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Molecular Imaging and Biology
Published in: Molecular Imaging and Biology 4/2020

01-08-2020 | Prostate Cancer | Research Article

SUV95th as a Reliable Alternative to SUVmax for Determining Renal Uptake in [68Ga] PSMA PET/CT

Authors: Serena Baiocco, Federica Matteucci, Emilio Mezzenga, Paola Caroli, Valentina Di Iorio, Corrado Cittanti, Alessandro Bevilacqua, Giovanni Paganelli, Anna Sarnelli

Published in: Molecular Imaging and Biology | Issue 4/2020

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Abstract

Purpose

Widely used in clinical practice, the maximum standardized uptake value (SUVmax) is a statistical index highly prone to physical and biological variations, which can lead to unpredictable errors. This study has a methodological aim: to identify a more robust SUV-based index representing the tracer accumulation. In particular, the new metric was tested to confirm the potential of mannitol to reduce renal uptake Ga-68 prostate-specific membrane antigen ([68Ga]PSMA).

Procedures

To this aim, our previously published work, proving the efficacy of mannitol, was considered as a background study. Renal SUVmax was calculated in nine patients undergoing [68Ga]PSMA positron emission tomography (PET)/X-ray computed tomography (CT) at baseline (b-PET/CT) and at follow-up after intravenous infusion of 500 ml of 10 % mannitol (m-PET/CT). SUV values of kidney volumes were extracted by a new 3D segmentation method. A new parameter, the median computed on the upper 10% of the SUV distribution (SUV95th), was introduced to better characterize the tracer accumulation. A comparison between SUVmax and SUV95th was also performed. Kruskal-Wallis test was used to assess the statistical significance of the differences in SUV95th between b-PET/CT and m-PET/CT.

Results

SUV95th not only confirmed the efficacy of mannitol as demonstrated in the previous study but improved the separability of b-PET/CT and m-PET/CT examinations, overturning SUVmax findings in two cases. The outcomes of the Kruskal-Wallis test computed for each kidney proved that differences between b-PET/CT and m-PET/CT SUV95th values were significant (p value < 0.001).

Conclusions

Our findings indicate that SUV95th is a more robust index to assess high uptake level, representing a reliable alternative to SUVmax. Independently from the segmentation method, the superiority of SUV95th and its easy computation could make its clinical impact decisive. The results obtained with SUV95th, more representative of tracer uptake than those with SUVmax suggest, in our opinion, that mannitol infusion could be used to reduce the adsorbed dose to the kidneys during [68Ga]PSMA PET/CT and Lu-177 or Ac-225 therapy. Our future goal will be confirming this effect in a larger cohort of patients, also verifying the role of SUV95th in the evaluation of tumor response to therapy.
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Metadata
Title
SUV95th as a Reliable Alternative to SUVmax for Determining Renal Uptake in [68Ga] PSMA PET/CT
Authors
Serena Baiocco
Federica Matteucci
Emilio Mezzenga
Paola Caroli
Valentina Di Iorio
Corrado Cittanti
Alessandro Bevilacqua
Giovanni Paganelli
Anna Sarnelli
Publication date
01-08-2020
Publisher
Springer International Publishing
Published in
Molecular Imaging and Biology / Issue 4/2020
Print ISSN: 1536-1632
Electronic ISSN: 1860-2002
DOI
https://doi.org/10.1007/s11307-019-01451-1

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