Pyka Thomas, Okamoto Shozo, Dahlbender Marielena, Tauber Robert, Retz Margitta, Heck Matthias, Tamaki Nagara, Schwaiger Markus, Maurer Tobias, Eiber Matthias
Department of Nuclear Medicine, Klinikum rechts der Isar der TU München, Ismaninger Str. 22, 81675, Munich, Germany.
Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Eur J Nucl Med Mol Imaging. 2016 Nov;43(12):2114-2121. doi: 10.1007/s00259-016-3435-0. Epub 2016 Jun 12.
The aim of our study was to compare the diagnostic performance of Ga-PSMA PET and Tc bone scintigraphy (BS) for the detection of bone metastases in prostate cancer (PC) patients.
One hundred twenty-six patients who received planar BS and PSMA PET within three months and without change of therapy were extracted from our database. Bone lesions were categorized into benign, metastatic, or equivocal by two experienced observers. A best valuable comparator (BVC) was defined based on BS, PET, additional imaging, and follow-up data. The cohort was further divided into clinical subgroups (primary staging, biochemical recurrence, and metastatic castration-resistant prostate cancer [mCRPC]). Additionally, subgroups of patients with less than 30 days delay between the two imaging procedures and with additional single-photon emission computed tomography (SPECT) were analyzed.
A total of 75 of 126 patients were diagnosed with bone metastases. Sensitivities and specificities regarding overall bone involvement were 98.7-100 % and 88.2-100 % for PET, and 86.7-89.3 % and 60.8-96.1 % (p < 0.001) for BS, with ranges representing results for 'optimistic' or 'pessimistic' classification of equivocal lesions. Out of 1115 examined bone regions, 410 showed metastases. Region-based analysis revealed a sensitivity and specificity of 98.8-99.0 % and 98.9-100 % for PET, and 82.4-86.6 % and 91.6-97.9 % (p < 0.001) for BS, respectively. PSMA PET also performed better in all subgroups, except patient-based analysis in mCRPC.
Ga-PSMA PET outperforms planar BS for the detection of affected bone regions as well as determination of overall bone involvement in PC patients. Our results indicate that BS in patients who have received PSMA PET for staging only rarely offers additional information; however, prospective studies, including a standardized integrated x-ray computed tomography (SPECT/CT) protocol, should be performed in order to confirm the presented results.
本研究旨在比较镓-前列腺特异性膜抗原（Ga-PSMA）正电子发射断层扫描（PET）和锝骨闪烁显像（BS）对前列腺癌（PC）患者骨转移的诊断性能。
从我们的数据库中提取126例在三个月内接受了平面BS和PSMA PET检查且治疗未改变的患者。由两名经验丰富的观察者将骨病变分为良性、转移性或可疑性。基于BS、PET、其他影像学检查和随访数据定义了最佳有效对照（BVC）。该队列进一步分为临床亚组（初始分期、生化复发和转移性去势抵抗性前列腺癌[mCRPC]）。此外，还分析了两次成像检查间隔时间少于30天且进行了额外单光子发射计算机断层扫描（SPECT）的患者亚组。
126例患者中共有75例被诊断为骨转移。PET对于总体骨受累的敏感性和特异性分别为98.7%-100%和88.2%-100%，而BS的敏感性和特异性分别为86.7%-89.3%和60.8%-96.1%（p<0.001），范围代表对可疑病变“乐观”或“悲观”分类的结果。在1115个检查的骨区域中，410个显示有转移。基于区域的分析显示，PET的敏感性和特异性分别为98.8%-99.0%和98.9%-100%，而BS的敏感性和特异性分别为82.4%-86.6%和91.6%-97.9%（p<0.001）。除了mCRPC患者基于个体的分析外，PSMA PET在所有亚组中也表现更好。
Ga-PSMA PET在检测PC患者受影响的骨区域以及确定总体骨受累情况方面优于平面BS。我们的结果表明，仅接受PSMA PET进行分期的患者进行BS很少能提供额外信息；然而，应进行前瞻性研究，包括标准化的综合X线计算机断层扫描（SPECT/CT）方案，以证实所呈现的结果。
