Bluemel Christina, Krebs Markus, Polat Bülent, Linke Fränze, Eiber Matthias, Samnick Samuel, Lapa Constantin, Lassmann Michael, Riedmiller Hubertus, Czernin Johannes, Rubello Domenico, Bley Thorsten, Kropf Saskia, Wester Hans-Juergen, Buck Andreas K, Herrmann Ken
From the Departments of *Nuclear Medicine, †Urology, and ‡Radiation Oncology, University Hospital of Würzburg, Würzburg; §Department of Radiation Oncology, Klinikum Ansbach, Ansbach; ∥Department of Nuclear Medicine, Technische Universität München, Munich, Germany; ¶Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA; #Department of Nuclear Medicine-PET/CT Oncologic & Endocrine Sections, Rovigo Hospital, Rovigo, Italy; **Department of Radiology, University Hospital of Würzburg, Würzburg, Germany; ††Scintomics GmbH, Fürstenfeldbruck; and ‡‡Pharmaceutical Radiochemistry, Technische Universität München, Munich, Germany.
Clin Nucl Med. 2016 Jul;41(7):515-21. doi: 10.1097/RLU.0000000000001197.
Investigating the value of Ga-PSMA-PET/CT in biochemically recurring prostate cancer patients with negative F-choline-PET/CT.
One hundred thirty-nine consecutive patients with biochemical recurrence after curative (surgery and/or radiotherapy) therapy were offered participation in this sequential clinical imaging approach. Patients first underwent an F-choline-PET/CT. If negative, an additional Ga-PSMA-PET/CT was offered. One hundred twenty-five of 139 eligible patients were included in the study; 32 patients underwent additional Ga-PSMA-PET/CT. Patients with equivocal findings (n = 5) on F-choline-PET/CT and those who declined the additional Ga-PSMA-PET/CT (n = 9) were excluded. Images were analyzed visually for the presence of suspicious lesions. Findings on PET/CT were correlated with PSA level, PSA doubling time (dt), and PSA velocity (vel).
The overall detection rates were 85.6% (107/125) for the sequential imaging approach and 74.4% (93/125) for F-choline-PET/CT alone. Ga-PSMA-PET/CT detected sites of recurrence in 43.8% (14/32) of the choline-negative patients. Detection rates of the sequential imaging approach and F-choline-PET/CT alone increased with higher serum PSA levels and PSA vel. Subgroup analysis of Ga-PSMA-PET/CT in F-choline negative patients revealed detection rates of 28.6%, 45.5%, and 71.4% for PSA levels of 0.2 or greater to less than 1 ng/mL, 1 to 2 ng/mL, and greater than 2 ng/mL, respectively.
The sequential imaging approach designed to limit Ga-PSMA imaging to patients with negative choline scans resulted in high detection rates. Ga-PSMA-PET/CT identified sites of recurrent disease in 43.8% of the patients with negative F-choline PET/CT scans.
探讨镓-前列腺特异性膜抗原正电子发射断层扫描/计算机断层扫描（Ga-PSMA-PET/CT）在F-胆碱正电子发射断层扫描/计算机断层扫描（F-choline-PET/CT）结果为阴性的生化复发前列腺癌患者中的价值。
139例根治性治疗（手术和/或放疗）后出现生化复发的患者参与了这一序贯临床成像研究。患者首先接受F-choline-PET/CT检查。若结果为阴性，则加做Ga-PSMA-PET/CT检查。139例符合条件的患者中有125例纳入研究；32例患者加做了Ga-PSMA-PET/CT检查。F-choline-PET/CT检查结果不明确的患者（n = 5）以及拒绝加做Ga-PSMA-PET/CT检查的患者（n = 9）被排除。对图像进行视觉分析，以确定是否存在可疑病变。PET/CT检查结果与前列腺特异性抗原（PSA）水平、PSA倍增时间（dt）和PSA速率（vel）进行相关性分析。
序贯成像方法的总体检出率为85.6%（107/125），单纯F-choline-PET/CT的检出率为74.4%（93/125）。Ga-PSMA-PET/CT在43.8%（14/32）的胆碱阴性患者中检测到复发部位。序贯成像方法和单纯F-choline-PET/CT的检出率随血清PSA水平和PSA vel升高而增加。对F-choline阴性患者的Ga-PSMA-PET/CT亚组分析显示，PSA水平在0.2 ng/mL及以上至小于1 ng/mL、1至2 ng/mL和大于2 ng/mL时的检出率分别为28.6%、45.5%和71.4%。
旨在将Ga-PSMA成像限制于胆碱扫描结果为阴性的患者的序贯成像方法具有较高的检出率。Ga-PSMA-PET/CT在43.8%的F-choline PET/CT扫描结果为阴性的患者中识别出复发疾病部位。
