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Open Access 17-06-2024 | Positron Emission Tomography | Review Article

The Homunculus of unspecific bone uptakes associated with PSMA-targeted tracers: a systematic review-based definition

Authors: Alessio Rizzo, Silvia Morbelli, Domenico Albano, Giuseppe Fornarini, Martina Cioffi, Riccardo Laudicella, Francesco Dondi, Serena Grimaldi, Francesco Bertagna, Manuela Racca, Giorgio Treglia, Matteo Bauckneht

Published in: European Journal of Nuclear Medicine and Molecular Imaging

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Abstract

Purpose

Prostate-Specific Membrane Antigen (PSMA)-targeted Positron Emission Tomography (PET) has revolutionised prostate cancer (PCa) diagnosis and treatment, offering superior diagnostic accuracy over traditional methods and enabling theragnostic applications. However, a significant diagnostic challenge has emerged with identifying unspecific bone uptakes (UBUs), which could lead to over-staging and inappropriate treatment decisions if misinterpreted. This systematic review explores the phenomenon of UBUs in PCa patients undergoing PSMA-PET imaging.

Methods

Studies assessing the prevalence, topographical distribution, and potential clinical implications of UBUs were selected according to the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) method and evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.

Results

The percentage of PCa patients with UBUs on PSMA-PET scans ranged from 0 to 71.7%, depending on the radiopharmaceutical used, with [18F]PSMA-1007 showing the highest incidence. The ribs are the primary site of UBUs across all PSMA-targeted radiopharmaceuticals. The spine is the second most frequent UBU site for [68Ga]Ga-PSMA-11, [18F]DCFPyL, [18F]rhPSMA-7, while the pelvic girdle represents the second most frequent site for [18F]PSMA-1007. The average maximum Standardized Uptake Value (SUVmax) of UBUs varied from 3.4 to 7.7 and was generally lower than that of bone metastases.

Conclusions

Our findings underscore the need for heightened awareness and precise interpretation of UBUs to avoid potential over-staging and subsequent inappropriate treatment decisions. Considering the radiopharmaceutical used, PET-derived semiquantitative parameters, the topographical distribution of UBUs, and accurately evaluating the pre-test probability based on clinical and laboratory parameters may aid nuclear medicine physicians in interpreting PSMA-PET findings.
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Metadata
Title
The Homunculus of unspecific bone uptakes associated with PSMA-targeted tracers: a systematic review-based definition
Authors
Alessio Rizzo
Silvia Morbelli
Domenico Albano
Giuseppe Fornarini
Martina Cioffi
Riccardo Laudicella
Francesco Dondi
Serena Grimaldi
Francesco Bertagna
Manuela Racca
Giorgio Treglia
Matteo Bauckneht
Publication date
17-06-2024
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-024-06797-5