Kanoun Salim, Walker Paul, Vrigneaud Jean-Marc, Depardon Edouard, Barbier Vincent, Humbert Olivier, Moulin Morgan, Créhange Gilles, Cormier Luc, Loffroy Romaric, Brunotte François, Cochet Alexandre
Department of Nuclear Medicine, Centre Georges-François Leclerc, Dijon, France; LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
LE2I UMR6306, Centre national de la recherche scientifique, Arts et Métiers, Université Bourgogne Franche-Comté, Dijon, France; MRI Unit, Centre Hospitalier Régional Universitaire, Hôpital François Mitterrand, Dijon, France.
Int J Radiat Oncol Biol Phys. 2017 Apr 1;97(5):986-994. doi: 10.1016/j.ijrobp.2016.12.025. Epub 2016 Dec 28.
To compare the diagnostic performance of F-fluorocholine positron emission tomography/computed tomography (FCH-PET/CT), multiparametric prostate magnetic resonance imaging (mpMRI), and a combination of both techniques for the detection of local recurrence of prostate cancer initially treated by radiation therapy.
This was a retrospective, single-institution study of 32 patients with suspected prostate cancer recurrence who underwent both FCH-PET/CT and 3T mpMRI within 3 months of one another for the detection of recurrence. All included patients had to be cleared for metastatic recurrence. The reference procedure was systematic 3-dimensional (3D)-transperineal prostate biopsy for the final assessment of local recurrence. Both imaging modalities were analyzed by 2 experienced readers blinded to clinical data. The analysis was made per-patient and per-segment using a 4-segment model.
The median prostate-specific antigen value at the time of imaging was 2.92 ng/mL. The mean prostate-specific antigen doubling time was 14 months. Of the 32 patients, 31 had a positive 3D-transperineal mapping biopsy for a local relapse. On a patient-based analysis, the detection rate was 71% (22 of 31) for mpMRI and 74% (23 of 31) for FCH-PET/CT. On a segment-based analysis, the sensitivity and specificity were, respectively, 32% and 87% for mpMRI, 34% and 87% for FCH-PET/CT, and 43% and 83% for the combined analysis of both techniques. Accuracy was 64%, 65%, and 66%, respectively. The interobserver agreement was κ = 0.92 for FCH-PET/CT and κ = 0.74 for mpMRI.
Both mpMRI and FCH-PET/CT show limited sensitivity but good specificity for the detection of local cancer recurrence after radiation therapy, when compared with 3D-transperineal mapping biopsy. Prostate biopsy still seems to be mandatory to diagnose local relapse and select patients who could benefit from local salvage therapy.
比较¹⁸F-氟胆碱正电子发射断层扫描/计算机断层扫描（FCH-PET/CT）、多参数前列腺磁共振成像（mpMRI）以及这两种技术联合使用对最初接受放射治疗的前列腺癌局部复发的诊断性能。
这是一项在单一机构进行的回顾性研究，纳入了32例疑似前列腺癌复发的患者，他们在3个月内先后接受了FCH-PET/CT和3T mpMRI检查以检测复发情况。所有纳入患者均已排除远处转移复发。参考检查方法为系统性三维（3D）经会阴前列腺穿刺活检，用于最终评估局部复发情况。两种成像方式均由2名对临床数据不知情的经验丰富的阅片者进行分析。分析采用4分区模型，按患者和分区分别进行。
成像时前列腺特异性抗原的中位数为2.92 ng/mL。前列腺特异性抗原的平均倍增时间为14个月。32例患者中，31例经3D经会阴定位活检证实为局部复发。基于患者的分析中，mpMRI的检出率为71%（31例中的22例），FCH-PET/CT的检出率为74%（31例中的23例）。基于分区的分析中，mpMRI的敏感性和特异性分别为32%和87%，FCH-PET/CT分别为34%和87%，两种技术联合分析分别为43%和83%。准确性分别为64%、65%和66%。观察者间一致性FCH-PET/CT为κ = 0.92，mpMRI为κ = 0.74。
与3D经会阴定位活检相比，mpMRI和FCH-PET/CT在检测放射治疗后局部癌症复发方面敏感性有限，但特异性良好。前列腺穿刺活检似乎仍是诊断局部复发和选择可能从局部挽救治疗中获益的患者的必要手段。
