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Lennartz and colleagues “Lymph Node Assessment in Prostate Cancer Evaluation of Iodine Quantification With Spectral Detector CT in Correlation to PSMA PET/CT​" compares spectral detector portal venous phase CT (SDCT)–derived iodine concentration (IC) of lymph nodes diagnosed as metastatic or benign in prostate-specific membrane antigen (PSMA) PET/CT in 34 patients with prostate cancer. There were16 patients with and 18 without lymph node metastases by PSMA PET/CT.

Only scan pairs with a stable nodal status indicated by constant size as well as comparable prostate-specific antigen (PSA) levels were included. One hundred benign and 96 suspected metastatic lymph nodes were annotated and correlated between SDCT and PSMA PET/CT. Iodine concentration in SDCT-derived iodine maps and SUVmax in ultra-high definition reconstructions from PSMA PET/CT were acquired based on the region of interest.

Compare with PSMA PET/CT, metastatic lymph nodes demonstrated higher IC than nonmetastatic nodes (1.9 ± 0.6 mg/mL vs 1.5 ± 0.5 mg/mL, P < 0.05), with an AUC of 0.72 and sensitivity and specificity of 81.3% and 58.5%.

The mean short axis diameter of metastatic lymph nodes was larger than that of nonmetastatic nodes (6.9 ± 3.6 mm vs 5.3 ± 1.3 mm; P < 0.05) and a size threshold of 1 cm short axis diameter resulted in a sensitivity and specificity of 12.8% and 99.0%. There was a weak positive correlation between SUVmax and IC (rs = 0.25; P < 0.001).

Spectral detector CT–derived IC was increased in lymph nodes diagnosed as metastatic in PSMA PET/CT but with considerable data overlap.

The authors concluded that the correlation between CT iodine concentration and SUVmax was weak compared to PSMA PET/CT for detection of lymph node metastases in patients with prostate.​



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