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@ARTICLE{Heilinger:1038069,
      author       = {Heilinger, Jan and Roth, Katrin Sabine and Weis, Henning
                      and Fink, Antonis and Weindler, Jasmin and Dietlein, Felix
                      and Krapf, Philipp and Schomäcker, Klaus and Neumaier,
                      Bernd and Dietlein, Markus and Drzezga, Alexander and Kobe,
                      Carsten},
      title        = {{D}o you know your {PSMA}-tracer? {V}ariability in the
                      biodistribution of different {PSMA} ligands and its
                      potential impact on defining {PSMA}-positivity prior to
                      {PSMA}-targeted therapy},
      journal      = {EJNMMI Research},
      volume       = {15},
      number       = {1},
      issn         = {2191-219X},
      address      = {Heidelberg},
      publisher    = {Springer},
      reportid     = {FZJ-2025-01118},
      pages        = {4},
      year         = {2025},
      abstract     = {Background In clinical practice, several
                      radiopharmaceuticals are used for PSMA-PET imaging, each
                      with distinctbiodistribution patterns. This may impact
                      treatment decisions and outcomes, as eligibility for
                      PSMA-directedradioligand therapy is usually assessed by
                      comparing tumoral uptake to normal liver uptake as a
                      reference. In thisstudy, we aimed to compare tracer uptake
                      intraindividually in various reference regions including
                      liver, parotid glandand spleen as well as the respective
                      tumor-to-background ratios (TBR) of different 18F-labeled
                      PSMA ligands to today’sstandard radiopharmaceutical
                      68Ga-PSMA-11 in a series of patients with biochemical
                      recurrence of prostate cancerwho underwent a dual PSMA-PET
                      examination as part of an individualized diagnostic
                      approach.Results Differences in background activity among
                      different PSMA-PET tracers lead to variations in
                      tumor-tobackgroundratios (TBR). In [18F]F-DCFPyL-PET, TBR
                      with the liver as the reference organ (TBRliver) was
                      comparableto [68Ga]Ga-PSMA-11-PET, while
                      [18F]F-PSMA-1007-PET and [18F]F-JK-PSMA-7-PET showed
                      significantly lower values.Using the parotid gland as the
                      reference (TBRparotidgland), [18F]F-DCFPyL-PET exhibited
                      significantly higher values,whereas [18F]F-PSMA-1007-PET and
                      [18F]F-JK-PSMA-7-PET were comparable. For the spleen
                      (TBRspleen), [18F]F-JK-PSMA-7-PET was comparable, but
                      [18F]F-DCFPyL-PET and [18F]F-PSMA-1007-PET showed
                      significantly higher and lowervalues, respectively. An
                      additional Bland-Altman analyses revealed low bias for
                      [18F]F-DCFPyL-PET in TBRparotidgland,whereas significant
                      differences in TBRliver and TBRspleen for the other tracers
                      resulted in higher bias.Conclusion Different PSMA-PET
                      tracers exhibit distinct biodistribution patterns, leading
                      to variations in tumor-tobackgroundratios (TBR) in reference
                      organs such as the liver, parotid gland, and spleen. Patient
                      selection for PSMA-directed radioligand therapy is currently
                      based on a semiquantitative approach using the liver as a
                      reference regionin [68Ga]Ga-PSMA-11-PET. Thus, the use of
                      alternative [18F]-labeled tracers may result in under- or
                      overestimation of apatient’s suitability for therapy. This
                      highlights the importance of a comprehensive understanding
                      of the differencesin tracer-specific uptake behavior for
                      accurate decisions regarding PSMA-expression levels.
                      However, as the patientcohort in this study is at earlier
                      disease stages, the generalizability of these findings to
                      later-stage patients remainsunclear and requires further
                      investigation.},
      cin          = {INM-5 / INM-2},
      ddc          = {610},
      cid          = {I:(DE-Juel1)INM-5-20090406 / I:(DE-Juel1)INM-2-20090406},
      pnm          = {5253 - Neuroimaging (POF4-525)},
      pid          = {G:(DE-HGF)POF4-5253},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {39792324},
      UT           = {WOS:001394361800001},
      doi          = {10.1186/s13550-024-01190-7},
      url          = {https://juser.fz-juelich.de/record/1038069},
}