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Research ArticleClinical Investigation

Development of a Visually Calculated SUVmean (HIT Score) on Screening PSMA PET/CT to Predict Treatment Response to 177Lu-PSMA Therapy: Comparison with Quantitative SUVmean and Patient Outcomes

Mina Swiha, Nathan Papa, Zahra Sabahi, Narjess Ayati, Nikeith John, Sarennya Pathmanandavel, Megan Crumbaker, Sherrington Li, Shikha Agrawal, Maria Ayers, Adam Hickey, Shikha Sharma, Andrew Nguyen and Louise Emmett
Journal of Nuclear Medicine June 2024, 65 (6) 904-908; DOI: https://doi.org/10.2967/jnumed.123.267014
Mina Swiha
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
2Nuclear Medicine Division, Department of Medical Imaging, University of Western Ontario, London, Ontario, Canada;
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Nathan Papa
3Garvan Institute of Medical Research, Sydney, New South Wales, Australia;
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Zahra Sabahi
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Narjess Ayati
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
3Garvan Institute of Medical Research, Sydney, New South Wales, Australia;
4St. Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia; and
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Nikeith John
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
4St. Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia; and
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Sarennya Pathmanandavel
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Megan Crumbaker
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
3Garvan Institute of Medical Research, Sydney, New South Wales, Australia;
4St. Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia; and
5Kinghorn Cancer Centre, St. Vincent’s Hospital, Sydney, New South Wales, Australia
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Sherrington Li
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Shikha Agrawal
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Maria Ayers
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Adam Hickey
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Shikha Sharma
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
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Andrew Nguyen
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
4St. Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia; and
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Louise Emmett
1Department of Theranostics and Nuclear Medicine, St. Vincent’s Hospital, Sydney, New South Wales, Australia;
3Garvan Institute of Medical Research, Sydney, New South Wales, Australia;
4St. Vincent’s Clinical School, University of New South Wales, Sydney, New South Wales, Australia; and
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  • FIGURE 1.
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    FIGURE 1.

    Maximum-intensity projection of PSMA PET/CT showing 2 patients with homogeneous PSMA uptake in lesions (left) and 2 patients with heterogeneous PSMA uptake in lesions (right).

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    FIGURE 2.

    Kaplan–Meier curve (log-rank tests) of PSA-PFS (A) and OS (B) for semiquantitative SUVmean quartiles (Q1–Q4).

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    FIGURE 3.

    Scatterplot of weighted regression curves of log SUVmean vs. SUVmax range, by visual heterogeneity score (homogeneous vs. heterogeneous).

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    FIGURE 4.

    Color-coded table of HIT scores 1–4 incorporating SUVmax range (most intense lesion) and binary visual heterogeneity with patient numbers in each group. Red = HIT score 1; yellow = HIT score 2; green = HIT score 3; blue = HIT score 4.

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    FIGURE 5.

    Kaplan–Meier curve (log-rank tests) of PSA-PFS (A) and OS (B) for HIT scores 1–4.

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    TABLE 1.

    Patient Characteristics

    CharacteristicValue
    n139
    Age (y)69 (64–74)
    Time since diagnosis (y)6 (3–9)
    ECOG status
     0–1122 (88)
     217 (12)
    Baseline PSA (ng/mL)94 (34–325)
    LDH (NR, 120–250 U/L)245 (216–317)
    ALP (NR, 30–110 U/L)112 (74–203)
    Hemoglobin (NR, 130–180 g/L)118 (106–129)
    Previous systemic treatments
     Androgen receptor signaling inhibitors139 (100)
     Docetaxel125 (90)
     Cabazitaxel88 (63)
    Disease volume from PSMA PET/CT
     <20 metastases49 (35)
     ≥20 metastases90 (65)
    Sites of disease on PSMA PET/CT
     Bone133 (96)
     Nodal*72 (52)
     Visceral31 (22)
    • ↵* Pelvic or distant.

    • ECOG = Eastern Cooperative Oncology Group; LDH = lactate dehydrogenase; NR = normal range; ALP = alkaline phosphatase.

    • Quantitative data are number and percentage. Continuous data are median and interquartile range.

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Journal of Nuclear Medicine: 65 (6)
Journal of Nuclear Medicine
Vol. 65, Issue 6
June 1, 2024
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Development of a Visually Calculated SUVmean (HIT Score) on Screening PSMA PET/CT to Predict Treatment Response to 177Lu-PSMA Therapy: Comparison with Quantitative SUVmean and Patient Outcomes
Mina Swiha, Nathan Papa, Zahra Sabahi, Narjess Ayati, Nikeith John, Sarennya Pathmanandavel, Megan Crumbaker, Sherrington Li, Shikha Agrawal, Maria Ayers, Adam Hickey, Shikha Sharma, Andrew Nguyen, Louise Emmett
Journal of Nuclear Medicine Jun 2024, 65 (6) 904-908; DOI: 10.2967/jnumed.123.267014

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Development of a Visually Calculated SUVmean (HIT Score) on Screening PSMA PET/CT to Predict Treatment Response to 177Lu-PSMA Therapy: Comparison with Quantitative SUVmean and Patient Outcomes
Mina Swiha, Nathan Papa, Zahra Sabahi, Narjess Ayati, Nikeith John, Sarennya Pathmanandavel, Megan Crumbaker, Sherrington Li, Shikha Agrawal, Maria Ayers, Adam Hickey, Shikha Sharma, Andrew Nguyen, Louise Emmett
Journal of Nuclear Medicine Jun 2024, 65 (6) 904-908; DOI: 10.2967/jnumed.123.267014
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Keywords

  • SUVmean
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