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Effect of Point-Spread Function Reconstruction for Indeterminate PSMA-RADS-3A Lesions on PSMA-Targeted PET Imaging of Men with Prostate Cancer

Khatri, Wajahat and Chung, Hyun Woo and Werner, Rudolf A. and Leal, Jeffrey P. and Pienta, Kenneth J. and Lodge, Martin A. and Gorin, Michael A. and Pomper, Martin G. and Rowe, Steven P. (2021) Effect of Point-Spread Function Reconstruction for Indeterminate PSMA-RADS-3A Lesions on PSMA-Targeted PET Imaging of Men with Prostate Cancer. Diagnostics, 11 (4). p. 665. ISSN 2075-4418

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Purpose: Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is emerging as an important modality for imaging patients with prostate cancer (PCa). As with any imaging modality, indeterminate findings will arise. The PSMA reporting and data system (PSMA-RADS) version 1.0 codifies indeterminate soft tissue findings with the PSMA-RADS-3A moniker. We investigated the role of point-spread function (PSF) reconstructions on categorization of PSMA-RADS-3A lesions. Methods: This was a post hoc analysis of an institutional review board approved prospective trial. Around 60 min after the administration of 333 MBq (9 mCi) of PSMA-targeted 18F-DCFPyL, patients underwent PET/computed tomography (CT) acquisitions from the mid-thighs to the skull vertex. The PET data were reconstructed with and without PSF. Scans were categorized according to PSMA-RADS version 1.0, and all PSMA-RADS-3A lesions on non-PSF images were re-evaluated to determine if any could be re-categorized as PSMA-RADS-4. The maximum standardized uptake values (SUVs) of the lesions, mean SUVs of blood pool, and the ratios of those values were determined. Results: A total of 171 PSMA-RADS-3A lesions were identified in 30 patients for whom both PSF reconstructions and cross-sectional imaging follow-up were available. A total of 13/171 (7.6%) were re-categorized as PSMA-RADS-4 lesions with PSF reconstructions. A total of 112/171 (65.5%) were found on follow-up to be true positive for PCa, with all 13 of the re-categorized lesions being true positive on follow-up. The lesions that were re-categorized trended towards having higher SUVmax-lesion and SUVmax-lesion/SUVmean-blood-pool metrics, although these relationships were not statistically significant. Conclusions: The use of PSF reconstructions for 18F-DCFPyL PET can allow the appropriate re-categorization of a small number of indeterminate PSMA-RADS-3A soft tissue lesions as more definitive PSMA-RADS-4 lesions. The routine use of PSF reconstructions for PSMA-targeted PET may be of value at those sites that utilize this technology


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Khatri, Wajahat
Chung, Hyun Woo
Werner, Rudolf A.
Leal, Jeffrey P.
Pienta, Kenneth J.
Lodge, Martin A.
Gorin, Michael A.
Pomper, Martin G.
Rowe, Steven P.
Date: 7 April 2021
Date Type: Publication
Journal or Publication Title: Diagnostics
Volume: 11
Number: 4
Publisher: MDPI AG
Page Range: p. 665
DOI or Unique Handle: 10.3390/diagnostics11040665
Schools and Programs: School of Medicine > Urology
Refereed: Yes
Uncontrolled Keywords: prostate-specific membrane antigen, reporting and data system, positron emission tomography
ISSN: 2075-4418
Official URL:
Funders: Prostate Cancer Foundation Young Investigator Award, Progenics Pharmaceuticals
Article Type: Research Article
Date Deposited: 21 Jul 2021 20:06
Last Modified: 21 Jul 2021 20:06


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