PSMA PET improves characterization of dural-based intracranial lesions in patients with metastatic prostate cancer

• Published in: European journal of radiology 2024-11, Vol.180, p.111711, Article 111711
• Main Authors: Yadav, Divya, Dutruel, Silvina P., O’Dwyer, Elisabeth, Ricaurte-Fajardo, Andres, Upadhyay, Rituraj, Palmer, Joshua D., Pannullo, Susan C., Tagawa, Scott T., Knisely, Jonathan P.S., Brandmaier, Andrew, Osborne, Joseph R., Ivanidze, Jana
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antigens, Surface - metabolism; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - secondary; Dural metastases; Glutamate Carboxypeptidase II - metabolism; Humans; Magnetic Resonance Imaging - methods; Male; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - secondary; Meningioma; Meningioma - diagnostic imaging; Meningioma - pathology; Meningioma - secondary; Middle Aged; Positron Emission Tomography Computed Tomography - methods; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; PSMA PET; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity
• ISSN: 0720-048X; 1872-7727; 1872-7727
• DOI: 10.1016/j.ejrad.2024.111711

Theranostic approaches combining prostate-specific membrane antigen (PSMA)-PET/CT or PET/MRI with PSMA-targeted radionuclide therapy have improved clinical outcomes in patients with prostate cancer (PCa) especially metastatic castrate resistant prostate cancer. Dural metastases in PCa are rare but can pose a diagnostic challenge, as meningiomas, a more common dural based lesions have been shown to express PSMA. The aim of this study is to compare PSMA PET parameters between brain lesions classified as dural metastases and meningiomas in prostate cancer patients. A retrospective analysis of PSMA PET/CT scans in patients with PCa and intracranial lesions was conducted. Brain lesions were categorized as dural metastases or meningiomas based on MRI characteristics, longitudinal follow-up, and histopathological characteristics. Standardized uptake values (SUVmax) of each brain lesion were measured, along with SUV ratio referencing parotid gland (SUVR). SUVs between lesions classified as metastases and meningiomas, respectively, were compared using Mann-Whitney-test. Diagnostic accuracy was evaluated using ROC analysis. 26 male patients (median age: 76.5 years, range: 59–96 years) met inclusion criteria. A total of 44 lesions (7 meningiomas and 37 metastases) were analyzed. Median SUVmax and SUVR were significantly lower in meningiomas compared to metastases (SUVmax: 2.7 vs. 11.5, p = 0.001; SUVR: 0.26 vs. 1.05, p