ORIGINAL ARTICLE   Open access

Hellenic Urology 2024 March;36(1):1-8

DOI: 10.23736/S2241-9136.24.00021-5

Copyright © 2024 THE AUTHORS

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lingua: Inglese

18F-PSMA-1007 PET/CT versus 18F-choline PET/CT in patients with recurrent prostate cancer: comparison by image processing and analysis on PET/CT images

Marios KATSIKAKIS ¹, Ilias GATOS ¹, Nikolaos PAPATHANASIOU ², Paraskevi F. KATSAKIORI ¹, Stavros TSANTIS ¹, Dimitrios APOSTOLOPOULOS ², Eleni KARAGKOUNI ^{3, 4}, Ioannis DATSERIS ⁵, Dimitris VISVIKIS ⁶, John D. HAZLE ⁷, George C. KAGADIS ^{1, 7} ✉

¹ Department of Medical Physics, School of Medicine, University of Patras, Rion, Greece; ² Department of Nuclear Medicine and PET/CT, School of Medicine, University Hospital, University of Patras, Rion, Greece; ³ Department of Radiology, School of Medicine, University of Patras, Patras, Greece; ⁴ University Hospital, Rion, Greece; ⁵ Department of Nuclear Medicine, “Evangelismos” General Hospital, Athens, Greece; ⁶ LaTIM, INSERM, UMR1101, Brest, France; ⁷ Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

BACKGROUND: This study aims to compare malignancy detection performance of two radioactive tracers, ¹⁸F-PSMA and ¹⁸F-choline in patients with prostate cancer biochemical recurrence having a PET-CT examination with both tracers using an image processing and analysis algorithm for suspicious findings extraction and evaluation.
METHODS: Twenty-five male patients (mean age: 70.68±6.6) having prostate cancer biochemical recurrence with elevated PSA values (>0.20 ng/mL) after initial radical prostatectomy were prospectively enrolled for both ¹⁸F-Choline and ¹⁸F-PSMA PET/CT examinations. For all patients the attenuation corrected PET-CT axial series were stored for both tracers. Then, an image processing algorithm was used on each image set initially involving the Minimum Intensity Projection (MinIP) method leading to a single coronal image for each tracer, representing its total uptake throughout the patient’s anatomy. A manual segmentation process was then performed on each resulting image involving delineation of suspicious findings by an expert nuclear medicine physician. The mean intensity of each delineated finding was calculated. An ROC analysis was performed on the mean intensity values of the delineated suspicious findings using post-examination evaluations by an expert urologist as reference class labels (benign = 0, malignant = 1).
RESULTS: A total of 95 suspicious findings were delineated and analyzed for all tracers. According to the ROC analysis, the accuracy of ¹⁸F-PSMA and ¹⁸F-choline in malignancy detection was 77.35% and 66.07% having an intensity threshold ≤210.40 and ≥43.14 respectively.
CONCLUSIONS: The results indicate that ¹⁸F-PSMA malignancy detection performance on PET-CT images is superior and presents lower uptake in benign/healthy tissues over ¹⁸F-choline.

KEY WORDS: Choline; Prostate-specific antigen; Prostatic neoplasms; Radiopharmaceuticals