Uptake of 18F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies

Steven P Rowe; Curtiland Deville; Channing Paller; Steve Y Cho; Elliot K Fishman; Martin G Pomper; Ashley E Ross; Michael A Gorin

doi:10.18383/j.tom.2015.00169

Uptake of ¹⁸F-DCFPyL in Paget's Disease of Bone, an Important Potential Pitfall in Clinical Interpretation of PSMA PET Studies

Tomography. 2015 Dec;1(2):81-84. doi: 10.18383/j.tom.2015.00169.

Authors

Steven P Rowe¹, Curtiland Deville², Channing Paller³, Steve Y Cho⁴, Elliot K Fishman¹, Martin G Pomper⁵, Ashley E Ross⁶, Michael A Gorin⁶

Affiliations

¹ The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
² Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
³ The Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁴ Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
⁵ The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA; The Sidney Kimmel Comprehensive Cancer Center at the Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁶ The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.

Abstract

Prostate-specific membrane antigen (PSMA)-targeted PET imaging is an emerging technique for evaluating patients with prostate cancer (PCa) in a variety of clinical contexts. As with any new imaging modality, there are interpretive pitfalls that are beginning to be recognized. In this image report, we describe the findings in a 63-year-old male with biochemically recurrent PCa after radical prostatectomy who was imaged with ¹⁸F-DCFPyL, a small molecule inhibitor of PSMA. Diffuse radiotracer uptake was noted throughout the sacrum, corresponding to imaging findings on contrast-enhanced CT, bone scan, and pelvic MRI consistent with Paget's disease of bone. The uptake of ¹⁸F-DCFPyL in Paget's disease is most likely due to hyperemia and increased radiotracer delivery. In light of the overlap in patients affected by PCa and Paget's, it is important for nuclear medicine physicians and radiologists interpreting PSMA PET/CT scans to be aware of the potential for this diagnostic pitfall. Correlation to findings on conventional imaging such as diagnostic CT and bone scan can help confirm the diagnosis.

Keywords: DCFPyL; PET/CT; PSMA; Prostate cancer.

Abstract

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