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@ARTICLE{Vinsensia:131624,
      author       = {M. Vinsensia and P. L. Chyoke and B. Hadaschik and T.
                      Holland-Letz$^*$ and J. Moltz and K. Kopka$^*$ and I.
                      Rauscher and W. Mier and M. Schwaiger and U. Haberkorn$^*$
                      and T. Mauer and C. Kratochwil and M. Eiber and F.
                      Giesel$^*$},
      title        = {68{G}a-{PSMA} {PET}/{CT} and {V}olumetric {M}orphology of
                      {PET}-{P}ositive {L}ymph {N}odes {S}tratified by {T}umor
                      {D}ifferentiation of {P}rostate {C}ancer.},
      journal      = {Journal of nuclear medicine},
      volume       = {58},
      number       = {12},
      issn         = {2159-662X},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2017-06256},
      pages        = {1949 - 1955},
      year         = {2017},
      abstract     = {68Ga-prostate-specific membrane antigen (PSMA) PET/CT is a
                      new method to detect early nodal metastases in patients with
                      biochemical relapse of prostate cancer. In this
                      retrospective investigation, the dimensions, volume,
                      localization, and SUVmax of nodes identified by 68Ga-PSMA
                      were correlated to their Gleason score (GS) at diagnosis.
                      Methods: All PET/CT images were acquired 60 ± 10 min after
                      intravenous injection of 68Ga-PSMA (mean dose, 176 MBq). In
                      147 prostate cancer patients (mean age, 68 y; range, 44-87
                      y) with prostate-specific antigen relapse (mean
                      prostate-specific antigen level, 5 ng/mL; range, 0.25-294
                      ng/mL), 362 68Ga-PSMA PET-positive lymph nodes (LNs) were
                      identified. These patients were classified on the basis of
                      their histopathology at primary diagnosis into either low-
                      (GS ≤ 6, well differentiated), intermediate- (GS = 7,
                      moderately differentiated), or high-GS cohorts (GS ≥ 8,
                      poorly differentiated prostate cancer). Using semiautomated
                      LN segmentation software (Fraunhofer MEVIS), we measured
                      node volume and short-axis dimensions (SADs) and long-axis
                      dimensions based on CT and compared with the SUVmax Nodes
                      demonstrating uptake of 68Ga-PSMA with an SUVmax of 2.0 or
                      more were considered PSMA-positive, and nodes with an SAD of
                      8 mm or more were considered positive by morphologic
                      criteria. Results: Mean SUVmax was 13.5 $(95\%$ confidence
                      interval [CI], 10.9-16.1), 12.4 $(95\%$ CI, 9.9-14.9), and
                      17.8 $(95\%$ CI, 15.4-20.3) within the low-, intermediate-,
                      and high-GS groups, respectively. The morphologic assessment
                      of the 68Ga-PSMA-positive LN demonstrated that the low-GS
                      cohort presented with smaller 68Ga-PSMA-positive LNs (mean
                      SAD, 7.7 mm; n = 113), followed by intermediate- (mean SAD,
                      9.4 mm; n = 122) and high-GS cohorts (mean SAD, 9.5 mm; n =
                      127). On the basis of the CT morphology criteria, only
                      $34\%$ of low-GS patients, $56\%$ of intermediate-GS
                      patients, and $53\%$ of high-GS patients were considered CT
                      positive. Overall, 68Ga-PSMA imaging led to a
                      reclassification of stage in 90 patients $(61\%)$ from cN0
                      to cN1 over CT. Conclusion:68Ga-PSMA PET is a promising
                      modality in biochemical recurrent prostate cancer patients
                      for N staging. Conventional imaging underestimates LN
                      involvement compared with PSMA molecular staging score in
                      each GS cohort. The sensitivity of 68Ga-PSMA PET/CT enables
                      earlier detection of subcentimeter LN metastases in the
                      biochemical recurrence setting.},
      keywords     = {(68Ga)Glu-urea-Lys(Ahx)-HBED-CC (NLM Chemicals) / Antigens,
                      Surface (NLM Chemicals) / Organometallic Compounds (NLM
                      Chemicals) / Radiopharmaceuticals (NLM Chemicals) /
                      Glutamate Carboxypeptidase II (NLM Chemicals) / glutamate
                      carboxypeptidase II, human (NLM Chemicals)},
      cin          = {C060 / E030 / E060},
      ddc          = {610},
      cid          = {I:(DE-He78)C060-20160331 / I:(DE-He78)E030-20160331 /
                      I:(DE-He78)E060-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:28637799},
      doi          = {10.2967/jnumed.116.185033},
      url          = {https://inrepo02.dkfz.de/record/131624},
}