SSTR-RADS Version 1.0 as a Reporting System for SSTR PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework

Werner, Rudolf A.; Solnes, Lilja B.; Javadi, Mehrbod S.; Weich, Alexander; Gorin, Michael A.; Pienta, Kenneth J.; Higuchi, Takahiro; Buck, Andreas K.; Pomper, Martin G.; Rowe, Steven P.; Lapa, Constantin

doi:10.2967/jnumed.117.206631

Cited by 62 publications

(89 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Similar to In-111 pentetreotide, false-positive findings can be seen and misinterpreted, and it is important to be aware of normal distribution and variants. No set diagnostic criteria currently exist for DOTATATE imaging, although there has been a proposal to standardize the reporting criteria using a 5-point structured system (54).…”

Section: A B Cmentioning

confidence: 99%

Imaging of Pheochromocytoma and Paraganglioma

Itani

Mhlanga

2019

Paraganglioma: A Multidisciplinary Approach

View full text Add to dashboard Cite

With improvements in genetics and oncology, and increased crosssectional imaging, there is rapid expansion in the existing knowledge regarding diagnosis and management of pheochromocytomas and paragangliomas (PPGL). According to the 2017 World Health Organization (WHO) Classification of Tumors of Endocrine Organs, genetic cancer susceptibility is more frequent in endocrine cancers, especially PPGL cancers. Imaging plays an important role in the diagnosis and staging of disease, as well as part of surveillance in the heritable syndromes. In this chapter, we review the imaging characteristics of PPGL, under both anatomic and physiologic imaging modalities, supported with multiple clinical examples. We allude to the role of imaging in specific scenarios, such as genetic syndromes, and describe some of the relevant recent advances particularly as related to physiologic imaging.

show abstract

Section: A B Cmentioning

confidence: 99%

Imaging of Pheochromocytoma and Paraganglioma

Itani

Mhlanga

2019

Paraganglioma: A Multidisciplinary Approach

View full text Add to dashboard Cite

show abstract

“…Additionally, all involved organ compartments were identified by the readers, and an overall scan score was assigned. The overall PSMA-RADS score was defined analogously to somatostatin receptor RADS (i.e., the highest PSMA-RADS score of any of the individual target lesions) (17). Moreover, the following general parameters were assessed by each observer in a binary fashion: overall scan result (positive in cases of suggestive radiotracer uptake above the background level), organ involvement, and LN involvement.…”

Section: Imaging Interpretationmentioning

confidence: 99%

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging

Werner

Bundschuh²,

Bundschuh³

et al. 2018

J Nucl Med

Self Cite

View full text Add to dashboard Cite

Recently, the standardized reporting and data system for prostate-specific membrane antigen (PSMA)-targeted PET imaging studies, termed PSMA-RADS version 1.0, was introduced. We aimed to determine the interobserver agreement for applying PSMA-RADS to imaging interpretation of F-DCFPyL (2-(3-{1-carboxy-5-[(6-F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid) PET examinations in a prospective setting mimicking the typical clinical workflow at a prostate cancer referral center. Four readers (2 experienced readers (ERs,>3 y of PSMA-targeted PET interpretation experience) and 2 inexperienced readers (IRs, <1 y of experience)), who had all read the initial publication on PSMA-RADS 1.0, assessed 50 F-DCFPyL PET/CT studies independently. Per scan, a maximum of 5 target lesions was selected by the observers, and a PSMA-RADS score for every target lesion was recorded. No specific preexisting conditions were placed on the selection of the target lesions, although PSMA-RADS 1.0 suggests that readers focus on the most avid or largest lesions. An overall scan impression based on PSMA-RADS was indicated, and interobserver agreement rates on a target lesion-based, on an organ-based, and on an overall PSMA-RADS score-based level were computed. The number of target lesions identified by each observer was as follows: ER 1, 123; ER 2, 134; IR 1, 123; and IR 2, 120. Among those selected target lesions, 125 were chosen by at least 2 individual observers (all 4 readers selected the same target lesion in 58 of 125 [46.4%] instances, 3 readers in 40 of 125 [32%], and 2 observers in 27 of 125 [21.6%]). The interobserver agreement for PSMA-RADS scoring among identical target lesions was good (intraclass correlation coefficient [ICC] for 4, 3, and 2 identical target lesions, ≥0.60, respectively). For lymph nodes, an excellent interobserver agreement was derived (ICC, 0.79). The interobserver agreement for an overall scan impression based on PSMA-RADS was also excellent (ICC, 0.84), with a significant difference for ER (ICC, 0.97) vs. IR (ICC, 0.74) ( = 0.005). PSMA-RADS demonstrated a high concordance rate in this study, even among readers with different levels of experience. This finding suggests that PSMA-RADS can be effectively used for communication with clinicians and can be implemented in the collection of data for large prospective trials.

show abstract

“…Although guidelines have suggested using SSTR PET to select patients for PRRT, there is limited literature on how to use such imaging studies for patient selection (6,7). For example, in the NETTER-1 trial, the inclusion criteria relied on interpretation of the 111 In-pentetreotide scintigraphy results using the Krenning score (eligible if the highest lesion uptake equaled or exceeded liver uptake) (8).…”

mentioning

confidence: 99%

“…European centers have used both 111 In-pentetreotide scintigraphy and SSTR PET for patient selection (9,10). The common approach for characterizing uptake on SSTR PET is to use a modified Krenning score in which the same qualitative approach (comparison to liver uptake) is applied to SSTR PET (6,11). It is unclear if the Krenning score is equivalent between modalities.…”

mentioning

confidence: 99%

¹¹¹In-Pentetreotide Scintigraphy Versus ⁶⁸Ga-DOTATATE PET: Impact on Krenning Scores and Effect of Tumor Burden

et al. 2019

View full text Add to dashboard Cite

Eligibility for somatostatin receptor (SSTR) radionuclide therapy uses the qualitative Krenning score based on 111 In-pentetreotide planar scintigraphy as was performed in the NETTER-1 trial. The purpose of this study was to determine the effect of using SSTR PET-based Krenning score in comparison to 111 In-pentetreotide. Methods: This was a post hoc headto-head comparison of 68 Ga-DOTATATE-based and 111 In-pentetreotide-based Krenning scores in 150 patients included in a prospective phase 2 study (NCT01967537). Patients were imaged using 68 Ga-DOTA-TATE PET/CT, 111 In-pentetreotide planar scintigraphy, and SPECT/CT within 1 wk. SSTR ligand uptake was graded using the Krenning score independently by 3 readers. Results: The detection rate of SSTRexpressing disease (Krenning scores 2-4) was 23%, 38%, and 72% with planar imaging, SPECT, and SSTR PET, respectively. The Krenning score was higher with SSTR PET (2.71 ± 1.74) than with planar imaging (0.75 ± 1.37; P , 0.001) or SPECT (1.23 ± 1.57; P , 0.001). In patients with a Krenning score of at least 3 on SSTR PET, the detection rate of planar imaging and SPECT was lower for lesions smaller than 2 cm than lesions 2 cm or larger: 15% and 24% versus 78% and 89%, respectively (P , 0.001). For lesions larger than 5 cm, Krenning scores between SSTR PET and 111 In-pentetreotide were nearly equivalent. Lesion size did not have an impact on SSTR PET Krenning scores. Interreader agreement was higher for SSTR PET than for planar imaging or SPECT (0.79 vs. 0.67 and 0.50, respectively). Conclusion: SSTR PET results in higher Krenning scores than 111 In-pentetreotide, particularly when lesions measured 2 cm or less. Small lesion size resulted in low Krenning scores using 111 In-pentetreotide, but lesion size did not affect SSTR PET-based Krenning scores. The results of the NETTER-1 trial cannot be directly applied to patients with small lesions. Further study of peptide receptor radionuclide therapy in patients with small lesions negative on 111 In-pentetreotide imaging and positive on SSTR PET is warranted.

show abstract

SSTR-RADS Version 1.0 as a Reporting System for SSTR PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework

Cited by 62 publications

References 37 publications

Imaging of Pheochromocytoma and Paraganglioma

Imaging of Pheochromocytoma and Paraganglioma

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging

¹¹¹In-Pentetreotide Scintigraphy Versus ⁶⁸Ga-DOTATATE PET: Impact on Krenning Scores and Effect of Tumor Burden

Contact Info

Product

Resources

About

SSTR-RADS Version 1.0 as a Reporting System for SSTR PET Imaging and Selection of Potential PRRT Candidates: A Proposed Standardization Framework

Cited by 62 publications

References 37 publications

Imaging of Pheochromocytoma and Paraganglioma

Imaging of Pheochromocytoma and Paraganglioma

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on 18F-DCFPyL PET/CT Imaging

111In-Pentetreotide Scintigraphy Versus 68Ga-DOTATATE PET: Impact on Krenning Scores and Effect of Tumor Burden

Contact Info

Product

Resources

About

Interobserver Agreement for the Standardized Reporting System PSMA-RADS 1.0 on ¹⁸F-DCFPyL PET/CT Imaging

¹¹¹In-Pentetreotide Scintigraphy Versus ⁶⁸Ga-DOTATATE PET: Impact on Krenning Scores and Effect of Tumor Burden