Diagnostic Performance of PSMA PET/MRI in Characterizing LI-RADS 3 Observations in Patients with Cirrhosis

作者：Onofrio A. Catalano, Irun Bhan, Luigi Asmundo, William Robert Bradley, Mattia Fonderico, M. Lisa Zhang, Amirkasra Mojtahed, Mark A. Anderson, Alexander Herold, Azadeh Hajati, Valeria Peña-Trujillo, Peter Caravan, Samantha G. Harrington, Shadi A. Esfahani, Umar Mahmood, Nahel Elias, Elizabeth Paige Walsh, Daniel S. Pratt, Abigail Scherrer, Haley Ellis, Emily D. Bethea, Claude Sirlin, Avinash Ramesh Kambadakone, David P. Ryan, Kelsey S. Lau-Min · 发表于：Journal of Nuclear Medicine · 年份：2025 · DOI：10.2967/jnumed.125.271228 · 被引用次数：1 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Prostate Cancer Treatment and Research、Cancer Research and Treatment

Liver Imaging Reporting and Data System (LI-RADS) category 3 (LR-3) observations remain indeterminate and often result in repeated follow-up or biopsy. Prostate-specific membrane antigen (PSMA) is overexpressed in hepatocellular carcinoma (HCC) neovasculature and may serve as a useful imaging biomarker. This study aimed to evaluate whether [ 68 Ga]Ga-PSMA-11 PET/MRI improved characterization of LR-3 observations in patients with cirrhosis compared with MRI alone. Methods: In this prospective study, conducted between March 2022 and June 2024, 19 patients with cirrhosis and 54 LR-3 observations identified on prior MRI underwent [ 68 Ga]Ga-PSMA-11 PET/MRI. An observation was classified as HCC if it demonstrated focal 68 Ga-PSMA uptake greater than background liver combined with at least 1 LI-RADS major or ancillary feature. The reference standard was histopathology or a follow-up MRI within 12 mo. Diagnostic metrics were calculated. Univariable logistic regression and decision tree analysis were performed to identify imaging predictors of malignancy. Results: Of the 54 LR-3 observations, 13 (24%) were confirmed as HCC and 41 (76%) as benign. [ 68 Ga]Ga-PSMA-11 PET/MRI correctly identified 12 of 13 HCCs (sensitivity, 92%; 95% CI, 66.7–99.6) and 39 of 41 benign observations (specificity, 95%; 95% CI, 81.9–99.3). Overall diagnostic accuracy was 94%, with a positive predictive value of 86% and negative predictive value of 97%. Diagnostic performance was significantly better tha...