Healing Sacral Fracture Masquerading as Metastatic Bone Disease on a 68Ga-PSMA PET/CT

Gykiere, Pieterjan; Goethals, Laurence; Everaert, Hendrik

doi:10.1097/rlu.0000000000001222

Cited by 48 publications

(29 citation statements)

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“…Furthermore, Gykiere et al presented a case of PSMA uptake in a healing sacral bone fracture mimicking bone metastasis. MRI revealed no evidence of an underlying pathologic fracture, but no biopsy was conducted to verify or rule out pathologic fracture (Gykiere et al, 2016).…”

Section: Pitfalls Of 68 Ga-psma Pet/ct In Bone Imagingmentioning

confidence: 99%

⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

Zacho

Nielsen

Haberkorn

et al. 2017

Clin Physio Funct Imaging

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Ga-PSMA PET/CT has shown to be a promising technique for use in prostate cancer. Ga-PSMA PET/CT shows more lesions than bone scans, but data on diagnostic performance are very limited and indicate improved diagnostic performance in primary staging but not in mCRPC. Properly designed studies are needed to clarify the diagnostic performance of Ga-PSMA PET/CT as well as its superiority over existing methods before Ga-PSMA PET/CT can be routinely used for bone imaging.

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Section: Pitfalls Of 68 Ga-psma Pet/ct In Bone Imagingmentioning

confidence: 99%

⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

Zacho

Nielsen

Haberkorn

et al. 2017

Clin Physio Funct Imaging

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“…It can often be difficult to determine if the rib lesion is a benign lesion or represent metastases from prostate cancer. Differential diagnoses include healed fractures [9][10][11], sarcoidosis [12,13], fibrous dysplasia [14,15] and Paget's disease [16,17], and literature on this topic is limited to a small number of case reports. Given the lack of data in the current literature, we conducted a retrospective review investigating cases of solitary rib lesions with PSMA uptake on pre-treatment 68 Ga-PSMA PET/CT.…”

Section: Introductionmentioning

confidence: 99%

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

et al. 2020

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Objectives To determine the proportion of solitary rib lesions on pre‐treatment 68Gallium‐labelled prostate‐specific membrane antigen (PSMA)/computed tomography (CT) scans in men with prostate cancer that are malignant and examine any predictive factors. Patients and methods This retrospective single tertiary referral institution cohort study of men reviewed the results of 68Ga‐PSMA‐11 positron emission tomography (PET)/CT scans performed for primary staging prior to treatment of prostate cancer from July 2014 to September 2019. Men with PSMA uptake outside the prostate in only the rib lesion were included. A solitary rib lesion was considered to be malignant if it increased in size on follow‐up imaging. A lesion was considered benign if the prostate‐specific antigen (PSA) level remained <0.1 µg/L following a radical prostatectomy (RP), <2 µg/L above nadir following radiotherapy (RT) as per the Phoenix criteria, histology was benign on rib biopsy, or follow‐up imaging showed no growth of the rib lesion. If a lesion did not meet these criteria it was considered indeterminate. Results A total of 62 men had PSMA uptake in a solitary rib lesion; 54 went on to have RPs and eight underwent RT. In all, 61 of the men (98.4%) met the criteria for a benign rib lesion. Only one man had a false‐negative malignant lesion. This man had a rib lesion with a low maximum standardised uptake value (SUVmax) of 2.21 reported as benign, but the postoperative PSA level was 0.67 µg/L and the rib lesion progressed on follow‐up imaging, with development of widespread metastases. Of the benign rib lesions, there were four false positives reported as possible metastases. Three had percutaneous rib biopsies, two of which came back with benign histology and one was indeterminate. The indeterminate biopsy patient had a RP and his postoperative PSA level was <0.1 µg/L. A total of 43 (69.4%) men with benign rib lesions had a SUVmax greater than the SUVmax of the malignant lesion. Conclusion To our knowledge, this is the first cohort study of men with PSMA‐avid solitary rib lesions on pre‐treatment 68Ga‐PSMA PET/CT staging scans for prostate cancer. Our results indicate that the vast majority of these lesions have low‐intensity uptake and are benign. Intervention to confirm this is not usually required.

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“…However, a wide range of malignancies other than prostate cancer have also been reported to express PSMA as part of tumor neovasculature [ 7 – 9 ] with 68Ga-PSMA avidity described in cases of breast cancer [ 10 ], renal cell carcinoma [ 11 ], glioblastoma multiforme [ 12 ], hepatocellular carcinoma [ 13 ], differentiated thyroid cancer [ 14 ], colorectal carcinoma [ 15 ], non-small cell lung cancer [ 16 ] and follicular lymphoma [ 17 ]. PSMA uptake has been also reported in a large variety of benign lesions such as retroperitoneal schwannoma [ 18 ], desmoid tumor [ 19 ], Paget’s disease of bone [ 20 ], sarcoidosis [ 21 ], sub-acute stroke [ 22 ] and bone fractures [ 23 , 24 ]. Uptake in benign processes as well as in the celiac ganglia can mimic a lymph node metastasis [ 24 , 25 ] and can therefore be pitfalls in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

68Ga-PSMA PET/CT in prostate cancer patients – patterns of disease, benign findings and pitfalls

et al. 2018

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Background68Ga-PSMA PET/CT has an important role in assessment of prostate cancer patients with biochemical recurrence and is evolving in staging high- and intermediate risk disease. The aim of present study was to describe the metastatic patterns and frequency of involved sites of prostate cancer and to assess the incidence of benign Ga68-PSMA avid PET/CT findings in a large patient population.Methods68Ga-PSMA PET/CT studies performed in two tertiary medical centers over a period of 24 months were retrospectively reviewed. The incidence and location of pathological 68Ga-PSMA avid foci, suspicious to represent malignancy, as well as those of unexpected benign foci of increased 68Ga-PSMA activity were documented and analyzed.ResultsThere were 445 68Ga-PSMA studies in 438 men (mean age 72.4, range 51–92 years) with prostate cancer referred for biochemical failure (n = 270, 61%), staging high-risk disease (n = 112, 25%), response assessment (n = 30, 7%), follow-up (n = 22, 5%) and suspected bone metastases (n = 11, 2%). 68Ga-PSMA avid disease sites were observed in 319 studies (72%), in 181 studies (67%) for biochemical recurrence, 94 studies for staging (84%) (p < 0.05), in 22 studies for response assessment (73%), 10 follow up studies (45%) and in five patients with suspected bone metastases (45%). 68Ga-PSMA avid lesions were most commonly detected in the prostate (n = 193, 43%), loco-regional spread (n = 51, 11%), abdomino-pelvic nodes (n = 129, 29%) and distant metastases (n = 158, 36%), including bone metastases (n = 11, 25%), distant lymphadenopathy (n = 29, 7%) and other organs (n = 18, 4%). Distant 68Ga-PSMA-avid metastases were commonly seen in patients with biochemical recurrence (14/21 lesions), but were not seen in patient referred for staging (p < 0.013). There were 96 non-malignant 68Ga-PSMA avid foci in 81 studies, most common in reactive lymph nodes (n = 36, 38%), nonmalignant bone lesions (n = 21, 22%), thyroid nodules (n = 9, 9%), ganglions (n = 9, 9%) and lung findings (n = 8, 8%).ConclusionThe distribution of 68Ga-PSMA avid metastatic lesions is similar to data previously reported mainly from autopsy with comparable detection rates, indicating 68Ga-PSMA PET/CT is an accurate detection tool in patients with metastatic prostate cancer. If confirmed by further prospective studies 68Ga-PSMA PET/CT should be included in the guidelines to evaluate disease extent in these patients.

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Healing Sacral Fracture Masquerading as Metastatic Bone Disease on a 68Ga-PSMA PET/CT

Cited by 48 publications

References 6 publications

⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

68Ga-PSMA PET/CT in prostate cancer patients – patterns of disease, benign findings and pitfalls

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Healing Sacral Fracture Masquerading as Metastatic Bone Disease on a 68Ga-PSMA PET/CT

Cited by 48 publications

References 6 publications

68Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

68Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging 68Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?

68Ga-PSMA PET/CT in prostate cancer patients – patterns of disease, benign findings and pitfalls

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⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

⁶⁸Ga‐PSMA PET/CT for the detection of bone metastases in prostate cancer: a systematic review of the published literature

Solitary rib lesions showing prostate‐specific membrane antigen (PSMA) uptake in pre‐treatment staging ⁶⁸Ga‐PSMA‐11 positron emission tomography scans for men with prostate cancer: benign or malignant?