• Hendrik Rathke, Ali Afshar-Oromieh, Frederik Lars Giesel, Christophe Kremer, Paul Flechsig, Sabine Haufe, Walter Mier, Tim Holland-Letz, Maximilian De Bucourt, Thomas Armor, John W Babich, Uwe Haberkorn, and Clemens Kratochwil.
• Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany hendrik.rathke@med.uni-heidelberg.de.
• J. Nucl. Med. 2018 Sep 1; 59 (9): 1373-1379.

AbstractThe 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.© 2018 by the Society of Nuclear Medicine and Molecular Imaging.

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