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Positron emission tomography (PET) is a medical imaging technique involving radiopharmaceuticals — substances that emit short-lived radiation. Although the first PET scanner was introduced in 1961, it took 15 more years before radiopharmaceuticals were combined with the technique and revolutionized its potential.
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Positron Emission Tomography (PET) is a medical imaging technique that provides crucial insights into the body's physiological functions at a molecular level. It is an indispensable resource for diagnosing, staging, and monitoring various illnesses, notably cancer, neurological disorders, and cardiovascular conditions.
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SPECT Versus PET for [177Lu]Lu-PSMA Response Assessment Using Quantitative RECIP 1.0.

Mutaz Kassas1, Ayoub Jaafari1, Qaid Ahmed Shagera1,2

  • 1Department of Nuclear Medicine, Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.

Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
|March 12, 2026
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Summary
This summary is machine-generated.

Cycle 2 SPECT/CT offers substantial agreement with PSMA PET/CT for assessing treatment response in metastatic castration-resistant prostate cancer patients undergoing radiopharmaceutical therapy. This imaging modality provides comparable prognostic accuracy for overall survival, supporting its use for early response assessment.

Keywords:
Lu-PSMARECIPSPECT/CTprostate cancerresponse assessment

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Area of Science:

  • Nuclear Medicine
  • Oncology
  • Radiopharmaceutical Therapy

Background:

  • Prostate-specific membrane antigen (PSMA) PET/CT is crucial for monitoring radiopharmaceutical therapy (RPT) response in metastatic castration-resistant prostate cancer (mCRPC).
  • Routine PSMA PET/CT use is limited by access and cost, necessitating evaluation of alternative imaging techniques.
  • 177Lu]Lu-PSMA RPT is a standard treatment for mCRPC, requiring effective response monitoring.

Purpose of the Study:

  • To compare the response status and prognostic significance of cycle 2 177Lu]Lu-PSMA SPECT/CT versus PSMA PET/CT in mCRPC patients undergoing RPT.
  • To evaluate the diagnostic agreement and prognostic accuracy of SPECT/CT compared to PET/CT for treatment response.

Main Methods:

  • 102 mCRPC patients receiving 177Lu]Lu-PSMA RPT underwent SPECT/CT 24 hours post-therapy and PSMA PET/CT at baseline and after two cycles.
  • Visual and quantitative analyses were performed, with lesion segmentation and response classification according to RECIP 1.0.
  • Progression-free survival (PFS) and overall survival (OS) were analyzed using Cox hazard ratios and Kaplan-Meier curves.

Main Results:

  • Cycle 2 SPECT/CT showed substantial agreement (κ = 0.67) with PSMA PET/CT in identifying progressive disease, with SPECT progression always confirmed by PET.
  • Both modalities identified progressive disease associated with significantly shorter PFS and OS.
  • PSMA PET/CT demonstrated higher prognostic accuracy for PFS (C-index, 0.66 vs. 0.57), but OS prognostic accuracy was comparable (C-index, 0.63 vs. 0.58).

Conclusions:

  • Cycle 2 SPECT/CT provides substantial agreement with PSMA PET/CT for response evaluation in 177Lu]Lu-PSMA RPT for mCRPC.
  • SPECT/CT achieved comparable prognostic accuracy for overall survival, supporting its utility for early treatment response assessment.
  • These findings suggest SPECT/CT is a viable alternative for monitoring 177Lu]Lu-PSMA RPT response when PET/CT access is limited.