与甲状腺相关的不良事件发生率较低。
