Evaluation of 9-Minute Dual-Energy Peak Time–Reduced 360° CZT Total-Body [ 177 Lu]Lu-PSMA SPECT/CT Imaging with Comparisons to [ 68 Ga]Ga-PSMA PET

Eighteen-minute 360° cadmium zinc telluride (CZT) total-body ¹⁷⁷Lu-labeled SPECT acquisitions on the single 113-keV ¹⁷⁷Lu photopeak (SP-18) have been reported to be suitable for monitoring [¹⁷⁷Lu]Lu-PSMA therapy. This study evaluated dual-energy 113- and 208-keV acquisitions with a more than 2-fold increase in acquired counts, allowing acquisition time to be reduced to 9 min (DP-9). Methods: In 20 patients with prostate cancer, 360° CZT total-body ¹⁷⁷Lu-labeled SPECT acquisitions performed after the first [¹⁷⁷Lu]Lu-PSMA therapeutic injection were reconstructed as SP-18, DP-9, and dual-energy 18-min reconstructions (DP-18), all from the same list-mode dataset, and tumor volume and SUV_mean were compared. A standard pretherapy [⁶⁸Ga]Ga-PSMA PET was also used as an external imaging reference. Results: DP-9 yielded tumor volume and SUV_mean that were comparable to those of DP-18. Compared with SP-18, DP-9 produced lower tumor volumes (median percentage difference, −15% [interquartile range, −25% to −12%]) with similar SUV_mean. Compared with PET, both SP-18 and DP-9 showed higher SUV_mean (+14% [+7% to + 36%] and +19% [−3% to +38%], respectively), likely reflecting the longer injection-to-imaging delay for SPECT, and higher tumor volumes (+68% [+5% to + 122%] and +47% [−15% to +95%], respectively), consistent with the lower spatial resolution of SPECT. Phantom results were similar for SPECT reconstructions, with PET showing better recovery coefficients for SUV and volume. Conclusion: Dual-energy 360° CZT total-body [¹⁷⁷Lu]Lu-PSMA SPECT/CT enables 9-min acquisitions while providing tumor volume and SUV_mean measurements comparable to those of the previously validated 18-min single-energy protocol. Tumor volumes are lower than those with SP-18 but are closer to PET-derived values. Differences between SPECT and PET mainly reflect the injection-to-imaging time for SUV_mean and the spatial resolution for tumor volume.