To determine whether concurrent contrast-enhanced diagnostic CT (DxCT) confers added diagnostic certainty compared to PSMA-PET/CT alone.
This retrospective multi-reader study analyzed imaging comprising combined F-18-piflufolastat PSMA-PET/CT with diagnostic chest/abdominopelvic CT from prostate cancer patients within the first 6 months of FDA-approval of the PET agent. Six nuclear radiology readers were randomly presented with PSMA-PET/CT studies with or without DxCT and asked to report their diagnostic certainty for PSMA-avid lesions found on PET. Subsequently, readers re-reviewed the same study after an interlude (with the CT if not previously presented and vice-versa) to determine if DxCT altered their diagnostic assessment. Inter-rater concordance was assessed on a subset of images read by all readers. Diagnostic certainties for PSMA-PET/CT with and without DxCT were compared, and the variables for which DxCT may add value were examined.
Good inter-rater concordance across readers was noted for both PET/CT (Finn's coefficient of reliability for overall scan certainty: 0.85,p < 0.01) and combined DxCT-PET/CT (0.59,p < 0.01). Overall certainty and concordance between PET/CT and combined DxCT-PET/CT datasets were similar (overall scan certainty: 92% ± 16 vs. 92% ± 17,p = 0.43), with no significant advantage for adding DxCT across different anatomic locations or clinical parameters. A slight predilection for combined DxCT-PET/CT was noted when interpreting images acquired for the initial staging of prostate cancer (89% ± 16 vs. 93% ± 17,p = 0.08).
Good inter-reader concordance can be achieved across different training levels with PSMA-PET/CT. Furthermore, using DxCT concurrent with PSMA-PET/CT does not significantly improve diagnostic certainty for most indications but may be useful for initial staging.
Academic radiology. 2024 Aug 14 [Epub ahead of print]
Kelly Trinh, David Z Chow, Hyesun Park, Ukasha Habib, Lily Offit, Elisa Franquet, Renata R Almeida, Yingbing Wang, Nuno Borges, Faisal Jamal, Heather A Jacene, Pedram Heidari, Thomas S C Ng
Texas Tech University Health Sciences Center, School of Medicine, Lubbock, TX 79430; Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: ., Department of Radiology, Lahey Clinic, Burlington, MA 01803. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: ., Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01655. Electronic address: ., Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, University of California, San Francisco, San Francisco, CA 94143. Electronic address: ., Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: ., Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: ., Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115; Joint Program in Nuclear Medicine, Harvard Medical School, Boston, MA 02115. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: ., Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114; Joint Program in Nuclear Medicine, Harvard Medical School, Boston, MA 02115; Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: .