Incremental Value of 18 F-PSMA-1007 PET/CT in Detection of Metastatic Renal Cell Carcinoma to the Brain Alyaa Sadeq, KBNM,* Sharjeel Usmani, FRCP, KBNM,*† Abdulredha A. Esmail, KBNM,* Wael Fathallah, FRCR,*† Mahmoud A. Alfeeli, KBNM,* and Fahad Marafi, KBNM* Abstract: 18 F-PSMA PET/CT is an emerging standard of care in staging prostate cancer, evaluating biochemical recurrence and response to therapy. Despite the nomenclature, PSMA expression is also documented at the tumor-associated neovasculature of other malignant solid tumors including renal cell carcinoma. We report a case of 44-year-old man known to have renal cell carcinoma who underwent 18 F-PSMA and 18 F-FDG PET/CT for restaging after radical nephrectomy. A well-defined solitary cerebel- lar lesion with marked PSMA expression and equivocal FDG uptake was noted. MRI brain confirmed a matching cerebellar metastatic lesion. 18 F-PSMA expression in the metastatic RCC raises a prospective guide to futuristic theragnostic uses. Key Words: 18 F-PSMA-1007 PET/CT, PSMA, brain metastasis, renal cell carcinoma, metastatic renal cell carcinoma, 18 F-FDG PET/CT (Clin Nucl Med 2022;47: 627–628) REFERENCES 1. Pierorazio PM, Johnson MH, Patel HD, et al. Management of renal masses and localized renal cancer: systematic review and meta-analysis. J Urol. 2016;196:989–999. 2. Wyler L, Napoli CU, Ingold B, et al. Brain metastasis in renal cancer pa- tients: metastatic pattern, tumour-associated macrophages and chemokine/ chemoreceptor expression. Br J Cancer . 2014;110:686–694. 3. Dudek AZ, Raza A, Chi M, et al. Brain metastases from renal cell carcinoma in the era of tyrosine kinase inhibitors. Clin Genitourin Cancer . 2013;11: 155–160. 4. Thomas AA, Rini BI, Lane BR, et al. Response of the primary tumor to neo- adjuvant sunitinib in patients with advanced renal cell carcinoma. J Urol. 2009;181:518–523. 5. Ma H, Shen G, Liu B, et al. Diagnostic performance of 18 F-FDG PET or PET/CT in restaging renal cell carcinoma: a systematic review and meta- analysis. Nucl Med Commun. 2017;38:156–163. 6. Kaschten B, Stevenaert A, Sadzot B, et al. Preoperative evaluation of 54 gliomas by PET with fluorine-18-fluorodeoxyglucose and/or carbon-11-methionine. J Nucl Med. 1998;39:778–785. 7. Chang SS, Reuter VE, Heston WD, et al. Five different anti-prostate-specific membrane antigen (PSMA) antibodies confirm PSMA expression in tumor- associated neovasculature. Cancer Res. 1999;59:3192–3198. 8. Conway RE, Petrovic N, Li Z, et al. Prostate-specific membrane antigen reg- ulates angiogenesis by modulating integrin signal transduction. Mol Cell Biol. 2006;26:5310–5324. 9. Pozzessere C, Bassanelli M, Ceribelli A, et al. Renal cell carcinoma: the on- cologist asks, can PSMA PET/CT answer? Curr Urol Rep. 2019;20:68. 10. Choueiri TK, Motzer RJ. Systemic therapy for metastatic renal-cell carci- noma. N Engl J Med. 2017;376:354–366. Received for publication June 14, 2021; revision accepted October 22, 2021. From the *Department of Nuclear Medicine, Jaber Al Ahmed Center of Molec- ular Imaging; and †Kuwait Cancer Control Center, Kuwait City, Kuwait. Conflicts of interest and sources of funding: none declared. Correspondence to: Alyaa Sadeq, KBNM, Department of Nuclear Medicine, Jaber Al Ahmed Center of Molecular Imaging, Shuwaikh 70030, Kuwait City, Kuwait. E-mail: alyaa.kbnm@gmail.com. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0363-9762/22/4707–0627 DOI: 10.1097/RLU.0000000000004162 INTERESTING IMAGE Clinical Nuclear Medicine • Volume 47, Number 7, July 2022 www.nuclearmed.com 627 Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. Downloaded from http://journals.lww.com/nuclearmed by IJFFeEaHn1cfHPNrSC3daWj6PKnKQFhW+EMTsaf/WKf0u7 T8lHlKpTwHXzgWSaBAry8173SbIClWBq6HXChpqdKiS7faR+2kS9oBugaqNhOGx5JlMOKzBQWgX6O7JOD8 on 07/02/2023