Why We Did What We Did: PSMA PET/CT Selection Criteria for the VISION Trial

Example of patient who would have been excluded by imaging selection criteria used in VISION trial. (A) Anterior maximum-intensity projection from ⁶⁸Ga-PSMA-11 PET/CT has readily evident PSMA-positive disease, such as in sacrum (arrow); thus, next step is to evaluate diagnostic CT for lesions that fulfill size criteria for possible exclusion. (B) On contrast-enhanced diagnostic CT, 1.8-cm metastasis is identified in right hepatic lobe (arrow). Transaxial low-dose CT (C), PET (D), and PET/CT (E) images show that metastasis (arrows) has activity similar to normal liver, is therefore PSMA-negative, and would result in exclusion. Level of uptake in hepatic metastasis was importantly confirmed in sagittal and coronal planes (not shown) in case of misregistration.