Evaluating the Added Value of Concurrent Contrast-enhanced Diagnostic CT for PSMA-PET/CT Interpretation.
Publication/Presentation Date
1-1-2025
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.
Volume
32
Issue
1
First Page
275
Last Page
286
ISSN
1878-4046
Published In/Presented At
Trinh, K., Chow, D. Z., Park, H., Habib, U., Offit, L., Franquet, E., Almeida, R. R., Wang, Y., Borges, N., Jamal, F., Jacene, H. A., Heidari, P., & Ng, T. S. C. (2025). Evaluating the Added Value of Concurrent Contrast-enhanced Diagnostic CT for PSMA-PET/CT Interpretation. Academic radiology, 32(1), 275–286. https://doi.org/10.1016/j.acra.2024.08.008
Disciplines
Medicine and Health Sciences
PubMedID
39147641
Department(s)
Fellows and Residents
Document Type
Article
