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The central zone has increased Ga-PSMA-11 uptake: "Mickey Mouse ears" can be hot on Ga-PSMA-11 PET


Pizzuto, Daniele A; Müller, Julian; Mühlematter, Urs; Rupp, Niels J; Töpfer, Antonia; Mortezavi, Ashkan; Nagel, Hannes; Kranzbühler, Benedikt; Eberli, Daniel; Burger, Irene A (2018). The central zone has increased Ga-PSMA-11 uptake: "Mickey Mouse ears" can be hot on Ga-PSMA-11 PET. European Journal of Nuclear Medicine and Molecular Imaging, 45(8):1335-1343.

Abstract

PURPOSE
Given the good correlation between PSMA expression and intraglandular tumour aggressiveness based on immunohistochemistry, there is increasing interest in Ga-PSMA-11 PET/MRI for staging prostate cancer (PCA). Therefore, accurate knowledge of prostate anatomy as well as normal distribution of PSMA within the prostate gland is becoming essential. The aim of this study was to investigate the physiological intraprostatic distribution of Ga-PSMA-11.
METHODS
We retrospectively analysed all patients who underwent a staging Ga-PSMA-11 PET/MRI scan between June 2016 and January 2018 for high-risk PCA, underwent radical prostatectomy in our institution, and gave written consent for further data analysis. In each patient, standardized volumes of interest (VOIs) were placed bilaterally in the central, transition and peripheral zones within the zonal anatomy according to T2 weighted sequences in the axial and coronal planes. VOIs were only placed if they were safely within healthy tissue without spillover from the PCA. SUV and SUV were determined and their differences among the regions were assessed using the Wilcoxon signed-ranks test.
RESULTS
Of 283 consecutive patients scanned with Ga-PSMA-11 PET/MR, 31 were analysed. A total of 133 VOIs were placed, 46 in the central zone, 41 in the transition zone and 46 in the peripheral zone. Differences in SUV between the central zone (mean 3.9 ± 0.58) and transition zone (mean 3.2 ± 0.59) and between the central zone and peripheral zone (mean 2.7 ± 0.54) were statistically significant (both p < 0.001).
CONCLUSION
Our results suggest that higher Ga-PSMA-11 accumulation in the central zone than in the transition and peripheral zones is normal, and leads to a pattern resembling "Mickey Mouse ears" on Ga-PSMA-11 PET. This pattern could be helpful in avoiding false-positive interpretations of PET scans.

Abstract

PURPOSE
Given the good correlation between PSMA expression and intraglandular tumour aggressiveness based on immunohistochemistry, there is increasing interest in Ga-PSMA-11 PET/MRI for staging prostate cancer (PCA). Therefore, accurate knowledge of prostate anatomy as well as normal distribution of PSMA within the prostate gland is becoming essential. The aim of this study was to investigate the physiological intraprostatic distribution of Ga-PSMA-11.
METHODS
We retrospectively analysed all patients who underwent a staging Ga-PSMA-11 PET/MRI scan between June 2016 and January 2018 for high-risk PCA, underwent radical prostatectomy in our institution, and gave written consent for further data analysis. In each patient, standardized volumes of interest (VOIs) were placed bilaterally in the central, transition and peripheral zones within the zonal anatomy according to T2 weighted sequences in the axial and coronal planes. VOIs were only placed if they were safely within healthy tissue without spillover from the PCA. SUV and SUV were determined and their differences among the regions were assessed using the Wilcoxon signed-ranks test.
RESULTS
Of 283 consecutive patients scanned with Ga-PSMA-11 PET/MR, 31 were analysed. A total of 133 VOIs were placed, 46 in the central zone, 41 in the transition zone and 46 in the peripheral zone. Differences in SUV between the central zone (mean 3.9 ± 0.58) and transition zone (mean 3.2 ± 0.59) and between the central zone and peripheral zone (mean 2.7 ± 0.54) were statistically significant (both p < 0.001).
CONCLUSION
Our results suggest that higher Ga-PSMA-11 accumulation in the central zone than in the transition and peripheral zones is normal, and leads to a pattern resembling "Mickey Mouse ears" on Ga-PSMA-11 PET. This pattern could be helpful in avoiding false-positive interpretations of PET scans.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Institute of Pathology and Molecular Pathology
04 Faculty of Medicine > University Hospital Zurich > Urological Clinic
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:July 2018
Deposited On:10 Aug 2018 06:26
Last Modified:10 Aug 2018 06:37
Publisher:Springer
ISSN:1619-7070
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s00259-018-3979-2
PubMed ID:29523924

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