Jiménez Londoño G A, García Vicente A M, Amo-Salas M, Fúnez Mayorga F, López Guerrero M A, Talavera Rubio M P, Gutierrez Martin P, González García B, de la Torre Pérez J A, Soriano Castrejón Á M
Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain.
Nuclear Medicine Department, Hospital Universitario de Ciudad Real, Ciudad Real, Spain.
Rev Esp Med Nucl Imagen Mol. 2017 Jul-Aug;36(4):241-246. doi: 10.1016/j.remn.2017.01.014. Epub 2017 Mar 18.
To study F-Choline PET/CT in the diagnosis and biopsy guide of prostate cancer (pCa) in patients with persistently high prostate-specific antigen (PSA) and previous negative prostate biopsy. To compare the clinical risk factors and metabolic variables as predictors of malignancy.
Patients with persistently elevated PSA in serum (total PSA >4ng/mL) and at least a previous negative or inconclusive biopsy were consecutively referred for a whole body F-Choline PET/CT. Patient age, PSA level, PSA doubling time (PSAdt) and PSA velocity (PSAvel) were obtained. PET images were visually (positive or negative) and semiquantitatively (SUVmax) reviewed. F-Choline uptake prostate patterns were defined as focal, multifocal, homogeneous or heterogeneous. Histology on biopsy using transrectal ultrasound-guided approach was the gold standard. Sensitivity (Se), specificity (Sp) and accuracy (Ac) of PET/CT for diagnosis of pCa were evaluated using per-patient and per-prostate lobe analysis. Receiver-operating-characteristic (ROC) curve analysis was used to assess the value of SUVmax to diagnose pCa. Correlation between PET/CT and biopsy results per-prostate lobe was assessed using the Chi-square test. Univariate and multivariate logistic regression analysis were applied to compare clinical risk factors and metabolic variables as predictors of malignancy.
Thirty-six out of 43 patients with histologic confirmation were included. In 11 (30.5%) patients, pCa was diagnosed (Gleason score from 4 to 9). The mean values of patient age, PSA level, PSAdt and PSAvel were: 65.5 years, 15.6ng/ml, 28.1 months and 8.5ng/mL per year, respectively. Thirty-three patients had a positive PET/CT; 18 had a focal pattern, 7 multifocal, 4 homogeneous and 4 heterogeneous. Se, Sp and Ac of PET/CT were of 100%, 12% and 38% in the patient based analysis, and 87%, 29% and 14% in the prostate lobe based analysis, respectively. The ROC curve analysis of SUVmax showed an AUC of 0.568 (p=0.52). On a lobe analysis, poor agreement was observed between PET/CT findings and biopsy results (p=0.097). In the univariate/multivariate analysis, none of clinical and metabolic variables were statistically significant as predictor of pCa.
Choline PET/CT is a suitable procedure for the detection of pCa in highly selected patients, however, a high rate of false positive should be expected.
研究F-胆碱PET/CT在前列腺特异性抗原（PSA）持续升高且既往前列腺穿刺活检阴性的前列腺癌（pCa）患者的诊断及活检引导中的应用。比较临床风险因素和代谢变量作为恶性肿瘤预测指标的情况。
血清PSA持续升高（总PSA>4ng/mL）且既往至少有一次穿刺活检阴性或结果不明确的患者连续接受全身F-胆碱PET/CT检查。记录患者年龄、PSA水平、PSA倍增时间（PSAdt）和PSA速率（PSAvel）。对PET图像进行视觉（阳性或阴性）和半定量（SUVmax）评估。F-胆碱摄取的前列腺模式分为局灶性、多灶性、均匀性或不均匀性。经直肠超声引导下穿刺活检的组织学检查为金标准。采用患者层面和前列腺叶层面分析评估PET/CT诊断pCa的敏感性（Se）、特异性（Sp）和准确性（Ac）。采用受试者操作特征（ROC）曲线分析评估SUVmax诊断pCa的价值。采用卡方检验评估PET/CT与前列腺叶层面活检结果之间的相关性。应用单因素和多因素逻辑回归分析比较临床风险因素和代谢变量作为恶性肿瘤预测指标的情况。
43例组织学确诊患者中36例纳入研究。11例（30.5%）患者诊断为pCa（Gleason评分4至9分）。患者年龄、PSA水平、PSAdt和PSAvel的平均值分别为：65.5岁、15.6ng/ml、28.1个月和8.5ng/mL/年。33例患者PET/CT检查阳性；18例为局灶性模式，7例为多灶性，4例为均匀性，4例为不均匀性。基于患者层面分析，PET/CT的Se、Sp和Ac分别为100%、12%和38%；基于前列腺叶层面分析，分别为87%、29%和14%。SUVmax的ROC曲线分析显示曲线下面积（AUC）为0.568（p=0.52）。在前列腺叶层面分析中，PET/CT检查结果与活检结果之间一致性较差（p=0.097）。在单因素/多因素分析中，没有临床和代谢变量作为pCa预测指标具有统计学意义。
胆碱PET/CT是高度选择患者中检测pCa的合适方法，然而，应预期有较高的假阳性率。
