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Year : 2016  |  Volume : 31  |  Issue : 2  |  Page : 150-151  

Metastatic superscan in prostate carcinoma on gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography scan


Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication9-Mar-2016

Correspondence Address:
Madhavi Tripathi
Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.178330

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   Abstract 

We describe the imaging features of a metastatic superscan on gallium-68 Glu-NH-CO-NH-Lys-(Ahx)-[Ga-68(HBED-CC)], abbreviated as gallium-68-prostate-specific membrane antigen ( 68 Ga-PSMA) positron emission tomography/computed tomography (PET/CT) imaging. 68 Ga-PSMA is novel radiotracer undergoing evaluation for PET/CT imaging of prostate carcinoma. This patient had a superscan of metastases on conventional bone scintigraphy and was referred for 68 Ga-PSMA PET/CT to evaluate the feasibility of 177 Lu-PSMA therapy.

Keywords: Gallium-68-prostate-specific membrane antigen, metastasis, positron emission tomography/computed tomography, prostate carcinoma


How to cite this article:
Agarwal KK, Tripathi M, Kumar R, Ba C. Metastatic superscan in prostate carcinoma on gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography scan. Indian J Nucl Med 2016;31:150-1

How to cite this URL:
Agarwal KK, Tripathi M, Kumar R, Ba C. Metastatic superscan in prostate carcinoma on gallium-68-prostate-specific membrane antigen positron emission tomography/computed tomography scan. Indian J Nucl Med [serial online] 2016 [cited 2019 Dec 16];31:150-1. Available from: http://www.ijnm.in/text.asp?2016/31/2/150/178330

A 55-year-old case of metastatic prostatic adenocarcinoma on docetaxel chemotherapy, with rising serum prostate-specific antigen (sPSA) level, underwent bone scintigraphy. Gleason score was 9 (5 + 4), and sPSA level was 340 ng/mL. Findings on bone scintigraphy showed diffusely increased skeletal accumulation with increased bone-to-soft tissue (renal uptake) ratio suggestive of a metastatic superscan [Figure 1]a - anterior and b - posterior view]. He further underwent gallium-68-prostate-specific membrane antigen ( 68 Ga-PSMA) PET/CT to evaluate feasibility for 177 Lu-PSMA therapy. Maximum intensity projection image [Figure 2]a showed generalized increased tracer uptake in entire axial and appendicular skeleton with reduced physiological uptake in bilateral lacrimal and salivary glands, spleen, small bowel, and kidneys. Sagittal [Figure 2]b and transaxial positron emission tomography/computed tomography (PET/CT) fusion images [Figure 2]c-e showed sclerotic changes in the entire axial skeleton with increased tracer uptake. All features were suggestive of metastatic superscan on 68 Ga-PSMA PET/CT.
Figure 1: Findings on bone scintigraphy showed diffusely increased skeletal accumulation with increased bone-to-soft tissue (renal uptake) ratio suggestive of a metastatic superscan (a) anterior, (b) posterior view

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Figure 2: Maximum intensity projection image (a) showed generalized increased tracer uptake in entire axial and appendicular skeleton with reduced physiological uptake in bilateral lacrimal and salivary glands, spleen, small bowel, and kidneys. Sagittal (b) and transaxial positron emission tomography/computed tomography fusion images (c-e) showed sclerotic changes in the entire axial skeleton with increased tracer uptake. All features were suggestive of metastatic superscan on gallium-68-prostate-specific membrane antigen positron emission tomography/ computed tomography

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Superscan is a well-known phenomenon on bone scintigraphy characterized by increased bone-to-soft tissue ratio with a symmetrical increased skeletal uptake and reduced tracer uptake in nonaffected bones and soft tissue. [1] Common conditions include metastatic cancers and metabolic bone disease that give rise to this appearance on skeletal scintigraphy. [2] This phenomenon has also been described previously in the literature on 18 F-fluorodeoxyglucose PET/CT and 68 Ga-labeled [1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid]-1-NaI3-octreotide PET/CT scan where a superscan implies a high contrast between metastatic and nonmetastatic organs. [3],[4],[5],[6] In this case, there was increased tracer accumulation in entire axial and appendicular skeleton and reduced tracer uptake in the salivary and lacrimal glands, spleen, proximal small gut, and kidneys which normally show the physiological distribution of 68 Ga-PSMA. This case demonstrates the altered biodistribution pattern in a metastatic superscan of 68 Ga-PSMA PET/CT, which further predicts a poor prognosis. [7],[8]

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
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2.
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Bailly M, Besse H, Kerdraon R, Metrard G, Gauvain S. 18F-FDG PET/CT superscan in prostate cancer. Clin Nucl Med 2014;39:912-4.  Back to cited text no. 4
    
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Lin CY, Chen YW, Chang CC, Yang WC, Huang CJ, Hou MF. Bone metastasis versus bone marrow metastasis? Integration of diagnosis by (18) F-fluorodeoxyglucose positron emission/computed tomography in advanced malignancy with super bone scan: Two case reports and literature review. Kaohsiung J Med Sci 2013;29:229-33.  Back to cited text no. 5
    
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Naswa N, Karunanithi S, Soundararajan R, Das KJ, Agarwal KK, Malhotra A, et al. Metastatic neuroendocrine carcinoma presenting as a "Superscan" on 68Ga-DOTANOC somatostatin receptor PET/CT. Clin Nucl Med 2012;37:892-4.  Back to cited text no. 6
    
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Mannweiler S, Amersdorfer P, Trajanoski S, Terrett JA, King D, Mehes G. Heterogeneity of prostate-specific membrane antigen (PSMA) expression in prostate carcinoma with distant metastasis. Pathol Oncol Res 2009;15:167-72.  Back to cited text no. 7
    
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Lawal I, Vorster M, Boshomane T, Ololade K, Ebenhan T, Sathekge M. Metastatic Prostate Carcinoma Presenting as a Superscan on 68Ga-PSMA PET/CT. Clin Nucl Med 2015;40:755-6.  Back to cited text no. 8
    


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  [Figure 1], [Figure 2]



 

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