Department of Nuclear Medicine and Endocrinology, PET-CT Center Linz, St Vincent's Hospital, Seilerstaette 4, A-4020 Linz, Austria.
Radiology. 2010 Mar;254(3):925-33. doi: 10.1148/radiol.09090413.
PURPOSE: To prospectively evaluate the potential value of fluorocholine (FCH) positron emission tomography (PET)/computed tomography (CT) in the preoperative staging of patients with prostate cancer who had intermediate or high risk of extracapsular disease. MATERIALS AND METHODS: Institutional review board approval and written informed consent were obtained. Overall, 132 patients with prostate cancer (mean age, 63 years +/- 7 [standard deviation]) were enrolled between October 2003 and June 2008. Two patients were subsequently excluded. In 111 patients, radical prostatectomy with extended pelvic lymph node (LN) dissection was performed. Patients were categorized into groups with intermediate (n = 47) or high (n = 83) risk of extracapsular extension on the basis of their Gleason scores and prostate specific antigen levels. Imaging was performed with an integrated PET/CT system after injection of 4.07 MBq FCH per kilogram of body weight with acquisition of dynamic images in the pelvis and whole-body images. Statistical analysis was performed on a per-patient basis. RESULTS: Significant correlation was found between sections with the highest FCH uptake and sextants with maximal tumor infiltration (r = 0.68; P = .0001). Overall, 912 LNs were histopathologically examined. A per-patient analysis revealed the sensitivity, specificity, and positive and negative predictive values of FCH PET/CT in the detection of malignant LNs were 45%, 96%, 82%, and 83%, respectively. For LN metastases greater than or equal to 5 mm in diameter, sensitivity, specificity, and positive and negative predictive values were 66%, 96%, 82%, and 92%, respectively. In 13 patients, 43 bone metastases were detected. Early bone marrow infiltration was detected with only FCH PET in two patients. FCH PET/CT led to a change in therapy in 15% of all patients and 20% of high-risk patients. CONCLUSION: FCH PET/CT could be useful in the evaluation of patients with prostate cancer who are at high risk for extracapsular disease, and it could be used to preoperatively exclude distant metastases. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090413/-/DC1.
目的：前瞻性评估氟胆碱（FCH）正电子发射断层扫描（PET）/计算机断层扫描（CT）在具有囊外疾病中高危风险的前列腺癌患者术前分期中的潜在价值。
材料与方法：获得机构审查委员会批准和书面知情同意。2003 年 10 月至 2008 年 6 月期间共纳入 132 例前列腺癌患者（平均年龄 63 岁 +/- 7[标准差]）。随后排除了 2 例患者。111 例患者接受根治性前列腺切除术和扩大盆腔淋巴结（LN）清扫术。根据 Gleason 评分和前列腺特异性抗原水平，患者被分为中危（n = 47）或高危（n = 83）组。在注射 4.07MBq/kg 体重的 FCH 后，使用集成的 PET/CT 系统进行成像，采集骨盆和全身动态图像。对每位患者进行统计学分析。
结果：在 FCH 摄取最高的节段与肿瘤浸润最大的六分区之间发现了显著相关性（r = 0.68；P =.0001）。共检查了 912 个淋巴结。对每位患者的分析显示，FCH PET/CT 检测恶性淋巴结的敏感性、特异性、阳性和阴性预测值分别为 45%、96%、82%和 83%。对于直径大于或等于 5mm 的淋巴结转移，敏感性、特异性、阳性和阴性预测值分别为 66%、96%、82%和 92%。在 13 例患者中，检测到 43 个骨转移灶。仅用 FCH PET 在 2 例患者中检测到早期骨髓浸润。FCH PET/CT 导致 15%的患者和 20%的高危患者的治疗方式发生改变。
结论：FCH PET/CT 可用于评估具有囊外疾病高危风险的前列腺癌患者，可用于术前排除远处转移。
补充材料：http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.09090413/-/DC1.
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