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Objective <p>This study aimed to evaluate the diagnostic accuracy of [<sup>99m</sup>Tc]-Tc-HYNIC-PSMA-11 SPECT/CT in differentiating glioblastoma recurrence from post-treatment changes, comparing both visual and quantitative parameters with follow-up MRI as the reference standard.</p> Methods <p>In this cross-sectional study, 31 lesions with suspected glioblastoma recurrence underwent [<sup>99m</sup>Tc]-Tc-HYNIC-PSMA-11 SPECT/CT imaging. PSMA uptake was assessed visually (0: no uptake, 1: mild, 2: moderate, 3: severe) and quantitatively using the tumor-to-background ratio (TBR). Diagnostic performance was evaluated through ROC analysis, sensitivity, specificity, and area under the curve (AUC) comparisons.</p> Results <p>Among the 30 patients with 31 lesions (70% male, mean age 46 years), initial MRI identified recurrence in 38.71% (<i>n</i> = 12), no recurrence in 35.48% (<i>n</i> = 11), and was indeterminate in 25.81% (<i>n</i> = 8) of lesions. Follow-up MRI and other clinical data confirmed recurrence in 58.06% (<i>n</i> = 18) and no recurrence in 41.94% (<i>n</i> = 13). Quantitative SPECT/CT analysis revealed a mean TBR of 13.08 ± 12.09. Visual PSMA assessment demonstrated a sensitivity of 83% and specificity of 92% when considering moderate/high uptake as positive. TBR quantitative analysis showed excellent discrimination (AUC = 0.87), with an optimal threshold of 7.55 yielding 89% sensitivity and 91% specificity. Initial MRI had 100% sensitivity and 91.67% specificity when excluding indeterminate cases. For the 8 patients with indeterminate initial MRI, both visual and quantitative PSMA parameters showed 100% accuracy in predicting the final diagnosis.</p> Conclusion <p>[<sup>99m</sup>Tc]-Tc-HYNIC-PSMA-11 SPECT/CT, particularly using quantitative TBR analysis, offers a reliable alternative to MRI for detecting GBM recurrence, especially in cases where MRI findings are equivocal.</p>

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Diagnostic accuracy of [99mTc]-Tc-HYNIC-PSMA-11 SPECT/CT in differentiating tumor recurrence from post-treatment changes in glioblastoma

  • 期刊论文

  • 发表日期：

    2026年5月28日

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  • Tahereh Ghaedian,
  • Hamid Aghaei,
  • Abbas Rakhsha,
  • Mehrnaz Ghaedian,
  • Abdolmajid Alipour,
  • Shabnam Shariat,
  • Zahra Shabani,
  • Keyvan Eghbal,
  • Mohammad Jamali,
  • Abdolkarim Rahmanian,
  • Ehsan Mohammadhosseini,
  • Zahra Ashrafi,
  • Manouchehr Davlatov

摘要

Objective

This study aimed to evaluate the diagnostic accuracy of [99mTc]-Tc-HYNIC-PSMA-11 SPECT/CT in differentiating glioblastoma recurrence from post-treatment changes, comparing both visual and quantitative parameters with follow-up MRI as the reference standard.

Methods

In this cross-sectional study, 31 lesions with suspected glioblastoma recurrence underwent [99mTc]-Tc-HYNIC-PSMA-11 SPECT/CT imaging. PSMA uptake was assessed visually (0: no uptake, 1: mild, 2: moderate, 3: severe) and quantitatively using the tumor-to-background ratio (TBR). Diagnostic performance was evaluated through ROC analysis, sensitivity, specificity, and area under the curve (AUC) comparisons.

Results

Among the 30 patients with 31 lesions (70% male, mean age 46 years), initial MRI identified recurrence in 38.71% (n = 12), no recurrence in 35.48% (n = 11), and was indeterminate in 25.81% (n = 8) of lesions. Follow-up MRI and other clinical data confirmed recurrence in 58.06% (n = 18) and no recurrence in 41.94% (n = 13). Quantitative SPECT/CT analysis revealed a mean TBR of 13.08 ± 12.09. Visual PSMA assessment demonstrated a sensitivity of 83% and specificity of 92% when considering moderate/high uptake as positive. TBR quantitative analysis showed excellent discrimination (AUC = 0.87), with an optimal threshold of 7.55 yielding 89% sensitivity and 91% specificity. Initial MRI had 100% sensitivity and 91.67% specificity when excluding indeterminate cases. For the 8 patients with indeterminate initial MRI, both visual and quantitative PSMA parameters showed 100% accuracy in predicting the final diagnosis.

Conclusion

[99mTc]-Tc-HYNIC-PSMA-11 SPECT/CT, particularly using quantitative TBR analysis, offers a reliable alternative to MRI for detecting GBM recurrence, especially in cases where MRI findings are equivocal.