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.

Authors

Reut Anconina, Miriam Priss, Esther Landau, Moshe Sason, Arnon Schwartz, Eli Atar, Chen Abitbol, Ur Metser, Hanna Bernstine, Dan Cohen

Published in

EJNMMI research. Volume 16. Issue 1. Aug 15, 2026. Epub Aug 15, 2026.

Abstract

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.
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 SUV_spleen also recorded for ¹⁸F-PSMA-1007. SUV_liver 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 SUV_{blood pool} and SUV_liver) and compressed that of score-2 (SUV range between SUV_liver and SUV_parotid). SUV_spleen in this group (12.24 ± 5.67) showed only moderate correlation with SUV_liver (r = 0.43) and exceeded SUV_liver 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 SUV_liver (¹⁸F-PSMA-1007 versus other tracers; factor = 0.56, 95% CI 0.51-0.61) yielded SUV_{liver-corrected} of 7.8 ± 2.63 in the ¹⁸F-PSMA-1007 group. Applying SUV_spleen 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 SUV_{liver-corrected} (SUV_liver × 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.
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.

PMID:
42902110
Bibliographic data and abstract were imported from PubMed on 21 Oct 2026.

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