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PSMA-expressing, fluciclovine-negative vertebral hemangioma
Azadeh Eslambolchi1, Amin Haghighat Jahromi2
1Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 South Kingshighway Blvd, Campus Box 8223, St. Louis, MO, 63110, USA.
EJNMMI Research
|May 9, 2025
Summary
False-positive Prostate-Specific Membrane Antigen (PSMA) PET-CT scans can misdiagnose prostate cancer. Fluciclovine PET-CT helps differentiate benign vertebral hemangiomas from metastatic cancer, improving diagnostic accuracy.
Area of Science:
- Oncology
- Radiology
- Nuclear Medicine
Background:
- Prostate-Specific Membrane Antigen Positron Emission Tomography-Computed Tomography (PSMA PET-CT) is crucial for prostate cancer staging.
- False-positive findings, such as vertebral hemangiomas, can lead to diagnostic ambiguity and unnecessary procedures.
- Accurate differentiation between benign lesions and metastatic disease is essential for appropriate patient management.
Purpose of the Study:
- To present a case illustrating the diagnostic challenge posed by a PSMA-expressing vertebral hemangioma in a prostate cancer patient.
- To highlight the utility of fluciclovine PET-CT in resolving such diagnostic ambiguities.
- To emphasize the importance of complementary imaging modalities in accurate cancer staging.
Main Methods:
- Case presentation of a 68-year-old male with prostate cancer.
- Utilized both PSMA PET-CT and fluciclovine PET-CT for imaging evaluation.
- Analyzed the imaging characteristics of a vertebral lesion with differential tracer uptake.
Main Results:
- The vertebral hemangioma demonstrated PSMA expression but was negative on fluciclovine PET-CT.
- This pattern distinguished the benign lesion from prostate cancer metastases.
- PSMA PET-CT findings were initially inconclusive, necessitating further investigation.
Conclusions:
- Fluciclovine PET-CT is valuable in differentiating benign vertebral hemangiomas from prostate cancer metastases.
- This complementary imaging approach enhances diagnostic accuracy in cases with equivocal PSMA PET-CT findings.
- Accurate staging of prostate cancer is improved by utilizing multiple PET tracers when necessary.
