Cho Suk Kyong, Choi Joon Young, Yoo Jang, Cheon Miju, Lee Ji Young, Hyun Seung Hyup, Lee Eun Jeong, Lee Kyung-Han, Kim Byung-Tae
Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710 Korea.
Nucl Med Mol Imaging. 2011 Sep;45(3):192-6. doi: 10.1007/s13139-011-0092-x. Epub 2011 Jul 6.
The extent and intensity of (18)F-FDG uptake in prostate cancer patients are known to be variable, and the clinical significance of focal (18)F-fluorodeoxyglucose ((18)F-FDG) uptake that is incidentally found on positron emission tomography (PET) has not been established. We investigated the clinical significance of incidental focal prostate uptake of (18)F-FDG on PET/computed tomography (CT) and analyzed differential findings on PET/CT between malignant and benign uptake.
A total of 14,854 whole-body (18)F-FDG PET/CT scans (4,806 that were conducted during cancer screening and 10,048 that were conducted to evaluate suspected or alleged cancer outside of the prostate) were retrospectively reviewed to determine the presence, location, multiplicity and maximum standardized uptake value (SUVmax) of focal prostate uptake and combined calcification. The final diagnosis determined by serum prostate-specific antigen (PSA) level and biopsy was compared with PET findings.
Incidental focal prostate uptake was observed in 148 of 14,854 scans (1.0 %). Sixty-seven of these 148 subjects who had diagnostic confirmation were selected for further analysis. Prostate cancer was diagnosed in nine of 67 subjects (13.4%). The remaining 58 subjects had no malignancy in the prostate based on normal serum PSA level (n = 53), or elevated serum PSA level with a negative biopsy result (n = 5). While 84.6% (11/13) of malignant uptake was peripherally located in the prostate glands, 60.2% (50/83) of benign uptake was centrally located (p < 0.05). The positive predictive value of peripheral focal uptake for malignancy was 25%. The SUVmax, multiplicity and combined calcification were not significantly different between the two groups.
Although incidental focal (18)F-FDG uptake in the prostate is not common, the incidence of cancer with focal uptake is not low. Therefore, these findings deserve further evaluation. The location of the focal prostate uptake may help with the selection of high-risk prostate cancer patients.
已知前列腺癌患者中（18）F-FDG摄取的范围和强度存在差异，而正电子发射断层扫描（PET）偶然发现的局灶性（18）氟脱氧葡萄糖（（18）F-FDG）摄取的临床意义尚未明确。我们研究了PET/计算机断层扫描（CT）上偶然出现的前列腺局灶性（18）F-FDG摄取的临床意义，并分析了PET/CT上恶性和良性摄取的差异表现。
回顾性分析了总共14854例全身（18）F-FDG PET/CT扫描（4806例在癌症筛查期间进行，10048例用于评估前列腺外疑似或确诊的癌症），以确定前列腺局灶性摄取和合并钙化的存在、位置、数量及最大标准化摄取值（SUVmax）。将血清前列腺特异性抗原（PSA）水平和活检确定的最终诊断结果与PET检查结果进行比较。
14854例扫描中有148例（1.0%）偶然发现前列腺局灶性摄取情况。这148例中经诊断确认的67例受试者被选作进一步分析。67例受试者中有9例（13.4%）被诊断为前列腺癌。其余58例受试者基于正常血清PSA水平（n = 53）或血清PSA水平升高但活检结果为阴性（n = 5），前列腺无恶性病变。恶性摄取的84.6%（11/13）位于前列腺外周腺，而良性摄取的60.2%（50/83）位于中央（p < 0.05）。外周局灶性摄取对恶性病变的阳性预测值为25%。两组间SUVmax、数量及合并钙化情况无显著差异。
虽然前列腺偶然出现局灶性（18）F-FDG摄取并不常见，但有局灶性摄取的癌症发生率并不低。因此，这些发现值得进一步评估。前列腺局灶性摄取的位置可能有助于高危前列腺癌患者的选择。
