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Purpose <p>Prostate-specific membrane antigen (PSMA) radiotracers have recently been used in brain tumor detection and characterization, demonstrating promising results. This study aimed to evaluate the efficacy of <sup>99m</sup>Tc-labeled PSMA radiotracer as an alternative to positron emitter tomography (PET) radiotracers in the initial preoperative differentiation of suspected glioma lesions, emphasizing its cost-effectiveness and accessibility.</p> Method <p>In this preliminary and prospective study, patients scheduled for elective surgery of an intra-parenchymal brain lesion were referred for brain [<sup>99m</sup>Tc]Tc-HYNIC-PSMA-11 single-photon emission computed tomography (SPECT)/CT. The presence of any degree of increased PSMA uptake in the intracranial lesion on the visual assessment of the SPECT/CT study was considered a positive result for high-grade glioma (HGG) and compared with the histopathologic results. The degree of PSMA uptake was also evaluated semi-quantitatively as tumor-to-background ratio (TBR) and tumor-to-parotid ratio (TPR).</p> Results <p>Thirty patients with a mean age of 48 years were enrolled. Sixteen patients were confirmed as HGG; all except one demonstrated PSMA uptake. Four metastatic lesions displayed various levels of PSMA uptake. The other 10 lesions consisted of 8 low-grade glioma (LGG) and 2 fungal abscesses with no PSMA uptake in all 8 LGG and mild PSMA uptake in abscesses. Considering only the gliomas, the specificity, sensitivity, negative predictive value, and positive predictive value of [<sup>99m</sup>Tc]Tc-HYNIC-PSMA-11SPECT/CT for the grading of glioma lesions as HGG or LGG on visual assessment were 100%, 93.75%, 88.8%, and 100%. While TPR was significantly higher in GBM patients compared to high-grade diffuse astrocytoma, the TBR revealed no significant difference.</p> Conclusion <p>[<sup>99m</sup>Tc]Tc-HYNIC-PSMA-11 SPECT/CT can serve as a promising tool in differentiating of LGG and HGG during the preoperative evaluation of intracranial lesions.</p>

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Pre-operative differentiation of glioma grades using [99mTc]Tc-HYNIC-PSMA-11 SPECT/CT: a preliminary study

  • 期刊论文

  • 发表日期：

    2025年1月5日

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  • Tahereh Ghaedian,
  • Shabnam Shariat,
  • Hamid Aghaei,
  • Zahra Shabani,
  • Amirreza Dehghanian,
  • Arash Saffarian,
  • Abbas Rakhsha

摘要

Purpose

Prostate-specific membrane antigen (PSMA) radiotracers have recently been used in brain tumor detection and characterization, demonstrating promising results. This study aimed to evaluate the efficacy of 99mTc-labeled PSMA radiotracer as an alternative to positron emitter tomography (PET) radiotracers in the initial preoperative differentiation of suspected glioma lesions, emphasizing its cost-effectiveness and accessibility.

Method

In this preliminary and prospective study, patients scheduled for elective surgery of an intra-parenchymal brain lesion were referred for brain [99mTc]Tc-HYNIC-PSMA-11 single-photon emission computed tomography (SPECT)/CT. The presence of any degree of increased PSMA uptake in the intracranial lesion on the visual assessment of the SPECT/CT study was considered a positive result for high-grade glioma (HGG) and compared with the histopathologic results. The degree of PSMA uptake was also evaluated semi-quantitatively as tumor-to-background ratio (TBR) and tumor-to-parotid ratio (TPR).

Results

Thirty patients with a mean age of 48 years were enrolled. Sixteen patients were confirmed as HGG; all except one demonstrated PSMA uptake. Four metastatic lesions displayed various levels of PSMA uptake. The other 10 lesions consisted of 8 low-grade glioma (LGG) and 2 fungal abscesses with no PSMA uptake in all 8 LGG and mild PSMA uptake in abscesses. Considering only the gliomas, the specificity, sensitivity, negative predictive value, and positive predictive value of [99mTc]Tc-HYNIC-PSMA-11SPECT/CT for the grading of glioma lesions as HGG or LGG on visual assessment were 100%, 93.75%, 88.8%, and 100%. While TPR was significantly higher in GBM patients compared to high-grade diffuse astrocytoma, the TBR revealed no significant difference.

Conclusion

[99mTc]Tc-HYNIC-PSMA-11 SPECT/CT can serve as a promising tool in differentiating of LGG and HGG during the preoperative evaluation of intracranial lesions.