Department of Radiation Oncology, University Hospitals Leuven, campus Gasthuisberg, Leuven, Belgium.
Strahlenther Onkol. 2013 Sep;189(9):789-95. doi: 10.1007/s00066-013-0359-5.
The aim of this work was to determine whether 11C-choline positron emission tomography (PET)-computed tomography (CT) makes a positive contribution to multiparametric magnetic resonance imaging (MRI) for localisation of intraprostatic tumour nodules.
A total of 73 patients with biopsy-proven intermediate- and high-risk prostate cancer were enrolled in a prospective imaging study consisting of T2-weighted (T2w), dynamic contrast-enhanced (DCE) and diffusion-weighted (DW) MRI and 11C-choline PET-CT before radical prostatectomy. Cancerous regions were delineated on the whole-mount prostatectomy sections and on the different MRI modalities and analysed in 24 segments per patient (3 sections, 8 segments each). To analyse PET-CT images, standardized uptake values (SUV) were calculated per segment.
In total, 1,752 segments were analyzed of which 708 (40.4%) were found to be malignant. A high specificity (94.7, 93.6 and 92.2%) but relatively low sensitivity (31.2, 24.9 and 44.1%) for tumour localisation was obtained with T2w, DCE and DW MRI, respectively. Sensitivity values significantly increased when combining all MRI modalities (57.2%). For PET-CT, mean SUVmax of malignant octants was significantly higher than mean SUVmax of benign octants (3.68±1.30 vs. 3.12±1.02, p<0.0001). In terms of accuracy, the benefit of adding PET-CT to (multiparametric) MRI was less than 1%.
The additional value of 11C-choline PET-CT to MRI in localising intraprostatic tumour nodules is limited, especially when multiparametric MRI is used.
本研究旨在确定 11C-胆碱正电子发射断层扫描（PET）-计算机断层扫描（CT）是否能对前列腺内肿瘤结节的定位有积极贡献。
本前瞻性影像学研究共纳入 73 例经活检证实的中高危前列腺癌患者，他们在接受根治性前列腺切除术之前接受了 T2 加权（T2w）、动态对比增强（DCE）和弥散加权（DW）磁共振成像以及 11C-胆碱 PET-CT 检查。在整个前列腺切除标本上以及不同的 MRI 模式上描绘出癌灶，并对每位患者的 24 个节段（3 个切片，每个切片 8 个节段）进行分析。为了分析 PET-CT 图像，对每个节段计算标准化摄取值（SUV）。
共分析了 1752 个节段，其中 708 个（40.4%）被发现为恶性。T2w、DCE 和 DW MRI 对肿瘤定位的特异性分别为 94.7%、93.6%和 92.2%，但敏感性相对较低（31.2%、24.9%和 44.1%）。当联合所有 MRI 模式时，敏感性值显著增加（57.2%）。对于 PET-CT，恶性节段的平均 SUVmax 明显高于良性节段（3.68±1.30 比 3.12±1.02，p<0.0001）。就准确性而言，将 PET-CT 添加到（多参数）MRI 中的获益小于 1%。
11C-胆碱 PET-CT 对 MRI 定位前列腺内肿瘤结节的额外价值有限，特别是在使用多参数 MRI 时。
