The influence of digital PET/CT on diagnostic certainty and interrater reliability in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer.

Alberts, Ian; Hünermund, Jan-Niklas; Sachpekidis, Christos; Mingels, Clemens; Fech, Viktor; Bohn, Karl Peter; Rominger, Axel; Afshar-Oromieh, Ali (2021). The influence of digital PET/CT on diagnostic certainty and interrater reliability in [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer. European radiology, 31(10), pp. 8030-8039. Springer 10.1007/s00330-021-07870-5

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To investigate the impact of digital PET/CT on diagnostic certainty, patient-based sensitivity and interrater reliability.


Four physicians retrospectively evaluated two matched cohorts of patients undergoing [68Ga]Ga-PSMA-11 PET/CT on a digital (dPET/CT n = 65) or an analogue scanner (aPET/CT n = 65) for recurrent prostate cancer between 11/2018 and 03/2019. The number of equivocal and pathological lesions as well as the frequency of discrepant findings and the interrater reliability for the two scanners were compared.


dPET/CT detected more lesions than aPET/CT (p < 0.001). A higher number of pathological scans were observed for dPET/CT (83% vs. 57%, p < 0.001). The true-positive rate at follow-up was 100% for dPET/CT compared to 84% for aPET/CT (p < 0.001). The proportion of lesions rated as non-pathological as a total of all PSMA-avid lesions detected for dPET/CT was comparable to aPET/CT (61.8% vs. 57.0%, p = 0.99). Neither a higher rate of diagnostically uncertain lesions (11.5% dPET/CT vs. 13.7% aPET/CT, p = 0.95) nor discrepant scans (where one or more readers differed in opinion as to whether the scan is pathological) were observed (18% dPET/CT vs. 17% aPET/CT, p = 0.76). Interrater reliability for pathological lesions was excellent for both scanner types (Cronbach's α = 0.923 dPET/CT; α = 0.948 aPET/CT) and interrater agreement was substantial for dPET/CT (Krippendorf's α = 0.701) and almost perfect in aPET/CT (α = 0.802).


A higher detection rate for pathological lesions for dPET/CT compared with aPET/CT in multiple readers was observed. This improved sensitivity was coupled with an improved true-positive rate and was not associated with increased diagnostic uncertainty, rate of non-specific lesions, or reduced interrater reliability.


• New generation digital scanners detect more cancer lesions in men with prostate cancer. • When using digital scanners, the doctors are able to diagnose prostate cancer lesions with better certainty • When using digital scanners, the doctors do not disagree with each other more than with other scanner types.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Radiology, Neuroradiology and Nuclear Medicine (DRNN) > Clinic of Nuclear Medicine

UniBE Contributor:

Alberts, Ian Leigh, Hünermund, Jan-Niklas, Sachpekidis, Christos, Mingels, Clemens, Fech, Viktor, Bohn, Karl Peter, Rominger, Axel Oliver, Afshar Oromieh, Ali


600 Technology > 610 Medicine & health








Daria Vogelsang

Date Deposited:

05 Jan 2022 17:25

Last Modified:

05 Dec 2022 15:55

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

Molecular imaging Nuclear medicine Positron emission tomography Prostate cancer




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