Evaluating the Added Value of Concurrent Contrast-enhanced Diagnostic CT for PSMA-PET/CT Interpretation

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

doi:10.1016/j.acra.2024.08.008

Evaluating the Added Value of Concurrent Contrast-enhanced Diagnostic CT for PSMA-PET/CT Interpretation

Acad Radiol. 2025 Jan;32(1):275-286. doi: 10.1016/j.acra.2024.08.008. Epub 2024 Aug 14.

Authors

Kelly Trinh¹, David Z Chow², Hyesun Park³, Ukasha Habib⁴, Lily Offit⁵, Elisa Franquet⁶, Renata R Almeida⁷, Yingbing Wang⁸, Nuno Borges⁹, Faisal Jamal¹⁰, Heather A Jacene¹¹, Pedram Heidari¹², Thomas S C Ng¹³

Affiliations

¹ 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: kelly.trinh@ttuhsc.edu.
² Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: David.Chow@mgh.harvard.edu.
³ Department of Radiology, Lahey Clinic, Burlington, MA 01803. Electronic address: hyesun.park@lahey.org.
⁴ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: uhabib1@mgh.harvard.edu.
⁵ Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: lily_offit@hms.harvard.edu.
⁶ Department of Radiology, University of Massachusetts Chan Medical School, Worcester, MA 01655. Electronic address: e.franquetelia@gmail.com.
⁷ Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: RRALMEIDA@BWH.HARVARD.EDU.
⁸ 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: yingbing.wang@ucsf.edu.
⁹ Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: NBORGESRIBEIROVAZ@BWH.HARVARD.EDU.
¹⁰ Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115. Electronic address: docfaisaljamal@gmail.com.
¹¹ Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115; Joint Program in Nuclear Medicine, Harvard Medical School, Boston, MA 02115. Electronic address: hjacene@bwh.harvard.edu.
¹² Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114. Electronic address: heidari.pedram@mgh.harvard.edu.
¹³ 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: scng@mgb.org.

PMID: 39147641
PMCID: PMC12173529 (available on 2026-01-01)
DOI: 10.1016/j.acra.2024.08.008

Abstract

Rationale and objectives: To determine whether concurrent contrast-enhanced diagnostic CT (DxCT) confers added diagnostic certainty compared to PSMA-PET/CT alone.

Materials and methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Diagnostic CT; Imaging protocols; PSMA-PET/CT; Prostate cancer.

MeSH terms

Aged
Antigens, Surface
Contrast Media
Glutamate Carboxypeptidase II*
Humans
Male
Middle Aged
Positron Emission Tomography Computed Tomography* / methods
Prostatic Neoplasms* / diagnostic imaging
Radiopharmaceuticals
Reproducibility of Results
Retrospective Studies
Sensitivity and Specificity

Substances

Contrast Media
Glutamate Carboxypeptidase II
FOLH1 protein, human
Radiopharmaceuticals
Antigens, Surface

Abstract

MeSH terms

Substances

Grants and funding