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1.  The diagnostic value of PET/CT imaging with the 68Ga-labelled PSMA ligand HBED-CC in the diagnosis of recurrent prostate cancer 
Purpose
Since the introduction of positron emission tomography (PET) imaging with 68Ga-PSMA-HBED-CC (=68Ga-DKFZ-PSMA-11), this method has been regarded as a significant step forward in the diagnosis of recurrent prostate cancer (PCa). However, published data exist for small patient cohorts only. The aim of this evaluation was to analyse the diagnostic value of 68Ga-PSMA-ligand PET/CT in a large cohort and the influence of several possibly interacting variables.
Methods
We performed a retrospective analysis in 319 patients who underwent 68Ga-PSMA-ligand PET/CT from 2011 to 2014. Potential influences of several factors such as prostate-specific antigen (PSA) level and doubling time (DT), Gleason score (GSC), androgen deprivation therapy (ADT), age and amount of injected tracer were evaluated. Histological verification was performed in 42 patients after the 68Ga-PSMA-ligand PET/CT. Tracer uptake was measured in 901 representative tumour lesions.
Results
In 82.8 % of the patients at least one lesion indicative of PCa was detected. Tumor-detection was positively associated with PSA level and ADT. GSC and PSA-DT were not associated with tumor-detection. The average maximum standardized uptake value (SUVmax) of tumour lesions was 13.3 ± 14.6 (0.7–122.5). Amongst lesions investigated by histology, 30 were false-negative in 4 different patients, and all other lesions (n = 416) were true-positive or true-negative. A lesion-based analysis of sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) revealed values of 76.6 %, 100 %, 91.4 % and 100 %. A patient-based analysis revealed a sensitivity of 88.1 %. Of 116 patients available for follow-up, 50 received local therapy after 68Ga-PSMA-ligand PET/CT.
Conclusion
68Ga-PSMA-ligand PET/CT can detect recurrent PCa in a high number of patients. In addition, the radiotracer is highly specific for PCa. Tumour detection is positively associated with PSA and ADT. 68Ga-PSMA-ligand PET/CT can help delay systemic therapy of PCa.
Electronic supplementary material
The online version of this article (doi:10.1007/s00259-014-2949-6) contains supplementary material, which is available to authorized users.
doi:10.1007/s00259-014-2949-6
PMCID: PMC4315487  PMID: 25411132
Prostate cancer; PET/CT; Positron emission tomography; PSMA; FMCH; FECH
2.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise throughout the year 2013 to the high quality and success of this journal.
doi:10.3941/jrcr.v8i1.2119
PMCID: PMC4037246  PMID: 24967015
3.  Comparison of PET imaging with a 68Ga-labelled PSMA ligand and 18F-choline-based PET/CT for the diagnosis of recurrent prostate cancer 
Purpose
Positron emission tomography (PET) with choline tracers has found widespread use for the diagnosis of prostate cancer (PC). However, choline metabolism is not increased in a considerable number of cases, whereas prostate-specific membrane antigen (PSMA) is overexpressed in most PCs. Therefore, a 68Ga-labelled PSMA ligand could be superior to choline tracers by obtaining a high contrast. The aim of this study was to compare such a novel tracer with standard choline-based PET/CT.
Methods
Thirty-seven patients with biochemical relapse of PC [mean prostate-specific antigen (PSA) 11.1 ± 24.1 ng/ml, range 0.01–116] were retrospectively analysed after 18F-fluoromethylcholine and 68Ga-PSMA PET/CT within a time window of 30 days. Radiotracer uptake that was visually considered as PC was semi-quantitatively analysed by measuring the maximum standardized uptake values (SUVmax) of the scans acquired 1 h after injection of 68Ga-PSMA complex solution (median 132 MBq, range 59–263 MBq) and 18F-fluoromethylcholine (median 237 MBq, range 114–374 MBq), respectively. In addition, tumour to background ratios were calculated.
Results
A total of 78 lesions characteristic for PC were detected in 32 patients using 68Ga-PSMA PET/CT and 56 lesions were detected in 26 patients using choline PET/CT. The higher detection rate in 68Ga-PSMA PET/CT was statistically significant (p = 0.04). In five patients no lesion was found with both methods. All lesions detected by 18F-fluoromethylcholine PET/CT were also seen by 68Ga-PSMA PET/CT. In 68Ga-PSMA PET/CT SUVmax was clearly (>10 %) higher in 62 of 78 lesions (79.1 %) and the tumour to background ratio was clearly (>10 %) higher in 74 of 78 lesions (94.9 %) when compared to 18F-fluoromethylcholine PET/CT.
Conclusion
68Ga-PSMA PET/CT can detect lesions characteristic for PC with improved contrast when compared to standard 18F-fluoromethylcholine PET/CT, especially at low PSA levels.
Electronic supplementary material
The online version of this article (doi:10.1007/s00259-013-2525-5) contains supplementary material, which is available to authorized users.
doi:10.1007/s00259-013-2525-5
PMCID: PMC3843747  PMID: 24072344
Prostate cancer; PET/CT; Positron emission tomography; PSMA; Choline
4.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise throughout the year 2012 to the high quality and success of this journal.
doi:10.3941/jrcr.v6i12.1504
PMCID: PMC3557126
5.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise throughout the year 2011 to the high quality and success of this journal.
doi:10.3941/jrcr.v5i12.994
PMCID: PMC3303426
6.  Impact of geometric mean imaging in the accurate determination of partial function in MAG3 renal scanning in a patient with retroperitoneal mass 
Liposarcoma frequently occurs in the retroperitoneum and lower extremities, accounting for 20% of all mesenchymal malignancies. Liposarcomas vary by histology and can be classified into four types. Those four types are well differentiated, myxoid/round cell, pleomorphic and dedifferentiated. Due to retroperitoneal location of this tumor, it is expected to affect the kidney position. Renography has provided a unique tool for noninvasive evaluation of various functional parameters e.g. relative renal function. Most renography studies are carried out using the posterior view, under the assumption that the depths of both kidneys are similar so that the radiotracer counts in the region of interest will be attenuated to the same extent. Errors in estimation of the relative renal function may arise if the kidneys are at different depths e.g. secondary to a pushing tumor. Geometric mean imaging from combined anterior and posterior views helps to overcome this issue. This case shows the impact of geometric mean imaging in the truthful determination of partial function in patients with retroperitoneal liposarcoma.
doi:10.3941/jrcr.v5i6.711
PMCID: PMC3303344  PMID: 22470796
MAG3; geometric mean; retroperitoneal liposarcoma; renal scan
7.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise throughout the year 2010 to the high quality and success of this journal.
doi:10.3941/jrcr.v4i12.671
PMCID: PMC3303365  PMID: 22470702
8.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise throughout the year 2009 to the high quality and success of this journal.
doi:10.3941/jrcr.v4i1.404
PMCID: PMC3303340  PMID: 22470688
9.  Educational treasures in Radiology: Radiolopolis – an international Radiology community 
This article focuses on a relatively new concept in the Internet: “Social networking” and especially on one program that successfully found a unique way to provide a social network for Radiology: Radiolopolis. Radiolopolis (www.Radiolopolis.com) is an international Radiology network to promote education, research and clinical practice in Radiology. What makes this Radiology community unique and special is that the founders of Radiolopolis implemented multiple educational and clinical/practical programs which have been developed over the past years.
doi:10.3941/jrcr.v3i9.256
PMCID: PMC3303334  PMID: 22470687
Radiology community; Radiology network; social networking; Radiology education; research; training; clinical practice; information exchange; teaching; Radiolopolis
10.  Honoring our helpers 
This special issue of the Journal of Radiology Case Reports honors the reviewers who donated their time and expertise to the high quality and success of this journal.
doi:10.3941/jrcr.v2i6.125
PMCID: PMC3303260  PMID: 22470609

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