Can the injected dose be reduced in 68Ga-PSMA-11 PET/CT maintaining high image quality for lesion detection?

Our purpose was to define a clinically useful lower limit of injected dose for (68)Ga-prostate-specific membrane antigen (PSMA)-11 PET/CT imaging of prostate cancer. Methods: (68)Ga-PSMA-11 PET/CT was performed on 11 patients. PET was acquired in list mode and reconstructed using a 3-min full acquisition, a 2-min acquisition, and a 1-min acquisition to generate images obtained with three thirds (standard dose), two thirds (low dose), and one third (very low dose) of the injected dose, respectively. Overall image quality (5-point scale) was assessed, and the detectability of PSMA-positive lesions was determined by 3 readers and compared with the reference standard. Results: Image quality declined with decreasing dose (mean score of 4.1 +/- 0.4 for the standard dose, 3.4 +/- 0.7 for the low dose, and 1.9 +/- 0.4 for the very low dose; all P < 0.05). Readers 1, 2, and 3 correctly identified the lesions (n = 21) at a rate of 100%, 100%, and 95% with the standard dose; 95%, 81%, and 90% with the low dose; and 71%, 76%, and 59% with the very low dose, respectively. Conclusion: (68)Ga-PSMA-11 dose reduction is not feasible without a negative impact on image quality and lesion detectability.