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Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging

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Abstract

Background

The rapidly expanding clinical adaptation of prostate-specific membrane antigen (PSMA)-targeted PET imaging in the evaluation of patients with prostate cancer has placed an increasing onus on understanding both the potential pearls of interpretation as well as limitations of this new technique. As with any new molecular imaging modality, accurate characterization of abnormalities on PSMA-targeted PET imaging can be accomplished only if one is aware of the normal distribution pattern, physiological variants of radiotracer uptake, and potential sources of false-positive and false-negative imaging findings. In recent years, a growing number of reports have come to light describing incidental non-prostatic benign or malignant pathologies with high uptake on PSMA-targeted PET imaging. In this review, we have summarized the published literature regarding the potential pearls and technical and interpretive pitfalls of this imaging modality. Knowledge of these limitations can increase the confidence of interpreting physicians and thus improve patient care.

Conclusions

As PSMA-targeted PET is expected to be evaluated in larger prospective trials, the dissemination of potential diagnostic pitfalls and the biologic underpinning of those findings will be of increased importance.

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Acknowledgements

We gratefully recognize funding from Progenics Pharmaceuticals, the Prostate Cancer Foundation Young Investigator Award, philanthropic funds donated to the James Buchanan Brady Urological Institute and Department of Urology, and National Institutes of Health grants CA124675, CA184228, and CA183031, all of which have helped support our work in PSMA imaging.

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Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolfe St, Baltimore, MD, USA

    Sara Sheikhbahaei, Lilja B. Solnes, Mehrbod S. Javadi, Martin G. Pomper & Steven P. Rowe

  2. Department of Nuclear Medicine, Heidelberg University Hospital, Heidelberg, Germany

    Ali Afshar-Oromieh & Uwe Haberkorn

  3. Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Matthias Eiber

  4. Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany

    Matthias Eiber

  5. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ashley E. Ross, Kenneth J. Pienta, Mohamad E. Allaf & Michael A. Gorin

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  1. Sara Sheikhbahaei
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  2. Ali Afshar-Oromieh
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  12. Steven P. Rowe
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Correspondence to Steven P. Rowe.

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Conflict of interest

MGP is a co-inventor on a U.S. patent covering 18F–DCFPyL and as such is entitled to a portion of any licensing fees and royalties generated by this technology. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict-of-interest policies. MAG has served as a consultant to Progenics Pharmaceuticals, the licensee of 18F–DCFPyL. KJP, MGP, MAG, and SPR have research funding from Progenics Pharmaceuticals. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sheikhbahaei, S., Afshar-Oromieh, A., Eiber, M. et al. Pearls and pitfalls in clinical interpretation of prostate-specific membrane antigen (PSMA)-targeted PET imaging. Eur J Nucl Med Mol Imaging 44, 2117–2136 (2017). https://doi.org/10.1007/s00259-017-3780-7

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  • DOI: https://doi.org/10.1007/s00259-017-3780-7

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