Head-to-head comparison of [99mTc]Tc-MDP and [99mTc]Tc-PSMA whole-body SPECT/CT in prostate cancer patients

Document Type : Original Article

Authors

1 Department of Nuclear Medicine, Rajaee Heart Institute, Iran University of Medical Sciences, Tehran, Iran

2 Department of Nuclear Medicine, Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran

3 Department of Nuclear Medicine, Hasheminezhad Hospital, Iran University of Medical Sciences, Tehran, Iran

4 Department of Radiation Oncology, Hasheminezhad Hospital, Iran University of Medical Sciences, Tehran, Iran

5 Department of Urology, Hasheminezhad Hospital, Iran University of Medical Sciences, Tehran, Iran

6 Department of Nuclear Medicine, Kosar Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran

Abstract

Intoduction: Due to high expenses and lack of wide availability of [68Ga]Ga-PSMA PET/CT scan, we aimed to evaluate [99mTc]Tc-MDP and [99mTc]Tc-PSMA scan findings in a cluster of prostate cancer patients.
Methods: This prospective cross-sectional study was conducted from March 2021 to March 2022 at Shahid Hashemi Nejad hospital in Tehran, Iran. In this study, prostate cancer patients with intermediate to high-risk or patients with PSA rise during follow-up were selected for undergoing both [99mTc]Tc-MDP bone scintigraphy and [99mTc]Tc-PSMA scan. The scans were performed with a maximum 2-week interval. The images were evaluated for presence, number and locations of abnormal lesions. CT findings were used as an anatomical comparator; however, CT was not considered a true reference standard.
Results: 20 patients were evaluated. 63 bone lesions on CT scan, 69 lesions on [99mTc]Tc-MDP bone scan, 23 lesions on [99mTc]Tc-PSMA SPECT/CT and 16 lesions on [99mTc]Tc-PSMA planar images, were visualized. 56.3%, 31.1% and 31.1% of patients had positive conventional bone scan, [99mTc]Tc-PSMA SPECT/CT and planar [99mTc]Tc-PSMA images. Mean number of lesions on these modalities were 4.31±6.85, 1.43±3.75 and 1.00±2.30, respectively. Sensitivity rates of these three modalities were 100%, 55.6% and 55.6% while specificity was 100% for all of these modalities. Mean number of bone lesions on [99mTc]Tc-MDP bone scintigraphy and [99mTc]Tc-PSMA SPECT/CT showed significant difference (p=0.027).
Conclusion: In this cohort, [99mTc]Tc-MDP whole-body SPECT/CT scintigraphy identified a greater number of skeletal lesions than [99mTc]Tc-PSMA SPECT/CT. however, because a composite reference standard was unavailable, these findings should be interpreted as differences in lesion detection rather than definitive evidence of superior diagnostic performance. Larger prospective multicenter studies are warranted.

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References

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