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.
5 affiliations
- 1Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petah Tikva, Israel.
- 2Department of Radiology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
- 3Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
- 4University 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.
- 5Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, 39 Jabotinsky Street, Petah Tikva, Israel. [email protected].
Abstract
Background
The 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
331 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
In 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.
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BibTeX
@article{anconina2026toward,
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.}},
author = {Reut Anconina and Miriam Priss and Esther Landau and Moshe Sason and Arnon Schwartz and Eli Atar and Chen Abitbol and Ur Metser and Hanna Bernstine and Dan Cohen},
journal = {EJNMMI research},
year = {2026},
month = aug,
doi = {10.1186/s13550-026-01499-5},
url = {https://europepmc.org/article/MED/42902110},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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.
AU - Reut Anconina
AU - Miriam Priss
AU - Esther Landau
AU - Moshe Sason
AU - Arnon Schwartz
AU - Eli Atar
AU - Chen Abitbol
AU - Ur Metser
AU - Hanna Bernstine
AU - Dan Cohen
PY - 2026
DA - 2026/08/01
JO - EJNMMI research
DO - 10.1186/s13550-026-01499-5
UR - https://europepmc.org/article/MED/42902110
AB - Background The 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 331 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 In 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.
SN - 2191-219X
ER -