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Research ArticleTheranostics

18F-DCFPyL PET/CT in Patients with Subclinical Recurrence of Prostate Cancer: Effect of Lesion Size, Smoothing Filter, and Partial-Volume Correction on PROMISE Criteria

Claudia Ortega, Josh Schaefferkoetter, Patrick Veit-Haibach, Reut Anconina, Alejandro Berlin, Nathan Perlis and Ur Metser
Journal of Nuclear Medicine November 2020, 61 (11) 1615-1620; DOI: https://doi.org/10.2967/jnumed.120.241737
Claudia Ortega
1Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Josh Schaefferkoetter
1Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
2Siemens Healthcare Limited, Oakville, Ontario, Canada
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Patrick Veit-Haibach
1Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Reut Anconina
1Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Alejandro Berlin
3Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada; and
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Nathan Perlis
4Urologic Oncology, University Health Network, Princess Margaret Cancer Centre Research Institute, University of Toronto, Toronto, Ontario, Canada
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Ur Metser
1Joint Department of Medical Imaging, Princess Margaret Hospital, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
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Article Figures & Data

Figures

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  • FIGURE 1.
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    FIGURE 1.

    A 75-y-old man with history of pT3a Gleason 7 (3 + 4) prostate cancer after radical prostatectomy 11 y ago, and salvage radiotherapy for biochemical recurrence 7 y ago, now with slowly rising PSA (2.1 ng/mL). Interaortocaval lymph node (left panel, arrow) had volume of 118.3 cm3 on CT. SUVmax measured on PET was 7.0 with miPSMA score of 1 (middle panel, arrow). After correction, SUVmax was 22.6 with miPSMA score of 3 (right panel, arrow).

  • FIGURE 2.
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    FIGURE 2.

    CF per lesion volume. (A) Distribution of CFs (y-axis) is graphed by lesion volume in mm3 (x-axis). (B) CF is graphed by volume and pixel size.

  • FIGURE 3.
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    FIGURE 3.

    Distribution of PSMA scores as function of lesion size before and after smoothing filter and PVC for lesions below 4 mm (A), between 4 and 7 mm (B), between 7 and 9 mm (C), and between 9 and 12 mm (D).

Tables

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    TABLE 1

    PSMA Scoring System

    ScorePSMA expressionUptake
    0None<Blood-pool activity
    1Low≥Blood pool and <liver
    2Intermediate≥Liver and <parotid gland
    3High≥Parotid gland
    • View popup
    TABLE 2

    Original Versus Corrected Parameters for All Lesions

    ParameterOriginalCorrected
    Mean SUVmax (P < 0.00001)11.0 ± 9.3 (1.8–57.1)28.5 ± 22.8 (5.1–116.3)
    Mean SUVmean (P < 0.00001)6.7 ± 5.7 (1–36.3)14.1 ± 11.3 (2.2–54.8)
    Mean miPSMA score (P < 0.00001)1.6 ± 0.76 (1–3)2.28 ± 0.77 (1–3)
    • Data are mean ± SD, followed by range in parentheses.

    • View popup
    TABLE 3

    CF per Lesion Size

    Lesion sizeCF
    <4 mm (n = 22)4 (2.5–6.4 ± 1.1)
    4–7 mm (n = 140)2.8 (1.6–4.9 ± 0.64)
    7–9 mm (n = 50)2.3 (1.6–3.3 ± 0.43)
    9–12 mm (n = 20)1.8 (1.4–2.4 ± 0.64)
    • Data are mean followed by range ± SD in parentheses.

    • View popup
    TABLE 4

    Original Versus Corrected SUVmax and miPSMA Scores

    Lesion sizeOriginalCorrected
    SUVmaxmiPSMASUVmaxmiPSMA
    <4 mm5.3 ± 5.2 (2.1–25.6)1.1 ± 0.521.5 ± 21.2 (5.6–96.3), P = 0.000722.1 ± 0.8, P < 0.00001
    4–7 mm8.4 ± 6.0 (1.8–34.3)1.4 ± 0.624.4 ± 19.7 (5.1–116.3), P < 0.000012.2 ± 0.8, P < 0.00001
    7–9 mm16.4 ± 9.2 (3.7–45.8)2.0 ± 0.839.0 ± 25.5 (5.8–102.9), P < 0.000012.6 ± 0.7, P < 0.00001
    9–12 mm22.2 ± 15.6 (3.8–57.1)2.2 ± 0.939.2 ± 27.1 (8.4–102.0), P = 0.000042.5 ± 0.8, P = 0.114
    • Data are mean ± SD with or without range in parentheses. P values are for original vs. corrected data.

    • View popup
    TABLE 5

    Corrected Versus RoT SUVmax and miPSMA Scores

    Lesion sizeCorrectedRoT
    SUVmaxmiPSMASUVmaxmiPSMA
    <4 mm21.5 ± 21.2 (5.6–96.3)2.1 ± 0.821.0 ± 20.4 (8.3–101.4), P = 0.6812.1 ± 0.6, P = 0.616
    4–7 mm24.4 ± 19.7 (5.1–116.3)2.2 ± 0.823.7 ± 16.8 (5.1–96.7), P = 0.1842.3 ± 0.8, P = 0.665
    7–9 mm39.0 ± 25.5 (5.8–102.9)2.6 ± 0.737.4 ± 21.0 (8.4–104.5), P = 0.2062.6 ± 0.7, P = 0.905
    9–12 mm39.2 ± 27.1 (8.4–102.0)2.5 ± 0.840.1 ± 28.1 (6.9–103.0), P = 0.5952.5 ± 0.8, P = 0.867
    • Data are mean ± SD. Numbers in parentheses represent range; range for miPSMA is fixed (1–3) and therefore not included in this table. P values are for corrected vs. RoT data.

    • View popup
    TABLE 6

    Distribution of Original, Corrected, and RoT miPSMA Scores

    Lesion sizeOriginalCorrectedRoT
    Score 1Score 2Score 3Score 1Score 2Score 3Score 1Score 2Score 3
    <4 mm20 (91)1 (4.5)1 (4.5)5 (22.7)10 (45.5)7 (31.8)3 (13.6)13 (59.1)6 (27.3)
    4–7 mm90 (64.3)38 (27.1)12 (8.6)31 (22.1)51 (36.4)58 (41.4)25 (17.9)53 (37.8)62 (44.3)
    7–9 mm15 (30)19 (38)16 (32)6 (12)10 (20)34 (68)5 (10)9 (18)36 (76)
    9–12 mm6 (30)4 (20)10 (50)4 (20)3 (15)13 (65)3 (10)4 (25)13 (65)
    • Data are numbers followed by percentages in parentheses.

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Journal of Nuclear Medicine: 61 (11)
Journal of Nuclear Medicine
Vol. 61, Issue 11
November 1, 2020
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18F-DCFPyL PET/CT in Patients with Subclinical Recurrence of Prostate Cancer: Effect of Lesion Size, Smoothing Filter, and Partial-Volume Correction on PROMISE Criteria
Claudia Ortega, Josh Schaefferkoetter, Patrick Veit-Haibach, Reut Anconina, Alejandro Berlin, Nathan Perlis, Ur Metser
Journal of Nuclear Medicine Nov 2020, 61 (11) 1615-1620; DOI: 10.2967/jnumed.120.241737

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18F-DCFPyL PET/CT in Patients with Subclinical Recurrence of Prostate Cancer: Effect of Lesion Size, Smoothing Filter, and Partial-Volume Correction on PROMISE Criteria
Claudia Ortega, Josh Schaefferkoetter, Patrick Veit-Haibach, Reut Anconina, Alejandro Berlin, Nathan Perlis, Ur Metser
Journal of Nuclear Medicine Nov 2020, 61 (11) 1615-1620; DOI: 10.2967/jnumed.120.241737
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