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CT during initial staging for prostate cancer
Rev Esp Med Nucl Imagen Mol. 2017;36(2):133–134
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Incidental detection of tracer avidity in meningioma in 68 Ga-PSMA PET/CT during initial staging for prostate cancer Detección incidental de avidez de trazador en meningioma en 68 Ga-PSMA PET/TC durante la estradificación inicial de un cáncer de próstata T.K. Jain a , A.G.S. Jois a , S. Kumar V a , S.K. Singh b , R. Kumar a , B.R. Mittal a,∗ a b
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
A 60-year-old male patient presented with lower urinary tract symptoms since five months. Per-rectal examination revealed enlarged prostate. Serum prostate specific antigen (PSA) level was 117 ng/ml (0–4 ng/ml) and pelvic contrast enhanced CT (CECT) revealed heterogeneous enlargement of prostate. 99m TcMDP whole body bone scan did not reveal skeletal metastasis.
Transrectal ultrasound guided biopsy of prostate revealed adenocarcinoma of prostate. Sixty minutes after intravenous injection of 370 MBq of 68 Ga-PSMA, whole body PET/CT images were acquired and (Fig. 1) revealed a tracer avid (SUVmax 10.3) nodular lesion with specks of calcification in enlarged prostate. However, no other tracer avid pelvic lymph nodes or skeletal lesions were
Fig. 1. Maximum intensity projection (MIP) image (Fig. 1A) reveals abnormal tracer avidity in the pelvis. Corresponding transaxial PET/CECT and CECT images (Fig. 1B and C) show tracer avid (SUVmax 10.3) nodular lesion with specks of calcification in the enlarged prostate. However, no other 68 Ga-PSMA avid pelvic lymph nodes or skeletal lesions is noted.
∗ Corresponding author. E-mail address: [email protected] (B.R. Mittal). http://dx.doi.org/10.1016/j.remn.2016.10.005 ˜ S.L.U. 2253-654X/© 2016 Published by Elsevier Espana,
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T.K. Jain et al. / Rev Esp Med Nucl Imagen Mol. 2017;36(2):133–134
Fig. 2. Transaxial and coronal CECT (Fig. 2A and D), 68 Ga-PSMA PET (Fig. 2B and E) and 18 F-FDG PET (Fig. 2C and F) images. They show a low grade PSMA avid (SUVmax 1.9) and non FDG avid well defined homogenously enhancing dural based lesion (∼1.7 cm × 2.6 cm) in the left frontal cortex.
noted. Additional CECT and 68 Ga-PSMA PET images (Fig. 2) of head and neck region showed a low grade PSMA avid (SUVmax 1.9) well defined homogenously enhancing dural based lesion (∼1.7 cm × 2.6 cm) in the left frontal cortex. To differentiate from metastasis regional 18 F-FDG PET/CT was performed, which did not show FDG avidity (Fig 2C and F). So this lesion was reported as meningioma and patient underwent for radical prostatectomy. Two month after the surgery, serum PSA level was 0.6 ng/ml (0–4 ng/ml) and patient underwent gamma knife surgery for brain lesion. Prostate-specific membrane antigen (PSMA) is a transmembranic protein which is significantly increased has in prostate cancer cells but very low levels in normal prostate. PSMA is also robustly expressed in tumor vascular endothelium and has low levels in kidney, proximal small intestine, lacrimal, salivary glands, liver and spleen.1 Normal brain parenchyma expresses very low levels of PSMA in a heterogeneous pattern.2 Meningiomas are nonglial primary brain tumors and arise from the arachnoidal cap cells of the meninges, attached to the inner layer of the dura mater. In 18 F-FDG PET/CT most of Meningiomas are non tracer avid which was supplementary to confirm CT/MRI findings.3 In our case meningioma shows low grade tracer avidity in 68 Ga-PSMA PET/CECT
which is possibly due to low grade PSMA expression by the tumor component or it may be blood pool effect. Funding There is no financial disclosure. Conflict of interest None declared. References 1. Reske SN, Winter G, Baur B, Machulla HJ, Kull T. Comment on Afshar-Oromieh et al.: PET imaging with a [68 Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:969–70. 2. Li T, Bourgeois JP, Celli S, Glacial F, Le Sourd AM, Mecheri S, et al. Cell-penetrating anti-GFAP VHH and corresponding fluorescent fusion protein VHH-GFP spontaneously cross the blood–brain barrier and specifically recognize astrocytes: application to brain imaging. FASEB J. 2012;26:3969–79. 3. Valotassiou V, Leondi A, Angelidis G, Psimadas D, Georgoulias P. SPECT and PET imaging of meningiomas. Sci World J. 2012;2012:412580, http://dx.doi.org/ 10.1100/2012/412580.
Interesting image
Incidental detection of tracer avidity in meningioma in 68 Ga-PSMA PET/CT during initial staging for prostate cancer Detección incidental de avidez de trazador en meningioma en 68 Ga-PSMA PET/TC durante la estradificación inicial de un cáncer de próstata T.K. Jain a , A.G.S. Jois a , S. Kumar V a , S.K. Singh b , R. Kumar a , B.R. Mittal a,∗ a b
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, India Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
A 60-year-old male patient presented with lower urinary tract symptoms since five months. Per-rectal examination revealed enlarged prostate. Serum prostate specific antigen (PSA) level was 117 ng/ml (0–4 ng/ml) and pelvic contrast enhanced CT (CECT) revealed heterogeneous enlargement of prostate. 99m TcMDP whole body bone scan did not reveal skeletal metastasis.
Transrectal ultrasound guided biopsy of prostate revealed adenocarcinoma of prostate. Sixty minutes after intravenous injection of 370 MBq of 68 Ga-PSMA, whole body PET/CT images were acquired and (Fig. 1) revealed a tracer avid (SUVmax 10.3) nodular lesion with specks of calcification in enlarged prostate. However, no other tracer avid pelvic lymph nodes or skeletal lesions were
Fig. 1. Maximum intensity projection (MIP) image (Fig. 1A) reveals abnormal tracer avidity in the pelvis. Corresponding transaxial PET/CECT and CECT images (Fig. 1B and C) show tracer avid (SUVmax 10.3) nodular lesion with specks of calcification in the enlarged prostate. However, no other 68 Ga-PSMA avid pelvic lymph nodes or skeletal lesions is noted.
∗ Corresponding author. E-mail address: [email protected] (B.R. Mittal). http://dx.doi.org/10.1016/j.remn.2016.10.005 ˜ S.L.U. 2253-654X/© 2016 Published by Elsevier Espana,
134
T.K. Jain et al. / Rev Esp Med Nucl Imagen Mol. 2017;36(2):133–134
Fig. 2. Transaxial and coronal CECT (Fig. 2A and D), 68 Ga-PSMA PET (Fig. 2B and E) and 18 F-FDG PET (Fig. 2C and F) images. They show a low grade PSMA avid (SUVmax 1.9) and non FDG avid well defined homogenously enhancing dural based lesion (∼1.7 cm × 2.6 cm) in the left frontal cortex.
noted. Additional CECT and 68 Ga-PSMA PET images (Fig. 2) of head and neck region showed a low grade PSMA avid (SUVmax 1.9) well defined homogenously enhancing dural based lesion (∼1.7 cm × 2.6 cm) in the left frontal cortex. To differentiate from metastasis regional 18 F-FDG PET/CT was performed, which did not show FDG avidity (Fig 2C and F). So this lesion was reported as meningioma and patient underwent for radical prostatectomy. Two month after the surgery, serum PSA level was 0.6 ng/ml (0–4 ng/ml) and patient underwent gamma knife surgery for brain lesion. Prostate-specific membrane antigen (PSMA) is a transmembranic protein which is significantly increased has in prostate cancer cells but very low levels in normal prostate. PSMA is also robustly expressed in tumor vascular endothelium and has low levels in kidney, proximal small intestine, lacrimal, salivary glands, liver and spleen.1 Normal brain parenchyma expresses very low levels of PSMA in a heterogeneous pattern.2 Meningiomas are nonglial primary brain tumors and arise from the arachnoidal cap cells of the meninges, attached to the inner layer of the dura mater. In 18 F-FDG PET/CT most of Meningiomas are non tracer avid which was supplementary to confirm CT/MRI findings.3 In our case meningioma shows low grade tracer avidity in 68 Ga-PSMA PET/CECT
which is possibly due to low grade PSMA expression by the tumor component or it may be blood pool effect. Funding There is no financial disclosure. Conflict of interest None declared. References 1. Reske SN, Winter G, Baur B, Machulla HJ, Kull T. Comment on Afshar-Oromieh et al.: PET imaging with a [68 Ga]gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions. Eur J Nucl Med Mol Imaging. 2013;40:969–70. 2. Li T, Bourgeois JP, Celli S, Glacial F, Le Sourd AM, Mecheri S, et al. Cell-penetrating anti-GFAP VHH and corresponding fluorescent fusion protein VHH-GFP spontaneously cross the blood–brain barrier and specifically recognize astrocytes: application to brain imaging. FASEB J. 2012;26:3969–79. 3. Valotassiou V, Leondi A, Angelidis G, Psimadas D, Georgoulias P. SPECT and PET imaging of meningiomas. Sci World J. 2012;2012:412580, http://dx.doi.org/ 10.1100/2012/412580.