比较（68）Ga 标记的 PSMA 配体与基于（18）F-胆碱的 PET/CT 在诊断复发性前列腺癌中的作用。
Comparison of PET imaging with a (68)Ga-labelled PSMA ligand and (18)F-choline-based PET/CT for the diagnosis of recurrent prostate cancer.
机构信息
Department of Nuclear Medicine, University Hospital of Heidelberg, INF 400, 69120, Heidelberg, Germany,
出版信息
Eur J Nucl Med Mol Imaging. 2014 Jan;41(1):11-20. doi: 10.1007/s00259-013-2525-5. Epub 2013 Sep 27.
PURPOSE
Positron emission tomography (PET) with choline tracers has found widespread use for the diagnosis of prostate cancer (PC). However, choline metabolism is not increased in a considerable number of cases, whereas prostate-specific membrane antigen (PSMA) is overexpressed in most PCs. Therefore, a (68)Ga-labelled PSMA ligand could be superior to choline tracers by obtaining a high contrast. The aim of this study was to compare such a novel tracer with standard choline-based PET/CT.
METHODS
Thirty-seven patients with biochemical relapse of PC [mean prostate-specific antigen (PSA) 11.1 ± 24.1 ng/ml, range 0.01-116] were retrospectively analysed after (18)F-fluoromethylcholine and (68)Ga-PSMA PET/CT within a time window of 30 days. Radiotracer uptake that was visually considered as PC was semi-quantitatively analysed by measuring the maximum standardized uptake values (SUVmax) of the scans acquired 1 h after injection of (68)Ga-PSMA complex solution (median 132 MBq, range 59-263 MBq) and (18)F-fluoromethylcholine (median 237 MBq, range 114-374 MBq), respectively. In addition, tumour to background ratios were calculated.
RESULTS
A total of 78 lesions characteristic for PC were detected in 32 patients using (68)Ga-PSMA PET/CT and 56 lesions were detected in 26 patients using choline PET/CT. The higher detection rate in (68)Ga-PSMA PET/CT was statistically significant (p=0.04). In five patients no lesion was found with both methods. All lesions detected by (18)F-fluoromethylcholine PET/CT were also seen by (68)Ga-PSMA PET/CT. In (68)Ga-PSMA PET/CT SUVmax was clearly (>10 %) higher in 62 of 78 lesions (79.1 %) and the tumour to background ratio was clearly (>10 %) higher in 74 of 78 lesions (94.9 %) when compared to (18)F-fluoromethylcholine PET/CT.
CONCLUSION
(68)Ga-PSMA PET/CT can detect lesions characteristic for PC with improved contrast when compared to standard (18)F-fluoromethylcholine PET/CT, especially at low PSA levels.
目的
正电子发射断层扫描（PET）用胆碱示踪剂已广泛用于前列腺癌（PC）的诊断。然而，胆碱代谢在相当数量的病例中没有增加，而前列腺特异性膜抗原（PSMA）在大多数 PC 中过度表达。因此，与胆碱示踪剂相比，（68）Ga 标记的 PSMA 配体可以通过获得更高的对比度而具有优势。本研究旨在比较这种新型示踪剂与标准基于胆碱的 PET/CT。
方法
对 37 例前列腺特异性抗原（PSA）水平为 11.1±24.1ng/ml（范围为 0.01-116）的生化复发 PC 患者[（18）F-氟甲基胆碱和（68）Ga-PSMA PET/CT]进行回顾性分析，在 30 天的时间窗内进行。通过测量注射（68）Ga-PSMA 络合物溶液后 1 小时获得的扫描的最大标准化摄取值（SUVmax），对视觉上认为是 PC 的放射性示踪剂摄取进行半定量分析（中位数 132MBq，范围 59-263MBq）和（18）F-氟甲基胆碱（中位数 237MBq，范围 114-374MBq）。此外，计算了肿瘤与背景的比值。
结果
在 32 名患者中，使用（68）Ga-PSMA PET/CT 检测到 78 个符合 PC 特征的病灶，在 26 名患者中，使用胆碱 PET/CT 检测到 56 个病灶。（68）Ga-PSMA PET/CT 的更高检测率具有统计学意义（p=0.04）。在 5 名患者中，两种方法均未发现病变。（18）F-氟甲基胆碱 PET/CT 检测到的所有病灶也都可见于（68）Ga-PSMA PET/CT。在（68）Ga-PSMA PET/CT 中，SUVmax 在 78 个病灶中的 62 个（79.1%）明显（>10%）升高，在 78 个病灶中的 74 个（94.9%）肿瘤与背景的比值明显（>10%）升高。
结论
与标准（18）F-氟甲基胆碱 PET/CT 相比，（68）Ga-PSMA PET/CT 可以检测到具有更高对比度的符合 PC 特征的病灶，尤其是在 PSA 水平较低时。
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