Impact of forced diuresis with furosemide and hydration on the halo artefact and intensity of tracer accumulation in the urinary bladder and kidneys on [68Ga]Ga-PSMA-11-PET/CT in the evaluation of prostate cancer patients

Uprimny, Christian; Bayerschmidt, Steffen; Kroiss, Alexander; Fritz, Josef; Nilica, Bernhard; Svirydenka, Anna; Decristoforo, Clemens; Santo, Gianpaolo di; Guggenberg, Elisabeth von; Horninger, Wolfgang; Virgolini, Irene

doi:10.1007/s00259-020-04846-3

Cited by 16 publications

(23 citation statements)

References 29 publications

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“…For example, later acquisitions show improved lesion detection for some PSMA tracers [49,50]; the time-point of image acquisition should therefore be standardised. None of the studies report the use of a diuretic for tracers undergoing renal excretion such as 68 Ga-PSMA-11 or 18 F-DCFPyL, a simple and low-cost clinical manoeuvre which can increase lesion detection [51,52] and is an important consideration in designing a fair comparison of renal with non-renal excreted tracers. Finally, we wish to highlight the point that no PSMA-radiotracer has yet demonstrated a 100% sensitivity, and non PSMA-avid rPC is a potentially underreported phenomenon.…”

Section: Update Forestmentioning

confidence: 99%

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

Alberts

Seide

Mingels

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose Numerous radiotracers are currently available for the detection of recurrent prostate cancer (rPC), yet many have not been compared head-to-head in comparative imaging studies. There is therefore an unmet need for evidence synthesis to guide evidence-based decisions in the selection of radiotracers. The objective of this study was to assess the detection rate of various radiotracers for the rPC. Methods The PUBMED, EMBASE, and the EU and NIH trials databases were searched without date or language restriction for comparative imaging tracers for 13 radiotracers of principal interest. Key search terms included 18F-PSMA-1007, 18F-DCPFyl, 68Ga-PSMA-11, 18F-PSMA-11, 68Ga-PSMA-I&T, 68Ga-THP-PSMA, 64Cu-PSMA-617, 18F-JK-PSMA-7, 18F-Fluciclovine, 18F-FABC, 18F-Choline, 11C-Choline, and 68Ga-RM2. Studies reporting comparative imaging data in humans in rPC were selected. Single armed studies and matched pair analyses were excluded. Twelve studies with eight radiotracers were eligible for inclusion. Two independent reviewers screened all studies (using the PRISMA-NMA statement) for inclusion criteria, extracted data, and assessed risk of bias (using the QUADAS-2 tool). A network meta-analysis was performed using Markov-Chain Monte Carlo Bayesian analysis to obtain estimated detection rate odds ratios for each tracer combination. Results A majority of studies were judged to be at risk of publication bias. With the exception of 18F-PSMA-1007, little difference in terms of detection rate was revealed between the three most commonly used PSMA-radiotracers (68Ga-PSMA-11, 18F-PSMA-1007, 18F-DCFPyl), which in turn showed clear superiority to choline and fluciclovine using the derived network. Conclusion Differences in patient-level detection rates were observed between PSMA- and choline-radiotracers. However, there is currently insufficient evidence to favour one of the four routinely used PSMA-radioligands (PSMA-11, PSMA-1007, PSMA-I&T, and DCFPyl) over another owing to the limited evidence base and risk of publication bias revealed by our systematic review. A further limitation was lack of reporting on diagnostic accuracy, which might favour radiotracers with low specificity in an analysis restricted only to detection rate. The NMA derived can be used to inform the design of future clinical trials and highlight areas where current evidence is weak.

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Section: Update Forestmentioning

confidence: 99%

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

Alberts

Seide

Mingels

et al. 2021

Eur J Nucl Med Mol Imaging

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“…For this retrospective analysis, a total of 190 PCa patients who were referred for 68Ga-PSMA-11 PET/CT between 3 January 2018 and 28 February 2020 for assessment of BR after definitive primary therapy were extracted from our database. Analysis included PET/CT exams of patients partly evaluated in previous publications by our group [ 7 , 9 ]. The median PSA value at the time of image acquisition was 0.7 ng/mL (range, 0.1–105.6 ng/mL), the median Gleason score was 7 (range, 5–10), and the median age was 71 years (range, 44–87 years).…”

Section: Methodsmentioning

confidence: 99%

“…This might lead to missed LR lesions in patients with BR [ 6 ]. Furthermore, high tracer accumulation can cause a so-called halo artifact, a phenomenon that leads to an extinction of the PET signal surrounding areas with intense tracer uptake, such as the urinary bladder [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Early Imaging and Imaging 60 min Post-Injection after Forced Diuresis with Furosemide in the Assessment of Local Recurrence in Prostate Cancer Patients with Biochemical Recurrence Referred for 68Ga-PSMA-11 PET/CT

et al. 2021

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Background: 68Ga-PSMA-11 PET/CT is a promising method for the assessment of local recurrence (LR) in prostate cancer (PCa) patients. The aim of this study was to evaluate the diagnostic performance of early 68Ga-PSMA-11 PET imaging in comparison to 68Ga-PSMA-11 PET imaging 60 min post-injection (p.i.) in the detection of LR in patients with biochemical recurrence (BR) of prostate carcinoma. Materials and Methods: 190 image sets of patients with BR in PCa who underwent 68Ga-PSMA-11 PET/CT were assessed retrospectively (median prostate specific antigen (PSA) value, 0.70 ng/mL (range, 0.1–105.6 ng/mL)). Patients received an early static scan of the pelvic area (median, 248 s p.i. (range, 56–923 s)) and a whole-body scan 60 min p.i. (median, 64 min p.i. (range, 45–100 min)) with intravenous administration of 20 mg furosemide i.v. at the time of tracer application, followed by intravenous hydration with 500 mL of sodium chloride (NaCl 0.9%). Assessment was based on visual analysis and calculation of the maximum standardized uptake value (SUVmax) of the pathologic lesions present in the prostate fossa found in the early PET imaging and 60 min PET scans. The scans were characterized as negative, positive, or equivocal. The results were compared, and the combination of early and 60 min p.i. imaging was evaluated. Results: Image assessment resulted in 30 (15.8%) positive, 17 (8.9%) equivocal, and 143 (75.3%) negative findings in early scans, and 28 (14.7%) positive, 25 (13.2%) equivocal, and 137 (72.1%) negative findings of LR in 60 min p.i. images. For combined image analysis, 33 (17.4%) cases were positive and 20 (10.5%) were equivocal. There was no statistical significance between the number of positive (p = 0.815), negative (p = 0.327), and equivocal (p = 0.152) findings. Furthermore, the combination of both scans showed no statistically significant differences for the positive and negative findings (p = 0.063). The median SUVmax was 4.9 (range, 2.0–55.2) for positive lesions in the early scans and 8.0 (range, 2.1–139.9) in the scans 60 min p.i. The median SUVmax for bladder activity was 2.5 (range, 0.9–12.2) in the early scans and 8.2 (range, 1.8–27.6) in the scans 60 min p.i. Conclusion: Early static imaging additional to 68Ga-PSMA-11 PET images acquired 60 min p.i. has limited value in patients prepared with furosemide and hydration, and showed no statistically significant change in the detection rate (DR) of LR and the number of equivocal findings. Based on our results, in departments following a protocol with forced diuresis, including furosemide, additional early static imaging cannot be routinely recommended for the assessment of BR in PCa patients.

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“…69 Indeed, although the detection of advanced metastatic disease may divert the patient from futile local therapy, this commonly occurs in more advanced disease, where the magnitude of the difference between PSMA and previous-generation radiotracers is small. 70 Whereas the combination of new radiotracers, 62 optimum imaging protocols, 71,72 and advanced digital scanners 73 act in concert to increase the detection rate at earlier stages of recurrence, the clinical rationale behind this approach remains unclear and there is uncertainty in the oncological literature about the best management approach for these patients. Although the ORIOLE Phase II trial suggests a role for stereotactic ablative radiotherapy in men with oligometastatic PC 74 this approach lacks a firm solid-evidence base at present and is a topic of debate in the urologic literature.…”

Section: Controversies In Psma Imagingmentioning

confidence: 99%

Prostate Cancer Theranostics

et al. 2021

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Impact of forced diuresis with furosemide and hydration on the halo artefact and intensity of tracer accumulation in the urinary bladder and kidneys on [68Ga]Ga-PSMA-11-PET/CT in the evaluation of prostate cancer patients

Cited by 16 publications

References 29 publications

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

Comparing the diagnostic performance of radiotracers in recurrent prostate cancer: a systematic review and network meta-analysis

Comparison of Early Imaging and Imaging 60 min Post-Injection after Forced Diuresis with Furosemide in the Assessment of Local Recurrence in Prostate Cancer Patients with Biochemical Recurrence Referred for 68Ga-PSMA-11 PET/CT

Prostate Cancer Theranostics

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