Article Figures & Data
Figures
- FIGURE 1.
Flowchart of patient selection criteria and lesion-level follow-up for patients with at least 1 IBL. Interpretations (benign, malignant, or equivocal) are shown for IBLs with no follow-up (prior imaging) and follow-up (imaging or biopsy).
- FIGURE 2.
A 63-y-old patient with BCR PCa and PSA of 0.46 ng/mL. Axial 18F-DCFPyL PET (left), 18F-DCFPyL PET/CT (middle), and CT (right) images show a single area of subtle PSMA-avid uptake with SUVmax of 2.4 in the right fifth rib and no CT correlate (arrows). This IBL was determined to be benign based on negative 17-mo follow-up bone scintigraphy findings.
- FIGURE 3.
A 60-y-old patient with BCR PCa and PSA of 3.9 ng/mL. Axial 18F-DCFPyL PET (left), 18F-DCFPyL PET/CT (middle), and CT (right) images show a single area of subtle PSMA-avid uptake with SUVmax of 3.9 in left iliac bone and mixed sclerotic and lytic CT features (arrows). This IBL was stable for 4 mo and negative on 4 other staging modalities; thus, the IBL was interpreted as benign.
- FIGURE 4.
A 73-y-old patient with BCR PCa and PSA of 4.9 ng/mL. Axial 18F-DCFPyL PET (A), 18F-DCFPyL PET/CT (B), CT (C), pre-PSMA MRI (D), and follow-up MRI (E) images show a single area of subtle PSMA-avid uptake with SUVmax of 3.3 in left T8 lamina and subtle sclerotic CT features (arrows). This IBL became more prominent and enhanced over a 3-y period between retrospective MRI (D) and follow-up MRI (E) and was determined to be malignant.
- FIGURE 5.
Model assessing the likelihood that an IBL is benign or malignant based on 18F-DCFPyL PET/CT imaging variables that predicted for benignancy or malignancy (n = 79).
- FIGURE 6.
Sankey diagram showing the relationship of multiple predictive 18F-DCFPyL features (n = 98). Specifically, lesion location, lesion SUVmax, and type of bone findings on a PSMA PET/CT scan are more likely associated with a particular lesion interpretation (right). Pathways with 1 lesion have been removed for clarity.
Tables
Characteristic Data Patients with IBL 48 Age (y) Median 66 Range 53–79 PSA (ng/mL) Median 4.00 Range 0.44–203.8 Disease phase BCR PCa 35 High-risk PCa 13 TNM stage Not available 5 T1 10 T2 13 T3 15 T2 N1 1 T3 N1 3 T4 N1 1 Gleason grade group 1 2 2 14 3 10 4 7 5 15 Data are number of events unless otherwise indicated.
Location of biopsied IBL SUVmax CT morphology Histopathologic result Finding Features Fifth rib 4.1 Sclerotic Benign Fibrous replacement of bone marrow Third rib 3.6 Sclerotic Benign Trabecular bone with trilineage hematopoiesis Sixth rib 2.9 Sclerotic Benign Fragments of bone marrow fibrosis Ischium bone 17.4 Mixed sclerotic/lytic Malignant Metastatic prostate adenocarcinoma involving bone and bone marrow Iliac bone 1.3 Negative Malignant Metastatic moderately differentiated prostate adenocarcinoma Clavicle bone 3.1 Negative Benign Bone marrow with trilineage hematopoiesis Seventh rib 2.8 Sclerotic Benign Bone with hematopoietic bone marrow Fifth rib 15.2 Mixed sclerotic/lytic Malignant Metastatic poorly differentiated prostate adenocarcinoma Predictive variable Incidence (n = 98) IBL interpretation P* M (n = 42) B (n = 37) E (n = 19) Location 0.0201 Spine 28 (28.6%) 16 12 0 Pelvis 21 (21.4%) 12 7 2 Rib 39 (39.8%) 8 14 17 Other 10 (10.2%) 6 4 0 SUVmax 0.0230 <5 64 (65.3%) 12 36 16 ≥5 34 (34.7%) 30 1 3 ↵* For 3-way assessment (M vs. B vs. E) statistical significance is evaluated using χ2 test for clustered data.
M = malignant; B = benign; E = equivocal.
- TABLE 4.
Logistic Regression Analysis Showing OR at 95% CI for Clinically Relevant 18F-DCFPyL PET/CT-Based Features That Predict IBLs as Benign vs. Malignant (n = 79)
18F-DCFPyL PET/CT feature Univariable analysis Multivariable analysis OR P OR P IBL located in pelvis 1.68 (0.48–5.96) 0.516 — — IBL located in spine 1.42 (0.55–3.65) 0.613 — — IBL located in ribs 0.38 (0.14–1.03) 0.170 — — IBL SUVmax 9.29 (3.49–24.75) 0.0016 13.87 (1.91–100.9) 0.0089 Other bone metastases 9.87 (2.00–48.82) 0.0112 11.35 (3.05–42.25) 0.0030 Other lymph node metastases 2.26 (0.62–8.26) 0.315 — — Data in parentheses are 95% CI. Features significantly associated with malignant interpretation were included in multivariable analysis.
- TABLE 5.
Model Predicting the Likelihood That IBLs Identified on 18F-DCFPyL PET/CT at 2 Hour of Uptake Are Benign or Malignant (n = 79)
Other PSMA-avid bone findings IBL location IBL SUVmax Likelihood of interpretation Interpretation accuracy No bone metastases Typical <5 81.0% benign True positive (n = 17); false negative (n = 4) No bone metastases Typical ≥5 94.7% malignant True positive (n = 18); false positive (n = 1) No bone metastases Atypical <5 94.4% benign True negative (n = 17); false negative (n = 1) No bone metastases Atypical ≥5 100% malignant True positive (n = 8) Bone metastases Any <5 77.8% malignant True positive (n = 7); false positive (n = 2) Bone metastases Any ≥5 100% malignant True positive (n = 4)
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