Sherief H. Gamie, MD, PhD, presents “Interpreting PSMA PET/CT Scan Reports.”
How to cite: Gamie, SH. “Interpreting PSMA PET/CT Scan Reports.” October 6, 2025. Accessed Nov 2025. https://grandroundsinurology.com/interpreting-psma-pet-ct-scan-reports/
Interpreting PSMA PET/CT Scan Reports – Summary
E. David Crawford, MD, Editor-in-Chief of Grand Rounds in Urology and Professor of Urology, University of California, San Diego, San Diego, California, introduces Dr. Sherief H. Gamie, MD, PhD, Chief & Director, Molecular Imaging and Theranostics, Professor of Clinical Radiology, University of California, San Diego, San Diego, California. Dr. Gamie explains how to interpret prostate-specific membrane antigen (PSMA) positron emission tomography (PET) with computed tomography (CT) reports.
This presentation provides a practical framework for reading PSMA PET/CT reports and translating standardized uptake value (SUV) data into clinical decisions. It clarifies how to use reference organs and prior studies to judge whether findings are physiologic, inflammatory, or pathologic.
When viewing the reports, the SUV, specifically the SUV maximum (SUVmax), is a ratio that reflects radiotracer activity in a lesion relative to the injected dose. Interpretation depends on the regional reference SUV, maximum values in the blood pool, bone marrow, and liver. Findings are assessed relative to these references and, on follow-up, by change in SUVmax rather than absolute values alone.
Dr. Gamie reviews key steps in analyzing data, including confirming the technique section for tracer type and injected dose, and documenting whether prior PET or magnetic resonance imaging (MRI) exists for comparison. He shares examples that suggest uncertainty, such as benign-appearing pulmonary nodules with SUVmax below blood pool and bone marrow or pelvic or osseous foci with uptake above liver, that indicate metastatic disease. Dr. Gamie also cautions that physiologic ureteral activity can mimic nodal disease and may require correlation with MRI or CT.
Dr. Gamie discusses the current PSMA reporting systems and their limitations, including the PSMA reporting and data system (PSMA-RADS). A proposed molecular imaging scale from the European Association of Urology compares uptake using organ references, a formal scale that reflects the SUVmax interpretation.
Ultimately, Dr. Gamie shares that maximum intensity projection images are the most informative single view for communicating overall disease distribution. When combined with the uptake values, the 3D image is the best tool for finding what areas of the patient require treatment.
