PET images were analyzed using XD3 Software (Mirada Medical, Oxford, UK). PET, CT, and hybrid PET/CT imaging overlays were assessed in the axial, sagittal, and coronal planes in all 50 patients. Lesions were identified as abnormal foci of radiotracer uptake above background and in expected patterns for PCa spread [18 (link)–19 (link)]. Lesions were selected by a single reader experienced in the interpretation of PSMA-targeted PET (MSJ) and verified by a second experienced reader (SPR).
The normal biodistribution of [18F]DCFPyL, includes uptake in the lacrimal glands, parotid glands, and submandibular glands, as well as in the liver, spleen, kidneys, and bowel (predominantly proximal small bowel) [18 (link)–19 (link)]. For the lacrimal glands, major salivary glands, liver, spleen, and kidneys, volume of interests (VOIs) were manually set covering the entire organ volume using the best visual approximation of the organ edge on the PET images using previously described methodology [20 (link)]. Moreover, as described in [12 ], the entire volume of all [18F]DCFPyL-avid tumor lesions (i.e., tumor burden) was manually segmented using the same procedure. The CT images were not used as a primary guide for the segmentation of the VOIs but were available as a reference to improve VOI placement in regions of complex anatomy or high background radiotracer uptake, as necessary [20 (link)].
For normal organs, the following parameters were recorded: mean standardized uptake value corrected to lean body mass (SULmean) and mean standardized uptake value corrected to body weight (SUVmean) [17 (link), 20 (link)]. For the entire tumor burden, the following parameters were assessed: SULmean, the maximum standardized uptake value corrected to lean body mass (SULmax), SUVmean, tumor volume (TV) and the fractional tumor activity (FTA) in the VOI. The latter parameter is well-established in the literature and has also been referred to as tumor lesion (TL)-PSMA [21 (link)–22 (link)]. FTA was calculated as follows: [TV x SUVmean]. An isocontour threshold of 50% of the SUVmax were determined between the background and the maximal pixel value of the VOI.
The normal biodistribution of [18F]DCFPyL, includes uptake in the lacrimal glands, parotid glands, and submandibular glands, as well as in the liver, spleen, kidneys, and bowel (predominantly proximal small bowel) [18 (link)–19 (link)]. For the lacrimal glands, major salivary glands, liver, spleen, and kidneys, volume of interests (VOIs) were manually set covering the entire organ volume using the best visual approximation of the organ edge on the PET images using previously described methodology [20 (link)]. Moreover, as described in [12 ], the entire volume of all [18F]DCFPyL-avid tumor lesions (i.e., tumor burden) was manually segmented using the same procedure. The CT images were not used as a primary guide for the segmentation of the VOIs but were available as a reference to improve VOI placement in regions of complex anatomy or high background radiotracer uptake, as necessary [20 (link)].
For normal organs, the following parameters were recorded: mean standardized uptake value corrected to lean body mass (SULmean) and mean standardized uptake value corrected to body weight (SUVmean) [17 (link), 20 (link)]. For the entire tumor burden, the following parameters were assessed: SULmean, the maximum standardized uptake value corrected to lean body mass (SULmax), SUVmean, tumor volume (TV) and the fractional tumor activity (FTA) in the VOI. The latter parameter is well-established in the literature and has also been referred to as tumor lesion (TL)-PSMA [21 (link)–22 (link)]. FTA was calculated as follows: [TV x SUVmean]. An isocontour threshold of 50% of the SUVmax were determined between the background and the maximal pixel value of the VOI.