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68Ga-PSMA I&T PET/CT for assessment of prostate cancer: evaluation of image quality after forced diuresis and delayed imaging

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Abstract

Objective

Urinary radiotracer excretion of 68Ga-Labelled prostate-specific membrane antigen (PSMA) ligands may complicate the assessment of the prostate region and differentiation of lymph nodes from ureteral activity. The aim of this study was to assess the value of delayed imaging after forced diuresis.

Materials and methods

Sixty-six patients underwent 68Ga-PSMA I&T PET/CT for evaluation of prostate cancer at 60 min post-injection. In subgroups of patients, this was amended by delayed imaging after 180 min post-injection, preceded by furosemide and oral hydration early, at the time of tracer injection, or delayed, at 100 min post-injection. Urinary tracer activity within the bladder and focal ureteral activity was analyzed.

Results

After forced diuresis, linear and focal visualization of ureters was significantly reduced. After delayed furosemide, mean and peak bladder activity decreased (p < 0.001), and image quality of the prostate region improved on delayed images (p < 0.001). Early furosemide co-injection with tracer resulted in increased mean and peak bladder activity (p < 0.001) and in deteriorated image quality of the prostate region on delayed images (p = 0.008).

Conclusion

Ga-PSMA I&T PET/CT delayed imaging after forced diuresis can improve the assessment of prostate region and pelvic lymph nodes by removing excreted tracer from the lower urinary tract.

Key points

• Forced diuresis can improve image quality in 68 Ga-PSMA I&T.

• After forced diuresis, linear and focal visualization of ureters was reduced.

• Timing of diuresis relative to 68 Ga-PSMA I&T injection is important.

• Early furosemide co-injection with tracer resulted in deteriorated image quality on delayed images.

• After delayed furosemide, image quality improved on delayed images.

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Acknowledgments

The authors would like to thank James Thackeray, PhD for his thorough revision and language editing of the manuscript. The scientific guarantor of this publication is Thorsten Derlin. The authors of this manuscript declare relationships with the following companies: Hans-Juergen Wester is the CEO of Scintomics. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding.

No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study.

Study subjects or cohorts have not been previously reported. Methodology: retrospective, diagnostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625, Hannover, Germany

    Thorsten Derlin, Desiree Weiberg, Tobias L. Ross & Frank M. Bengel

  2. Department of Urology and Urologic Oncology, Hannover Medical School, Hannover, Germany

    Christoph von Klot

  3. Pharmaceutical Radiochemistry, Technische Universität München, Garching, Germany

    Hans-Jürgen Wester

  4. Department of Radiation Oncology, Hannover Medical School, Hannover, Germany

    Christoph Henkenberens & Hans Christiansen

  5. Department of Urology, Campus Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany

    Axel S. Merseburger

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  1. Thorsten Derlin
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Correspondence to Thorsten Derlin.

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Derlin, T., Weiberg, D., von Klot, C. et al. 68Ga-PSMA I&T PET/CT for assessment of prostate cancer: evaluation of image quality after forced diuresis and delayed imaging. Eur Radiol 26, 4345–4353 (2016). https://doi.org/10.1007/s00330-016-4308-4

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  • DOI: https://doi.org/10.1007/s00330-016-4308-4

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