Can Ga-PSMA-11 PET/CT renal uptake parameters predict renal function impairment?

[OBJECTIVE] The aim is to investigate the correlation between renal maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), molecular kidney volume (MKV), and total kidney uptake (TKU), which are indicators of the PSMA kidney uptake pattern in Ga-PSMA-11 PET/CT imaging and kidney function tests. We secondarily aim to investigate how accurately renal parameters obtained from Ga-PSMA-11 PET/CT can provide information about the patient's kidney functions.

[METHODS] The study included 196 patients with prostate cancer who underwent Ga-PSMA-11 PET/CT imaging for staging purposes. Semiquantitative analyses were performed on the kidneys in the PET/CT images, and renal SUVmax, SUVmean, MKV, TKU values, as well as anatomical kidney volume (CT-KV) from CT imaging, were calculated. The patients' concurrent laboratory results, including eGFR, BUN, and creatinine levels, were recorded. Statistical analyses were performed using the SPSS 22 software. The Spearman test was used to determine the correlation between the parameters. The ANOVA test was used for intergroup comparisons, and the Tamhane test was used for post-hoc analyses.

[RESULTS] When comparing eGFR, BUN, and creatinine values with PET/CT renal parameters, a significant correlation was found between eGFR and MKV (r = 0.397), TKU (r = 0.271), and CT-KV (r = 0.216). Similar correlations were also observed for BUN and creatinine. When patients were grouped based on eGFR values, Group 1 (eGFR > 90; normal) included 75 patients, Group 2 (eGFR: 89-60; mild reduction) included 98 patients, and Group 3 (eGFR: 59-30; moderate reduction) included 21 patients. Significant differences were observed between the groups in terms of TKU, MKV, and CT-KV. In post-hoc analyses, the most significant parameter was MKV.

[CONCLUSION] Ga-PSMA-11 PET/CT-derived renal parameters, particularly the molecular kidney volume (MKV), exhibit a significant positive correlation with renal function and demonstrate a significant decrease in patients with renal dysfunction compared to those with normal renal function.