Cahenzli Martin A, Kreusch Andreas S, Huber Philipp, Dressler Marco, Blautzik Janusch P, Sommer Gregor
Institute of Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, 6006 Lucerne, Switzerland.
Prostate Cancer Center, Hirslanden Klinik St. Anna, 6006 Lucerne, Switzerland.
Diagnostics (Basel). 2025 Jul 31;15(15):1931. doi: 10.3390/diagnostics15151931.
: F-PSMA-1007 is one of the more widely used radioligands in prostate cancer imaging with PET/CT. Its major advantage lies in the low urinary tracer activity due to primarily hepatobiliary clearance, but unexpectedly high tracer accumulation in the bladder can occur, potentially hindering assessment of lesions near the prostate bed. This study assesses the impact of furosemide on F-PSMA-1007 tracer accumulation in the bladder. : In this single-center, retrospective, intra-individual comparative analysis, 18 patients undergoing two consecutive F-PSMA-1007 PET/CT scans for biochemical relapse (BCR) or persistence (BCP)-one with and one without prior furosemide administration-were included. Images were acquired 60 min post-injection of 250 MBq of tracer activity. Standardized Uptake Values (SUVmax, SUVpeak, SUVmean) were measured in the bladder and in tissues with physiological uptake by three readers. Differences were analyzed using Wilcoxon signed-rank tests. The inter-reader agreement was assessed using intraclass correlation coefficient. : Furosemide significantly decreased bladder SUVmax, SUVpeak, and SUVmean (all < 0.001). Mean bladder SUVmax decreased from 13.20 ± 10.40 to 3.92 ± 3.47, SUVpeak from 10.94 ± 8.02 to 3.47 ± 3.13, and SUVmean from 8.74 ± 6.66 to 2.81 ± 2.56, representing a large effect size (r ≈ 0.55). Physiological tracer uptake in most organs was not significantly influenced by furosemide (all > 0.05). : Despite the predominantly hepatobiliary clearance of F-PSMA-1007, furosemide-induced forced diuresis leads to a significant reduction in tracer activity in the bladder, which in clinical practice could help in early detection of tumor recurrence.
F-PSMA-1007是前列腺癌PET/CT成像中使用较为广泛的放射性配体之一。其主要优势在于主要通过肝胆清除，使得尿液中的示踪剂活性较低，但膀胱中示踪剂的意外高积聚可能会出现，这可能会妨碍对前列腺床附近病变的评估。本研究评估了呋塞米对F-PSMA-1007示踪剂在膀胱中积聚的影响。
在这项单中心、回顾性、个体内比较分析中，纳入了18例因生化复发（BCR）或持续存在（BCP）而连续接受两次F-PSMA-1007 PET/CT扫描的患者，其中一次扫描前给予了呋塞米，另一次未给予。在注射250 MBq示踪剂活性后60分钟采集图像。由三位阅片者测量膀胱和有生理性摄取的组织中的标准化摄取值（SUVmax、SUVpeak、SUVmean）。使用Wilcoxon符号秩检验分析差异。使用组内相关系数评估阅片者间的一致性。
呋塞米显著降低了膀胱的SUVmax、SUVpeak和SUVmean（均P<0.001）。膀胱平均SUVmax从13.20±10.40降至3.92±3.47，SUVpeak从10.94±8.02降至3.47±3.13，SUVmean从8.74±6.66降至2.81±2.56，效应量较大（r≈0.55）。呋塞米对大多数器官的生理性示踪剂摄取没有显著影响（均P>0.05）。
尽管F-PSMA-1007主要通过肝胆清除，但呋塞米诱导的强制利尿导致膀胱中示踪剂活性显著降低，这在临床实践中有助于早期发现肿瘤复发。
