From the Molecular Imaging Program (B.T., E.M., M.L.L., M.B., Y.L.M., S.A., P.L.C., K.A.K.), Biometric Research Branch, Division of Cancer Treatment and Diagnosis (J.S.), Urologic Oncology Branch (P.A.P.), and Laboratory of Pathology (M.J.M.), National Institutes of Health, National Cancer Institute, 10 Center Dr, MSC 1182 Bldg 10, Room B3B85 Bethesda, MD 20892-1088; and Medical Diagnostics Research and Development, GE Healthcare, Uppsala, Sweden (R.O.).
Radiology. 2014 Mar;270(3):849-56. doi: 10.1148/radiol.13130240. Epub 2013 Nov 8.
To characterize uptake of 1-amino-3-fluorine 18-fluorocyclobutane-1-carboxylic acid ((18)F FACBC) in patients with localized prostate cancer, benign prostatic hyperplasia (BPH), and normal prostate tissue and to evaluate its potential utility in delineation of intraprostatic cancers in histopathologically confirmed localized prostate cancer in comparison with magnetic resonance (MR) imaging.
Institutional review board approval and written informed consent were obtained for this HIPAA-compliant prospective study. Twenty-one men underwent dynamic and static abdominopelvic (18)F FACBC combined positron emission tomography (PET) and computed tomography (CT) and multiparametric (MP) 3-T endorectal MR imaging before robotic-assisted prostatectomy. PET/CT and MR images were coregistered by using pelvic bones as fiducial markers; this was followed by manual adjustments. Whole-mount histopathologic specimens were sliced with an MR-based patient-specific mold. (18)F FACBC PET standardized uptake values (SUVs) were compared with those at MR imaging and histopathologic analysis for lesion- and sector-based (20 sectors per patient) analysis. Positive and negative predictive values for each modality were estimated by using generalized estimating equations with logit link function and working independence correlation structure.
(18)F FACBC tumor uptake was rapid but reversible. It peaked 3.6 minutes after injection and reached a relative plateau at 15-20 minutes (SUVmax[15-20min]). Mean prostate tumor SUVmax(15-20min) was significantly higher than that of the normal prostate (4.5 ± 0.5 vs 2.7 ± 0.5) (P < .001); however, it was not significantly different from that of BPH (4.3 ± 0.6) (P = .27). Sector-based comparison with histopathologic analysis, including all tumors, revealed sensitivity and specificity of 67% and 66%, respectively, for (18)F FACBC PET/CT and 73% and 79%, respectively, for T2-weighted MR imaging. (18)F FACBC PET/CT and MP MR imaging were used to localize dominant tumors (sensitivity of 90% for both). Combined (18)F FACBC and MR imaging yielded positive predictive value of 82% for tumor localization, which was higher than that with either modality alone (P < .001).
(18)F FACBC PET/CT shows higher uptake in intraprostatic tumor foci than in normal prostate tissue; however, (18)F FACBC uptake in tumors is similar to that in BPH nodules. Thus, it is not specific for prostate cancer. Nevertheless, combined (18)F FACBC PET/CT and T2-weighted MR imaging enable more accurate localization of prostate cancer lesions than either modality alone.
描述 1-氨基-3-氟-18-氟环丁烷-1-羧酸（18F-FACBC）在局限性前列腺癌、良性前列腺增生（BPH）和正常前列腺组织中的摄取情况，并评估其在经组织病理学证实的局限性前列腺癌中与磁共振（MR）成像相比勾画前列腺内癌灶的潜在效用。
本 HIPAA 合规性前瞻性研究获得了机构审查委员会的批准和书面知情同意。21 例男性患者在机器人辅助前列腺切除术前行动态和静态腹部盆腔 18F-FACBC 正电子发射断层扫描（PET）和计算机断层扫描（CT）以及多参数（MP）3-T 直肠内 MR 成像。通过使用骨盆作为基准标记对 PET/CT 和 MR 图像进行配准；然后进行手动调整。使用基于 MR 的患者专用模具对全器官组织学标本进行切片。对病灶和 20 个病灶/患者的扇形区进行基于病灶和基于扇形区的分析，比较 18F-FACBC PET 标准摄取值（SUV）与 MR 成像和组织病理学分析的结果。使用广义估计方程和对数链接函数及工作独立性相关结构估计每种方法的阳性和阴性预测值。
18F-FACBC 肿瘤摄取迅速但可逆转。注射后 3.6 分钟达到摄取峰值，在 15-20 分钟达到相对平台期（SUVmax[15-20min]）。平均前列腺肿瘤 SUVmax[15-20min]显著高于正常前列腺（4.5±0.5 比 2.7±0.5）（P＜0.001）；然而，与 BPH（4.3±0.6）相比，其并无显著差异（P=0.27）。包括所有肿瘤的基于扇形区的分析与组织病理学分析比较，18F-FACBC PET/CT 的敏感性和特异性分别为 67%和 66%，T2 加权 MR 成像的敏感性和特异性分别为 73%和 79%。18F-FACBC PET/CT 和 MP MR 成像可用于定位优势肿瘤（两者的敏感性均为 90%）。联合使用 18F-FACBC 和 MR 成像的肿瘤定位阳性预测值为 82%，高于单独使用任何一种方法（P＜0.001）。
18F-FACBC PET/CT 显示在前列腺内肿瘤灶中的摄取高于正常前列腺组织；然而，18F-FACBC 在肿瘤中的摄取与 BPH 结节相似。因此，它对前列腺癌并不具有特异性。然而，与单独使用任何一种方法相比，联合使用 18F-FACBC PET/CT 和 T2 加权 MR 成像能够更准确地定位前列腺癌病灶。
