Thorsten Derlin, Liam Widjaja, Nina Natascha Harke, Christoph Czerner, Desiree Weiberg, Tobias L. Ross, Frank M. Bengel
{"title":"99mTc-MIP-1404 SPECT/CT伴随诊断：177Lu-PSMA治疗转移性去势抵抗性前列腺癌","authors":"Thorsten Derlin, Liam Widjaja, Nina Natascha Harke, Christoph Czerner, Desiree Weiberg, Tobias L. Ross, Frank M. Bengel","doi":"10.2967/jnumed.124.269319","DOIUrl":null,"url":null,"abstract":"<p>Our objective was to determine the feasibility, diagnostic performance, and predictive value of <sup>99m</sup>Tc-MIP-1404 SPECT in patients undergoing baseline staging and assessment of eligibility for prostate-specific membrane antigen (PSMA)–targeted radiopharmaceutical therapy (RPT) for metastatic castration-resistant prostate cancer. <strong>Methods:</strong> Data of 46 patients undergoing <sup>99m</sup>Tc-MIP-1404 planar scintigraphy and SPECT/CT for staging and assessment of eligibility for <sup>177</sup>Lu-PSMA RPT were retrospectively analyzed. Overall image quality was assessed, and images were visually analyzed for the presence and localization of pathologic uptake. Metastatic uptake was visually scored using a 3-point scale. <sup>99m</sup>Tc-MIP-1404 findings were compared with the results of posttherapeutic <sup>177</sup>Lu-PSMA scans in patients subsequently commencing RPT (<em>n</em> = 35). The predictive and prognostic significance of uptake intensity in <sup>99m</sup>Tc-MIP-1404 scans was evaluated. <strong>Results:</strong> The image quality of <sup>99m</sup>Tc-MIP-1404 scans was rated as excellent in 98% of cases. Imaging results were concordant in 206 of 210 localizations, demonstrating almost perfect agreement with <sup>177</sup>Lu-PSMA scans (κ = 0.957 [95% CI, 0.916–0.999]). Uptake intensity higher than liver uptake identified responders (<em>P</em> = 0.0115) and was associated with prolonged progression-free survival (median, 146 vs. 96 d; hazard ratio for progression, 0.3838 [95% CI, 0.1721–0.8556]; <em>P</em> = 0.0192). In multivariable analysis, <sup>99m</sup>Tc-MIP-1404 uptake higher than in liver emerged as an independent predictor of treatment response (odds ratio, 12.37 [95% CI, 1.613–203.3]; <em>P</em> = 0.0319). Nevertheless, 27% of responders demonstrated uptake no higher than that in the liver. <strong>Conclusion:</strong> <sup>99m</sup>Tc-MIP-1404 imaging is suitable for assessment of eligibility for RPT in patients with advanced metastatic castration-resistant prostate cancer. In particular, pretherapeutic uptake intensity is predictive of response to <sup>177</sup>Lu-PSMA RPT.</p>","PeriodicalId":22820,"journal":{"name":"The Journal of Nuclear Medicine","volume":"25 2 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"99mTc-MIP-1404 SPECT/CT Companion Diagnostic for 177Lu-PSMA Therapy in Metastatic Castration-Resistant Prostate Cancer\",\"authors\":\"Thorsten Derlin, Liam Widjaja, Nina Natascha Harke, Christoph Czerner, Desiree Weiberg, Tobias L. Ross, Frank M. Bengel\",\"doi\":\"10.2967/jnumed.124.269319\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p>Our objective was to determine the feasibility, diagnostic performance, and predictive value of <sup>99m</sup>Tc-MIP-1404 SPECT in patients undergoing baseline staging and assessment of eligibility for prostate-specific membrane antigen (PSMA)–targeted radiopharmaceutical therapy (RPT) for metastatic castration-resistant prostate cancer. <strong>Methods:</strong> Data of 46 patients undergoing <sup>99m</sup>Tc-MIP-1404 planar scintigraphy and SPECT/CT for staging and assessment of eligibility for <sup>177</sup>Lu-PSMA RPT were retrospectively analyzed. Overall image quality was assessed, and images were visually analyzed for the presence and localization of pathologic uptake. Metastatic uptake was visually scored using a 3-point scale. <sup>99m</sup>Tc-MIP-1404 findings were compared with the results of posttherapeutic <sup>177</sup>Lu-PSMA scans in patients subsequently commencing RPT (<em>n</em> = 35). The predictive and prognostic significance of uptake intensity in <sup>99m</sup>Tc-MIP-1404 scans was evaluated. <strong>Results:</strong> The image quality of <sup>99m</sup>Tc-MIP-1404 scans was rated as excellent in 98% of cases. Imaging results were concordant in 206 of 210 localizations, demonstrating almost perfect agreement with <sup>177</sup>Lu-PSMA scans (κ = 0.957 [95% CI, 0.916–0.999]). Uptake intensity higher than liver uptake identified responders (<em>P</em> = 0.0115) and was associated with prolonged progression-free survival (median, 146 vs. 96 d; hazard ratio for progression, 0.3838 [95% CI, 0.1721–0.8556]; <em>P</em> = 0.0192). In multivariable analysis, <sup>99m</sup>Tc-MIP-1404 uptake higher than in liver emerged as an independent predictor of treatment response (odds ratio, 12.37 [95% CI, 1.613–203.3]; <em>P</em> = 0.0319). Nevertheless, 27% of responders demonstrated uptake no higher than that in the liver. <strong>Conclusion:</strong> <sup>99m</sup>Tc-MIP-1404 imaging is suitable for assessment of eligibility for RPT in patients with advanced metastatic castration-resistant prostate cancer. In particular, pretherapeutic uptake intensity is predictive of response to <sup>177</sup>Lu-PSMA RPT.</p>\",\"PeriodicalId\":22820,\"journal\":{\"name\":\"The Journal of Nuclear Medicine\",\"volume\":\"25 2 1\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-02-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Journal of Nuclear Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.2967/jnumed.124.269319\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Journal of Nuclear Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.2967/jnumed.124.269319","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
99mTc-MIP-1404 SPECT/CT Companion Diagnostic for 177Lu-PSMA Therapy in Metastatic Castration-Resistant Prostate Cancer
Our objective was to determine the feasibility, diagnostic performance, and predictive value of 99mTc-MIP-1404 SPECT in patients undergoing baseline staging and assessment of eligibility for prostate-specific membrane antigen (PSMA)–targeted radiopharmaceutical therapy (RPT) for metastatic castration-resistant prostate cancer. Methods: Data of 46 patients undergoing 99mTc-MIP-1404 planar scintigraphy and SPECT/CT for staging and assessment of eligibility for 177Lu-PSMA RPT were retrospectively analyzed. Overall image quality was assessed, and images were visually analyzed for the presence and localization of pathologic uptake. Metastatic uptake was visually scored using a 3-point scale. 99mTc-MIP-1404 findings were compared with the results of posttherapeutic 177Lu-PSMA scans in patients subsequently commencing RPT (n = 35). The predictive and prognostic significance of uptake intensity in 99mTc-MIP-1404 scans was evaluated. Results: The image quality of 99mTc-MIP-1404 scans was rated as excellent in 98% of cases. Imaging results were concordant in 206 of 210 localizations, demonstrating almost perfect agreement with 177Lu-PSMA scans (κ = 0.957 [95% CI, 0.916–0.999]). Uptake intensity higher than liver uptake identified responders (P = 0.0115) and was associated with prolonged progression-free survival (median, 146 vs. 96 d; hazard ratio for progression, 0.3838 [95% CI, 0.1721–0.8556]; P = 0.0192). In multivariable analysis, 99mTc-MIP-1404 uptake higher than in liver emerged as an independent predictor of treatment response (odds ratio, 12.37 [95% CI, 1.613–203.3]; P = 0.0319). Nevertheless, 27% of responders demonstrated uptake no higher than that in the liver. Conclusion:99mTc-MIP-1404 imaging is suitable for assessment of eligibility for RPT in patients with advanced metastatic castration-resistant prostate cancer. In particular, pretherapeutic uptake intensity is predictive of response to 177Lu-PSMA RPT.
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