Healthy Tissue Uptake of 68Ga-Prostate Specific Membrane Antigen (PSMA), 18F-DCFPyL, 18F-Fluoromethylcholine (FCH) and 18F-Dihydrotestosterone (FDHT)

Bernard H E Jansen, Gerbrand M Kramer, Matthijs C F Cysouw, Maqsood M Yaqub, Bart de Keizer, Jules Lavalaye, Jan Booij, Hebert Alberto Vargas, Michael J Morris, André N Vis, Reindert van Moorselaar, Otto S Hoekstra, Ronald Boellaard, Daniela E Oprea-Lager

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Abstract

Positron Emission Tomography (PET) is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include 68Ga-Prostate-Specific Membrane Antigen HBED-CC (68Ga-PSMA), 18F-DCFPyL, 18F-fluoromethylcholine (18F-FCH) and 18F-dihydrotestosterone (18F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, since malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. Methods: A total of n = 232 PCa PET/CT scans from multiple hospitals was analyzed, including n = 87 68Ga-PSMA scans; n = 50 18F-DCFPyL scans; n = 68 18F-FCH scans and n = 27 18F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow and muscle - using several Standarized Uptake Values (SUVmax, SUVmean, SUVpeak). Variability in uptake between patients was analyzed using the Coefficient of Variation (COV%). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based Quality Control for future PET acquisitions. Results: For 68Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV 19.9%), which was significantly more stable than all other tissues (COV 29.8-35.2%, P = 0.001-0.024). For 18F-DCFPyL, lowest variability was observed in the blood pool and liver (COV 14.4% and 21.7%, P = 0.001-0.003). The least variable 18F-FCH uptake was observed in the liver, blood pool and bone marrow (COV 16.8-24.2%, P = 0.001-0.012). For 18F-FDHT, low uptake variability was observed in all tissues, except the lung (COV 14.6-23.6%, P = 0.001-0.040). The different SUV-types had limited effect on variability (COVs within 3 percentage points). Conclusion: In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for 68Ga-PSMA and 18F-DCFPyL, and the liver for 18F-FCH and 18F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based Quality Control.

Original languageEnglish
JournalJournal of nuclear medicine : official publication, Society of Nuclear Medicine
DOIs
Publication statusE-pub ahead of print - 10 Jan 2019

Cite this

@article{cec2e1b94c03407180f75bf406188f68,
title = "Healthy Tissue Uptake of 68Ga-Prostate Specific Membrane Antigen (PSMA), 18F-DCFPyL, 18F-Fluoromethylcholine (FCH) and 18F-Dihydrotestosterone (FDHT)",
abstract = "Positron Emission Tomography (PET) is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include 68Ga-Prostate-Specific Membrane Antigen HBED-CC (68Ga-PSMA), 18F-DCFPyL, 18F-fluoromethylcholine (18F-FCH) and 18F-dihydrotestosterone (18F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, since malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. Methods: A total of n = 232 PCa PET/CT scans from multiple hospitals was analyzed, including n = 87 68Ga-PSMA scans; n = 50 18F-DCFPyL scans; n = 68 18F-FCH scans and n = 27 18F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow and muscle - using several Standarized Uptake Values (SUVmax, SUVmean, SUVpeak). Variability in uptake between patients was analyzed using the Coefficient of Variation (COV{\%}). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based Quality Control for future PET acquisitions. Results: For 68Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV 19.9{\%}), which was significantly more stable than all other tissues (COV 29.8-35.2{\%}, P = 0.001-0.024). For 18F-DCFPyL, lowest variability was observed in the blood pool and liver (COV 14.4{\%} and 21.7{\%}, P = 0.001-0.003). The least variable 18F-FCH uptake was observed in the liver, blood pool and bone marrow (COV 16.8-24.2{\%}, P = 0.001-0.012). For 18F-FDHT, low uptake variability was observed in all tissues, except the lung (COV 14.6-23.6{\%}, P = 0.001-0.040). The different SUV-types had limited effect on variability (COVs within 3 percentage points). Conclusion: In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for 68Ga-PSMA and 18F-DCFPyL, and the liver for 18F-FCH and 18F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based Quality Control.",
author = "Jansen, {Bernard H E} and Kramer, {Gerbrand M} and Cysouw, {Matthijs C F} and Yaqub, {Maqsood M} and {de Keizer}, Bart and Jules Lavalaye and Jan Booij and Vargas, {Hebert Alberto} and Morris, {Michael J} and Vis, {Andr{\'e} N} and {van Moorselaar}, Reindert and Hoekstra, {Otto S} and Ronald Boellaard and Oprea-Lager, {Daniela E}",
note = "Copyright {\circledC} 2019 by the Society of Nuclear Medicine and Molecular Imaging, Inc.",
year = "2019",
month = "1",
day = "10",
doi = "10.2967/jnumed.118.222505",
language = "English",
journal = "Journal of nuclear medicine : official publication, Society of Nuclear Medicine",
issn = "1535-5667",

}

TY - JOUR

T1 - Healthy Tissue Uptake of 68Ga-Prostate Specific Membrane Antigen (PSMA), 18F-DCFPyL, 18F-Fluoromethylcholine (FCH) and 18F-Dihydrotestosterone (FDHT)

AU - Jansen, Bernard H E

AU - Kramer, Gerbrand M

AU - Cysouw, Matthijs C F

AU - Yaqub, Maqsood M

AU - de Keizer, Bart

AU - Lavalaye, Jules

AU - Booij, Jan

AU - Vargas, Hebert Alberto

AU - Morris, Michael J

AU - Vis, André N

AU - van Moorselaar, Reindert

AU - Hoekstra, Otto S

AU - Boellaard, Ronald

AU - Oprea-Lager, Daniela E

N1 - Copyright © 2019 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

PY - 2019/1/10

Y1 - 2019/1/10

N2 - Positron Emission Tomography (PET) is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include 68Ga-Prostate-Specific Membrane Antigen HBED-CC (68Ga-PSMA), 18F-DCFPyL, 18F-fluoromethylcholine (18F-FCH) and 18F-dihydrotestosterone (18F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, since malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. Methods: A total of n = 232 PCa PET/CT scans from multiple hospitals was analyzed, including n = 87 68Ga-PSMA scans; n = 50 18F-DCFPyL scans; n = 68 18F-FCH scans and n = 27 18F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow and muscle - using several Standarized Uptake Values (SUVmax, SUVmean, SUVpeak). Variability in uptake between patients was analyzed using the Coefficient of Variation (COV%). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based Quality Control for future PET acquisitions. Results: For 68Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV 19.9%), which was significantly more stable than all other tissues (COV 29.8-35.2%, P = 0.001-0.024). For 18F-DCFPyL, lowest variability was observed in the blood pool and liver (COV 14.4% and 21.7%, P = 0.001-0.003). The least variable 18F-FCH uptake was observed in the liver, blood pool and bone marrow (COV 16.8-24.2%, P = 0.001-0.012). For 18F-FDHT, low uptake variability was observed in all tissues, except the lung (COV 14.6-23.6%, P = 0.001-0.040). The different SUV-types had limited effect on variability (COVs within 3 percentage points). Conclusion: In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for 68Ga-PSMA and 18F-DCFPyL, and the liver for 18F-FCH and 18F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based Quality Control.

AB - Positron Emission Tomography (PET) is increasingly used for prostate cancer (PCa) diagnostics. Important PCa radiotracers include 68Ga-Prostate-Specific Membrane Antigen HBED-CC (68Ga-PSMA), 18F-DCFPyL, 18F-fluoromethylcholine (18F-FCH) and 18F-dihydrotestosterone (18F-FDHT). Knowledge on the variability of tracer uptake in healthy tissues is important for accurate PET interpretation, since malignancy is suspected only if the uptake of a lesion contrasts with its background. Therefore, the aim of this study was to quantify uptake variability of PCa tracers in healthy tissues and identify stable reference regions for PET interpretation. Methods: A total of n = 232 PCa PET/CT scans from multiple hospitals was analyzed, including n = 87 68Ga-PSMA scans; n = 50 18F-DCFPyL scans; n = 68 18F-FCH scans and n = 27 18F-FDHT scans. Tracer uptake was assessed in the blood pool, lung, liver, bone marrow and muscle - using several Standarized Uptake Values (SUVmax, SUVmean, SUVpeak). Variability in uptake between patients was analyzed using the Coefficient of Variation (COV%). For all tracers, SUV reference ranges (95th percentiles) were calculated, which could be applicable as image-based Quality Control for future PET acquisitions. Results: For 68Ga-PSMA, the lowest uptake variability was observed in the blood pool (COV 19.9%), which was significantly more stable than all other tissues (COV 29.8-35.2%, P = 0.001-0.024). For 18F-DCFPyL, lowest variability was observed in the blood pool and liver (COV 14.4% and 21.7%, P = 0.001-0.003). The least variable 18F-FCH uptake was observed in the liver, blood pool and bone marrow (COV 16.8-24.2%, P = 0.001-0.012). For 18F-FDHT, low uptake variability was observed in all tissues, except the lung (COV 14.6-23.6%, P = 0.001-0.040). The different SUV-types had limited effect on variability (COVs within 3 percentage points). Conclusion: In this multicenter analysis, healthy tissues with limited uptake variability were identified, which may serve as reference regions for PCa PET interpretation. These reference regions include the blood pool for 68Ga-PSMA and 18F-DCFPyL, and the liver for 18F-FCH and 18F-FDHT. Healthy tissue SUV reference ranges are presented and applicable as image-based Quality Control.

U2 - 10.2967/jnumed.118.222505

DO - 10.2967/jnumed.118.222505

M3 - Article

JO - Journal of nuclear medicine : official publication, Society of Nuclear Medicine

JF - Journal of nuclear medicine : official publication, Society of Nuclear Medicine

SN - 1535-5667

ER -