A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis
Bone is the most common metastatic site in prostate cancer (PCa). <sup>68</sup>Ga-PSMA-11 (or gozetotide) and sodium fluoride-18 (Na<sup>18</sup>F) are rather new radiopharmaceuticals for assessing PCa-associated bone metastases. Gozetotide uptake reflects cell membrane enzym...
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MDPI AG
2022-11-01
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| Series: | Life |
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| author | Kalevi Kairemo Aki Kangasmäki Srinivasan Cheenu Kappadath Timo Joensuu Homer A. Macapinlac |
| author_facet | Kalevi Kairemo Aki Kangasmäki Srinivasan Cheenu Kappadath Timo Joensuu Homer A. Macapinlac |
| author_sort | Kalevi Kairemo |
| collection | DOAJ |
| description | Bone is the most common metastatic site in prostate cancer (PCa). <sup>68</sup>Ga-PSMA-11 (or gozetotide) and sodium fluoride-18 (Na<sup>18</sup>F) are rather new radiopharmaceuticals for assessing PCa-associated bone metastases. Gozetotide uptake reflects cell membrane enzyme activity and the sodium fluoride uptake measures bone mineralization in advanced PCa. Here, we aim to characterize this difference and possibly provide a new method for patient selection in targeted therapies. <b>Methods:</b> The study consisted of 14 patients with advanced PCa (M group > 5 lesions), who had had routine PET/CT both with PSMA and NaF over consecutive days, and 12 PCa patients with no skeletal metastases (N). The bone regions in CT were used to coregister the two PET/CT scans. The whole skeleton volume(s) of interest (VOIs) were defined using the CT component of PET (HU > 150); similarly, the sclerotic/dense bone was defined as HU > 600. Additional VOIs were defined for PET, with pathological threshold values for PSMA (SUV > 3.0) and NaF (SUV > 10). Besides the pathological bone volumes measured with each technique (CT, NaF, and PSMA-PET) and their contemporaneous combinations, overlapping VOIs with the CT-based skeletal and sclerotic volumes were also recorded. Additionally, thresholds of 4.0, 6.0, and 10.0 were tested for SUV<sub>PSMA</sub>. <b>Results:</b> In group M, the skeletal VOI volumes were 8.77 ± 1.80 L, and the sclerotic bone volumes were 1.32 ± 0.50 L; in contrast, in group N, they were 8.73 ± 1.43 L (skeletal) and 1.23 ± 0.28 L (sclerosis). The total enzyme activity for PSMA was 2.21 ± 5.15 in the M group and 0.078 ± 0.053 in the N group (<i>p</i> < 0.0002). The total bone demineralization activity for NaF varied from 4.31 ± 6.17 in the M group and 0.24 ± 0.56 in group N (<i>p</i> < 0.0002). The pathological PSMA volume represented 0.44–132% of the sclerotic bone volume in group M and 0.55–2.3% in group N. The pathological NaF volume in those patients with multiple metastases represented 0.27–68% of the sclerotic bone volume, and in the control group, only 0.00–6.5% of the sclerotic bone volume (<i>p</i> < 0.0003). <b>Conclusions:</b> These results confirm our earlier findings that CT alone does not suit the evaluation of the extent of active skeletal metastases in PCa. PSMA and NaF images give complementary information about the extent of the active skeletal disease, which has a clinical impact and may change its management. The PSMA and NaF absolute volumes could be used for planning targeted therapies. A cut-off value 3.0 for SUV<sub>PSMA</sub> given here is the best correlation in the presentation of active metastatic skeletal disease. |
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| spelling | doaj.art-3eafddf3b63b48b092963ed4480fc2932023-11-24T16:11:26ZengMDPI AGLife2075-17292022-11-011212197710.3390/life12121977A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic AnalysisKalevi Kairemo0Aki Kangasmäki1Srinivasan Cheenu Kappadath2Timo Joensuu3Homer A. Macapinlac4Department of Theragnostics, Docrates Cancer Center, 00180 Helsinki, FinlandDepartment of Medical Physics, Docrates Cancer Center, 00180 Helsinki, FinlandDepartment of Imaging Physics, MD Anderson Cancer Center, Houston, TX 77030, USADepartment of Medical Oncology and Radiotherapy, Docrates Cancer Center, 00180 Helsinki, FinlandDepartment of Nuclear Medicine, MD Anderson Cancer Center, Houston, TX 77030, USABone is the most common metastatic site in prostate cancer (PCa). <sup>68</sup>Ga-PSMA-11 (or gozetotide) and sodium fluoride-18 (Na<sup>18</sup>F) are rather new radiopharmaceuticals for assessing PCa-associated bone metastases. Gozetotide uptake reflects cell membrane enzyme activity and the sodium fluoride uptake measures bone mineralization in advanced PCa. Here, we aim to characterize this difference and possibly provide a new method for patient selection in targeted therapies. <b>Methods:</b> The study consisted of 14 patients with advanced PCa (M group > 5 lesions), who had had routine PET/CT both with PSMA and NaF over consecutive days, and 12 PCa patients with no skeletal metastases (N). The bone regions in CT were used to coregister the two PET/CT scans. The whole skeleton volume(s) of interest (VOIs) were defined using the CT component of PET (HU > 150); similarly, the sclerotic/dense bone was defined as HU > 600. Additional VOIs were defined for PET, with pathological threshold values for PSMA (SUV > 3.0) and NaF (SUV > 10). Besides the pathological bone volumes measured with each technique (CT, NaF, and PSMA-PET) and their contemporaneous combinations, overlapping VOIs with the CT-based skeletal and sclerotic volumes were also recorded. Additionally, thresholds of 4.0, 6.0, and 10.0 were tested for SUV<sub>PSMA</sub>. <b>Results:</b> In group M, the skeletal VOI volumes were 8.77 ± 1.80 L, and the sclerotic bone volumes were 1.32 ± 0.50 L; in contrast, in group N, they were 8.73 ± 1.43 L (skeletal) and 1.23 ± 0.28 L (sclerosis). The total enzyme activity for PSMA was 2.21 ± 5.15 in the M group and 0.078 ± 0.053 in the N group (<i>p</i> < 0.0002). The total bone demineralization activity for NaF varied from 4.31 ± 6.17 in the M group and 0.24 ± 0.56 in group N (<i>p</i> < 0.0002). The pathological PSMA volume represented 0.44–132% of the sclerotic bone volume in group M and 0.55–2.3% in group N. The pathological NaF volume in those patients with multiple metastases represented 0.27–68% of the sclerotic bone volume, and in the control group, only 0.00–6.5% of the sclerotic bone volume (<i>p</i> < 0.0003). <b>Conclusions:</b> These results confirm our earlier findings that CT alone does not suit the evaluation of the extent of active skeletal metastases in PCa. PSMA and NaF images give complementary information about the extent of the active skeletal disease, which has a clinical impact and may change its management. The PSMA and NaF absolute volumes could be used for planning targeted therapies. A cut-off value 3.0 for SUV<sub>PSMA</sub> given here is the best correlation in the presentation of active metastatic skeletal disease.https://www.mdpi.com/2075-1729/12/12/1977PSMAprostate specific membrane antigensodium fluoridepositron emission tomographyprostate cancerbone metastases |
| spellingShingle | Kalevi Kairemo Aki Kangasmäki Srinivasan Cheenu Kappadath Timo Joensuu Homer A. Macapinlac A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis Life PSMA prostate specific membrane antigen sodium fluoride positron emission tomography prostate cancer bone metastases |
| title | A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis |
| title_full | A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis |
| title_fullStr | A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis |
| title_full_unstemmed | A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis |
| title_short | A Retrospective Comparative Study of Sodium Fluoride Na<sup>18</sup>F-PET/CT and <sup>68</sup>Ga-PSMA-11 PET/CT in the Bone Metastases of Prostate Cancer Using a Volumetric 3-D Radiomic Analysis |
| title_sort | retrospective comparative study of sodium fluoride na sup 18 sup f pet ct and sup 68 sup ga psma 11 pet ct in the bone metastases of prostate cancer using a volumetric 3 d radiomic analysis |
| topic | PSMA prostate specific membrane antigen sodium fluoride positron emission tomography prostate cancer bone metastases |
| url | https://www.mdpi.com/2075-1729/12/12/1977 |
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