Lindgren Belal Sarah, Sadik May, Kaboteh Reza, Hasani Nezar, Enqvist Olof, Svärm Linus, Kahl Fredrik, Simonsen Jane, Poulsen Mads H, Ohlsson Mattias, Høilund-Carlsen Poul F, Edenbrandt Lars, Trägårdh Elin
Department of Translational Medicine, Lund University, Malmö, Sweden.
Department of Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
EJNMMI Res. 2017 Dec;7(1):15. doi: 10.1186/s13550-017-0264-5. Epub 2017 Feb 16.
Sodium fluoride (NaF) positron emission tomography combined with computer tomography (PET/CT) has shown to be more sensitive than the whole-body bone scan in the detection of skeletal uptake due to metastases in prostate cancer. We aimed to calculate a 3D index for NaF PET/CT and investigate its correlation to the bone scan index (BSI) and overall survival (OS) in a group of patients with prostate cancer.
NaF PET/CT and bone scans were studied in 48 patients with prostate cancer. Automated segmentation of the thoracic and lumbar spines, sacrum, pelvis, ribs, scapulae, clavicles, and sternum were made in the CT images. Hotspots in the PET images were selected using both a manual and an automated method. The volume of each hotspot localized in the skeleton in the corresponding CT image was calculated. Two PET/CT indices, based on manual (manual PET index) and automatic segmenting using a threshold of SUV 15 (automated PET index), were calculated by dividing the sum of all hotspot volumes with the volume of all segmented bones. BSI values were obtained using a software for automated calculations.
BSI, manual PET index, and automated PET index were all significantly associated with OS and concordance indices were 0.68, 0.69, and 0.70, respectively. The median BSI was 0.39 and patients with a BSI >0.39 had a significantly shorter median survival time than patients with a BSI <0.39 (2.3 years vs not reached after 5 years of follow-up [p = 0.01]). The median manual PET index was 0.53 and patients with a manual PET index >0.53 had a significantly shorter median survival time than patients with a manual PET index <0.53 (2.5 years vs not reached after 5 years of follow-up [p < 0.001]). The median automated PET index was 0.11 and patients with an automated PET index >0.11 had a significantly shorter median survival time than patients with an automated PET index <0.11 (2.3 years vs not reached after 5 years of follow-up [p < 0.001]).
PET/CT indices based on NaF PET/CT are correlated to BSI and significantly associated with overall survival in patients with prostate cancer.
氟化钠（NaF）正电子发射断层扫描结合计算机断层扫描（PET/CT）在检测前列腺癌转移引起的骨骼摄取方面已显示出比全身骨扫描更敏感。我们旨在计算NaF PET/CT的三维指数，并研究其与一组前列腺癌患者的骨扫描指数（BSI）和总生存期（OS）的相关性。
对48例前列腺癌患者进行了NaF PET/CT和骨扫描研究。在CT图像中对胸椎、腰椎、骶骨、骨盆、肋骨、肩胛骨、锁骨和胸骨进行自动分割。使用手动和自动方法选择PET图像中的热点。计算相应CT图像中骨骼中每个热点的体积。通过将所有热点体积之和除以所有分割骨骼的体积，计算基于手动（手动PET指数）和使用SUV 15阈值的自动分割（自动PET指数）的两个PET/CT指数。使用自动计算软件获得BSI值。
BSI、手动PET指数和自动PET指数均与OS显著相关，一致性指数分别为0.68、0.69和0.70。BSI中位数为0.39，BSI>0.39的患者中位生存时间显著短于BSI<0.39的患者（2.3年 vs 随访5年后未达到[p = 0.01]）。手动PET指数中位数为0.53，手动PET指数>0.53的患者中位生存时间显著短于手动PET指数<0.53的患者（2.5年 vs 随访5年后未达到[p < 0.001]）。自动PET指数中位数为0.11，自动PET指数>0.11的患者中位生存时间显著短于自动PET指数<0.11的患者（2.3年 vs 随访5年后未达到[p < 0.001]）。
基于NaF PET/CT的PET/CT指数与BSI相关，并且与前列腺癌患者的总生存期显著相关。
