ArticleAnnals of nuclear medicine2026
Lesion-level quantitative Lu-177 PSMA SPECT/CT SUV metrics are associated with interim treatment response in mCRPC: a PET-correlated study.
Article in Annals of nuclear medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate the correlation between standardized uptake value (SUV) parameters derived from Ga-68 PSMA PET/CT and post-therapeutic Lu-177 PSMA SPECT/CT, and to evaluate whether SPECT derived quantitative SUV metrics are associated with lesion-based interim treatment response in patients with metastatic castration resistant prostate cancer (mCRPC).
methodsFifty-five mCRPC patients who received 2–6 cycles of Lu-177 PSMA therapy and underwent both baseline Ga-68 PSMA PET/CT and 24-h post-therapy Lu-177 PSMA SPECT/CT were retrospectively analyzed. SUVmax, SUVmean, and SUVmin values were measured on PET (PSUV) and SPECT (QSUV) in up to 10 index metastatic lesions per scan and in predefined physiological regions. A patient-level aggregate metric (mean SUV across the selected metastatic lesions) was also calculated. Lesion-based response was defined by changes in PSUVmax on follow-up PET/CT and categorized as response, stable, or progressive. Correlation analyses, ROC curves, and logistic regression models were applied to examine relationships between QSUV parameters, PET derived metrics, and lesion response.
resultsA total of 915 volumes of interest (VOIs) were analyzed, with 664 being pathological and 251 physiological. QSUV parameters showed strong positive correlations with PSUV parameters (rho: 0.71, p < 0.01), particularly in lesions > 3 mL and prostate primary lesions. Responding lesions had significantly higher QSUV values compared to progressing lesions (p < 0.05). ROC analysis yielded AUC values of 0.696 for QSUVmax, 0.699 for QSUVmean, and 0.701 for QSUVmin. QSUVmax, QSUVmean, and QSUVmin were independently associated with lesion-based response in logistic regression models (p < 0.01). In the subgroup analysis excluding stable lesions, PSUV outperformed QSUV in predicting response (p < 0.01 via DeLong test). However, when stable lesions were included (Responders vs. Non-responders), ROC analysis yielded comparable AUC values for PSUV (0.710–0.716) and QSUV (0.615–0.620), with no statistically significant differences observed (p > 0.05). Furthermore, a multimodality approach combining PSUV and QSUV metrics via binary logistic regression did not provide a synergistic improvement in predictive accuracy over individual parameters (p > 0.05).
conclusionQuantitative SUV parameters from Lu-177 PSMA SPECT/CT correlate significantly with Ga-68 PSMA PET/CT and are associated with therapeutic response. While PET remains the superior modality for high-precision quantification, the comparable performance of QSUV metrics in a clinically representative setting suggests that SPECT-derived parameters can serve as a reliable and accessible tool for interim response assessment. These metrics may serve as accessible tools for interim response assessment and lesion-level prognostication in PSMA-targeted radioligand therapy.
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