Garcia J R, Moreno C, Valls E, Cozar P, Bassa P, Soler M, Alvarez-Moro F J, Moragas M, Riera E
Unidad PET CETIR-ERESA, Esplugues, Barcelona, España.
Unidad PET CETIR-ERESA, Esplugues, Barcelona, España.
Rev Esp Med Nucl Imagen Mol. 2015 May-Jun;34(3):155-61. doi: 10.1016/j.remn.2014.08.001. Epub 2014 Nov 15.
To compare bone scan (BS) with (11)C-Choline PET/CT for the detection of bone metastases in patients with biochemical recurrence of prostate cancer (PC).
A total of 169 patients with biochemical recurrence of PC(PSA:2.4-58 ng/ml) who were referred for both exams (0-15 days-in-between) were included. Lesion-detection-rate per patients and lesions were analyzed for both BS and (11)C-Choline PET/CT. Metastasis diagnosis was reached by: biopsy, CT/(18)F-Fluoride PET/MRI confirmation, or evidence of progression in subsequent imaging procedures.
A total of 91 lesions were found to be active in BS and/or (11)C-choline PET/CT (40 patients), with 78 of which were metastatic. BS detected 38 blastic, 2 lytic and 10 non-CT-evident lesions. (11)C-Choline PET/CT detected 41 blastic, 4 lytic and 29 non-CT-evident lesions. BS and (11)C-Choline PET/CT sensitivities were 65.4% and 96.1%; specificities ere 38.5 and 92.3% (χ(2) 8.27, p<0.04). Both imaging techniques were negative in 118 patients. Tracer avid lesions were found in 51 patients: with 30/51 being BS and (11)C-Choline PET/CT concordant; in 21/51 patients had discordant lesions (kappa 0.712, p=0.00). Lesions were absolutely discordant in 10/19 patients,: 5 FN BS, 2 FP BS (degenerative changes; dysplasia), 1 FN (11)C-Choline PET/CT (blastic), 1 FP (11)C-Choline PET/CT (degenerative), 1 out of field-of-view lesion with (11)C-Choline PET/CT (tibia alone). (11)C-Choline PET/CT showed extraosseous involvement in 26/51 patients with bone metastases: 9 local recurrences, 5 infra-diaphragmatic-lymph-nodes, 2 supra-diaphragmatic, 5 local and infra-diaphragmatic, 4 infra- and supra-diaphragmatic, 1 supra-diaphragmatic and lung metastases.
(11)C-Choline PET/CT yielded better sensitivity and specificity than BS for the detection of bone involvement in patients with biochemical recurrence of PC and allowed extraosseous restaging, with an impact in the clinical management of these patients.
比较骨扫描（BS）与（11）C - 胆碱PET/CT在检测前列腺癌（PC）生化复发患者骨转移中的应用。
纳入169例PC生化复发患者（PSA：2.4 - 58 ng/ml），均接受了两种检查（间隔0 - 15天）。分析了BS和（11）C - 胆碱PET/CT的每位患者病变检出率及病变情况。通过活检、CT/（18）F - 氟化物PET/MRI确认或后续影像学检查中的进展证据来确诊转移。
共发现91个病变在BS和/或（11）C - 胆碱PET/CT中呈活性（40例患者），其中78个为转移性病变。BS检测到38个成骨性、2个溶骨性和10个CT未显示的病变。（11）C - 胆碱PET/CT检测到41个成骨性、4个溶骨性和29个CT未显示的病变。BS和（11）C - 胆碱PET/CT的敏感性分别为65.4%和96.1%；特异性分别为38.5%和92.3%（χ² = 8.27，p < 0.04）。两种成像技术在118例患者中均为阴性。在51例患者中发现有示踪剂摄取的病变：其中30/51例BS和（11）C - 胆碱PET/CT结果一致；21/51例患者有不一致的病变（kappa = 0.712，p = 0.00）。19例患者中有10例病变完全不一致：5例BS假阴性，2例BS假阳性（退行性改变；发育异常），1例（11）C - 胆碱PET/CT假阴性（成骨性），1例（11）C - 胆碱PET/CT假阳性（退行性），1例（11）C - 胆碱PET/CT视野外病变（仅胫骨）。（11）C - 胆碱PET/CT显示26/51例骨转移患者有骨外受累：9例局部复发，5例膈下淋巴结转移，2例膈上转移，5例局部和膈下转移，4例膈下和膈上转移，1例膈上和肺转移。
对于检测PC生化复发患者的骨受累情况，（11）C - 胆碱PET/CT比BS具有更高的敏感性和特异性，并且能够进行骨外分期，对这些患者的临床管理有重要影响。
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