RT Journal Article
SR Electronic
T1 Intraindividual Comparison of <sup>99m</sup>Tc-Methylene Diphosphonate and Prostate-Specific Membrane Antigen Ligand <sup>99m</sup>Tc-MIP-1427 in Patients with Osseous Metastasized Prostate Cancer
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 1373
OP 1379
DO 10.2967/jnumed.117.200220
VO 59
IS 9
A1 Hendrik Rathke
A1 Ali Afshar-Oromieh
A1 Frederik Lars Giesel
A1 Christophe Kremer
A1 Paul Flechsig
A1 Sabine Haufe
A1 Walter Mier
A1 Tim Holland-Letz
A1 Maximilian De Bucourt
A1 Thomas Armor
A1 John W. Babich
A1 Uwe Haberkorn
A1 Clemens Kratochwil
YR 2018
UL http://jnm.snmjournals.org/content/59/9/1373.abstract
AB The objective of this study was to evaluate the rate of detection of bone metastases obtained with the prostate-specific membrane antigen (PSMA)–targeting tracer 99mTc-MIP-1427, as opposed to conventional bone scanning with 99mTc-methylene diphosphonate (99mTc-MDP), in a collective of patients with known advanced-stage osseous metastasized prostate cancer. Methods: Twenty-one patients with known metastatic disease were staged with both conventional bone scanning and PSMA ligand scintigraphy within a time frame of less than 10 d. Imaging included planar whole-body scanning and SPECT or SPECT/CT with 2 bed positions 3 h after injection of either 500–750 MBq of 99mTc-MIP-1427 or 600–750 MBq of 99mTc-MDP. Lesions were scored as typical tumor, equivocal (benign/malignant), or normal within a standard reporting schema divided into defined anatomic regions. Masked and consensus readings were performed with sequential unmasking: planar scans first, then SPECT/CT, the best evaluable comparator (including MRI), PET/CT, and follow-up examinations. Results: Eleven patients had PSMA-positive visceral metastases that were predictably not diagnosed with conventional bone scanning. However, SPECT/CT was required to distinguish between soft-tissue uptake and overlapping bone. Four patients had extensive 99mTc-MDP–negative bone marrow lesions. Seven patients had superscan characteristics on bone scans; in contrast, the extent of red marrow involvement was more evident on PSMA scans. Only 3 patients had equivalent results on bone scans and PSMA scans. In 16 patients, more suspect lesions were detected with PSMA scanning than with bone scanning. In 2 patients (10%), a PSMA-negative tumor phenotype was present. Conclusion: PSMA scanning provided a clear advantage over bone scanning by reducing the number of equivocal findings in most patients. SPECT/CT was pivotal for differentiating bone metastases from extraosseous tumor lesions.