Article Figures & Data
Figures
- FIGURE 1.
From left to right, maximum-intensity projections of screening [68Ga]Ga-PSMA-11 PET/CT, 4-h [177Lu]Lu-PSMA SPECT/CT, and 24-h [177Lu]Lu-PSMA SPECT/CT (top row) and corresponding quantitative maximum-intensity projections (bottom row) of 63-y-old man with mCRPC to regional and distant lymph nodes and widespread osseous metastases showing identical disease distribution on all studies both visually and quantitatively.
- FIGURE 2.
From left to right, maximum-intensity projections, coronal images, and sagittal images of screening [68Ga]Ga-PSMA-11 PET/CT (B) and 4-h [177Lu]Lu-PSMA SPECT/CT (A) of 83-y-old man with mCRPC to retroperitoneal and mediastinal lymph nodes and multiple osseous and bilateral pulmonary lesions. Good image quality is seen at 4-h [177Lu]Lu-PSMA SPECT/CT, with disease distribution identical to that on screening [68Ga]Ga-PSMA-11 PET/CT.
- FIGURE 3.
From left to right, transaxial screening [68Ga]Ga-PSMA-11 PET/CT, 4-h [177Lu]Lu-PSMA SPECT/CT, and 24-h [177Lu]Lu-PSMA SPECT/CT. (A) Small left hilar lymph node was missed on 4-h [177Lu]Lu-PSMA SPECT/CT (orange arrow) compared with 24-h [177Lu]Lu-PSMA SPECT/CT and screening [68Ga]Ga-PSMA-11 PET/CT (red arrows). (B) Small osseous lesion was missed on in right pedicle of T4 on 4- and 24-h posttherapy [177Lu]Lu-PSMA SPECT/CT (orange arrows) compared with [68Ga]Ga-PSMA-11 PET/CT (red arrow) (B).
- FIGURE 4.
(A–D) Bland–Altman plots of difference in 4-h and 24-h [177Lu]Lu-PSMA SPECT/CT TTV (A), number of lesions (B), SUVmax (C), and SUVmean (D), with dashed horizontal 95% limits of agreement and solid line and cap indicating mean difference with 95% CI. (E–H) Bland–Altman plots of ratio in 4-h and 24-h [177Lu]Lu-PSMA SPECT/CT TTV (E), number of lesions (F), SUVmax (G), and SUVmean (H), with dashed regression-derived limits of agreement lines and solid regression-derived bias line. Both axes are on log scale. Shaded area indicates acceptable agreement ratio. ρc = concordance correlation coefficient.
- FIGURE 5.
Kaplan–Meier plots (log-rank test) for PSA progression-free survival by ΔTTV (Δ Volume).
Tables
Characteristic Data Age at first 177Lu-PSMA cycle (y) 78 (70–81) Time since diagnosis (y) 1–5 9 (43%) 6–10 6 (29%) >10 6 (29%) De novo metastatic 12 (57%) Eastern Cooperative Oncology Group status 0–1 14 (67%) 2 7 (33%) Baseline PSA (ng/mL) 54 (15–510) Lactate dehydrogenase (RR, 120–250 U/L) 204 (181–266) Alkaline phosphatase (RR, 30–110 U/L) 121 (84–149) Hemoglobin (RR, 130–180 g/L) 122 (116–130) Estimated glomerular filtration rate (mL/min/1.73 m2) 83 (71–90) Previous systemic treatments Androgen receptor pathway inhibitor 21 (100%) Docetaxel 11 (52%) Cabazitaxel 5 (24%) PSMA PET/CT to first [177Lu]Lu-PSMA-I&T cycle (d) 34 (24–37) Disease volume (PSMA PET/CT) <20 metastases 7 (33%) ≥20 metastases 14 (67%) Sites of disease Bone 19 (90%) Nodal (pelvic or distant) 12 (57%) Visceral 4 (19%) RR = reference range.
Data are absolute counts followed by percentage in parentheses or median followed by IQR in parentheses.
- TABLE 2.
Quantitative Biomarkers on Screening [68Ga]Ga-PSMA-11 PET/CT and 4- and 24-Hour [177Lu]Lu-PSMA-I&T SPECT/CT
Biomarker 68Ga PSMA-PET/CT 4-h SPECT/CT 24-h SPECT/CT TTV 471 (46–646) 517 (56–948) 364 (55–856) Lesions (n) 49 (11–121) 45 (8–116) 46 (9–116) SUVmax 36 (32–63) 44 (20–79) 47 (27–69) SUVmean 7.4 (6.2–9.5) 8.0 (5.9–8.8) 7.3 (5.9–9.4) Data are median followed by IQR in parentheses.
Supplemental Data
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