{
  "abstract": "Background\n\nThe PROMISE framework standardizes PSMA PET interpretation using reference organs, particularly the liver. For hepatobiliary-excreted tracers (e.g., ¹⁸F-PSMA-1007), the spleen was proposed as an alternative reference, though without quantitative validation. We evaluated PSMA-ligand uptake patterns among ¹⁸F-PSMA-1007, ⁶⁸Ga-PSMA-11, and ¹⁸F-DCFPyL to assess the validity of spleen-based referencing and develop a simple approach that may harmonize ¹⁸F-PSMA-1007 liver uptake with that of renally-excreted tracers.Results\n\n331 consecutive PSMA PET-CT studies (n = 118/95/118 for ⁶⁸Ga-PSMA-11/¹⁸F-PSMA-1007/¹⁸F-DCFPyL) were analyzed: SUVs were retrospectively measured in all studies in reference tissues (blood pool, liver, parotid), with SUVspleen also recorded for ¹⁸F-PSMA-1007. SUVliver differed markedly across tracers: ¹⁸F-PSMA-1007 (13.95 ± 4.71) > ⁶⁸Ga-PSMA-11 (7.45 ± 4.59) ≈ ¹⁸F-DCFPyL (8.11 ± 1.78), p < 0.01. The elevated ¹⁸F-PSMA-1007 liver uptake expanded the PROMISE score-1 range (SUV range between SUVblood pool and SUVliver) and compressed that of score-2 (SUV range between SUVliver and SUVparotid). SUVspleen in this group (12.24 ± 5.67) showed only moderate correlation with SUVliver (r = 0.43) and exceeded SUVliver in 29% of cases, questioning the utility of spleen uptake as a consistent alternative to liver uptake-based cutoff. Linear correction using the inverse ratio of mean SUVliver (¹⁸F-PSMA-1007 versus other tracers; factor = 0.56, 95% CI 0.51-0.61) yielded SUVliver-corrected of 7.8 ± 2.63 in the ¹⁸F-PSMA-1007 group. Applying SUVspleen as a PSMA score 1-2 cutoff failed to resolve score distribution imbalance, upstaging only 11.8% of score-1 lesions to score-2. By contrast, the use of SUVliver-corrected (SUVliver × 0.56) as this cutoff harmonized the score distribution in the ¹⁸F-PSMA-1007 cohort relative to ⁶⁸Ga-PSMA-11 and ¹⁸F-DCFPyL, leading to reclassification of 38.2% of score-1 lesions as score-2.Conclusion\n\nIn PET with ¹⁸F-PSMA-1007, PROMISE scoring based on unadjusted liver or spleen uptake systematically underestimates lesion scores. The simple linear correction approach proposed here offers a research avenue for enhancing the consistency of PSMA scoring for improved interpretive standardization. This study contains data obtained from a prospective Registry Trial: ClinicalTrials.gov, NCT03718260, registered October 24, 2018.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petah Tikva, Israel.",
    "Department of Radiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.",
    "Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.",
    "University Medical Imaging Toronto; Joint Department of Medical Imaging: University Health Network, Sinai Health Systems, Women's College Hospital & Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.",
    "Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petah Tikva, Israel. cohendandan@gmail.com."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
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        0,
        1
      ],
      "name": "Reut Anconina"
    },
    {
      "affs": [
        0
      ],
      "name": "Miriam Priss"
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    {
      "affs": [
        1
      ],
      "name": "Esther Landau"
    },
    {
      "affs": [
        0
      ],
      "name": "Moshe Sason"
    },
    {
      "affs": [
        0
      ],
      "name": "Arnon Schwartz"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Eli Atar"
    },
    {
      "affs": [
        1
      ],
      "name": "Chen Abitbol"
    },
    {
      "affs": [
        3
      ],
      "name": "Ur Metser",
      "orcid": "0000-0003-3726-8994"
    },
    {
      "affs": [
        0,
        2
      ],
      "name": "Hanna Bernstine"
    },
    {
      "affs": [
        4
      ],
      "name": "Dan Cohen",
      "orcid": "0000-0001-8804-4806"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/2wyn0bssgv4t8.bib",
  "cited_by": 0,
  "doi": "10.1186/s13550-026-01499-5",
  "fulltext_url": "https://europepmc.org/articles/PMC13683290",
  "id": "2wyn0bssgv4t8",
  "issns": [
    "2191-219X"
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  "landing_url": "https://europepmc.org/article/MED/42902110",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
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      "lcc",
      "R895-920"
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      "2741|Medical Imaging Techniques and Applications"
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  "pdf_url": "https://europepmc.org/articles/PMC13683290?pdf=render",
  "pmcid": "PMC13683290",
  "pmid": "42902110",
  "published": "2026-08-01",
  "publisher": "SpringerOpen",
  "ris": "https://research.draconitic.com/paper/2wyn0bssgv4t8.ris",
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  "subjects": [
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  "title": "Toward harmonized PROMISE PSMA scoring: a simple approach for correcting ¹⁸F-PSMA-1007 liver uptake based on ⁶⁸Ga-PSMA-11 and ¹⁸F-DCFPyL reference values.",
  "title_text": "Toward harmonized PROMISE PSMA scoring: a simple approach for correcting ¹⁸F-PSMA-1007 liver uptake based on ⁶⁸Ga-PSMA-11 and ¹⁸F-DCFPyL reference values.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T13:46:23Z",
  "url": "https://research.draconitic.com/paper/2wyn0bssgv4t8",
  "venue": "EJNMMI research",
  "versions": []
}