Department of Nuclear Medicine, Royal Perth Hospital, Perth, WA, Australia.
Eur J Nucl Med Mol Imaging. 2011 Jan;38(1):14-22. doi: 10.1007/s00259-010-1579-x. Epub 2010 Sep 23.
The aim of the study was to assess the utility of (18)F-fluorocholine (FCH), compared to standard imaging of bone scan (BS) and contrast-enhanced abdominopelvic computed tomography (CT), in patients with castration-resistant prostate carcinoma.
FCH has shown promise as a metabolic imaging agent for prostate carcinoma. Twenty-six patients with castration-resistant prostate carcinoma had FCH, BS and CT imaging within a 2-month period. Individual FCH-positive lesions in bone were compared to the BS and soft tissue lesions were compared to CT. The lesions were then classified as concordant or discordant for the presence or absence of prostate cancer metastases. Discordant bone or soft tissue lesions were followed up with BS or CT, respectively, at 6-month intervals for up to 2 years or until a definitive diagnosis of the discordant lesion could be made.
In 13 (50%) of the patients, all lesions identified were concordant; this included 5 patients in whom no lesions could be identified with any imaging modality. In 21 patients, 183 lesions were observed with 149 being concordant and 34 (19%) being discordant (13 patients). Based on follow-up, FCH correctly identified the presence or absence of disease in 27 of 34 lesions, and in 14 cases FCH-positive lesions, not identified on initial imaging, were confirmed as disease on follow-up. The sensitivity, specificity, accuracy, positive predictive and negative predictive values for lesion detection by FCH are 96% (92-98%), 96% (81-99%), 96% (93-97%), 99% (96-100%) and 81% (64-88%), respectively, with 95% confidence intervals shown in parentheses.
In this patient cohort, FCH shows good initial concordance (81%) with BS and CT in the detection of metastatic prostate carcinoma. Follow-up of the cases where FCH was initially discordant with subsequent BS or CT shows that FCH was accurate in determining the presence or absence of prostate metastasis in 79% of lesions. While FCH imaging as compared to BS and CT in this patient group has a good sensitivity and specificity for the detection of lesions representing prostate metastasis, further prospective studies are needed to determine its role.
本研究旨在评估（18）F-氟胆碱（FCH）与骨扫描（BS）和对比增强的腹盆腔计算机断层扫描（CT）相比，在去势抵抗性前列腺癌患者中的应用价值。
FCH 已被证明是一种代谢成像剂，可用于前列腺癌。26 例去势抵抗性前列腺癌患者在 2 个月内接受了 FCH、BS 和 CT 检查。对骨中的 FCH 阳性病变与 BS 进行比较，对软组织病变与 CT 进行比较。然后，根据是否存在前列腺癌转移，将病变分类为一致或不一致。对于不一致的骨或软组织病变，分别在 6 个月的时间间隔内进行 BS 或 CT 随访，最长随访时间为 2 年，直至能够明确不一致病变的诊断。
在 13 例（50%）患者中，所有的病变都是一致的；其中 5 例患者在任何影像学检查中均未发现病变。在 21 例患者中，共观察到 183 个病变，其中 149 个病变与其他影像学检查结果一致，34 个病变（13 例患者）不一致。根据随访结果，FCH 正确识别了 34 个病变中 27 个病变的存在或不存在，在 14 例初始影像学检查未发现 FCH 阳性病变的情况下，这些病变在随访中被证实为疾病。FCH 检测病变的灵敏度、特异性、准确性、阳性预测值和阴性预测值分别为 96%（92-98%）、96%（81-99%）、96%（93-97%）、99%（96-100%）和 81%（64-88%），置信区间为 95%。
在本患者队列中，FCH 与 BS 和 CT 在检测转移性前列腺癌方面具有良好的初始一致性（81%）。对 FCH 最初与 BS 或 CT 不一致的病例进行随访，结果表明，FCH 在确定 79%的病变是否存在前列腺转移方面是准确的。虽然与 BS 和 CT 相比，FCH 在检测代表前列腺转移的病变方面具有良好的灵敏度和特异性，但仍需要进一步的前瞻性研究来确定其作用。
