Wallitt Kathryn L, Khan Sairah R, Dubash Suraiya, Tam Henry H, Khan Sameer, Barwick Tara D
From the Departments of Nuclear Medicine (K.L.W., S.D., H.H.T.) and Radiology (S.R.K., S.K., T.D.B.), Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, England.
Radiographics. 2017 Sep-Oct;37(5):1512-1536. doi: 10.1148/rg.2017170035. Epub 2017 Aug 11.
Prostate cancer is the second most common cancer in men worldwide, with a wide spectrum of biologic behavior ranging from indolent low-risk disease to highly aggressive castration-resistant prostate cancer. Conventional imaging with computed tomography, magnetic resonance imaging, and bone scintigraphy is limited for the detection of nodal disease and distant bone metastases. In addition, advances in the available therapeutic options, both localized and systemic, drive the requirement for precise diagnostic and prognostic tools to refine the individual therapeutic approach at various times in the management of patients with prostate cancer. Positron emission tomography (PET) has a rapidly evolving role in the assessment of prostate cancer, particularly in the scenario of biochemical relapse. Fluorine 18 (F) fluorodeoxyglucose, the most widely available PET tracer, has limitations, particularly in indolent prostate cancer. In the past decade, several PET tracers with specific molecular targets have reached the clinical domain. These tracers include F-sodium fluoride, which is a bone-specific biomarker of osteoblastic activity; F-choline and carbon 11-choline, which are directed at cell membrane metabolism; gallium 68-prostate-specific membrane antigen ligands; and, more recently, an amino acid analog, F-fluciclovine (anti-1-amino-3-F-fluorocyclobutane-1-carboxylic acid; also known as FACBC), which is also directed at cell membrane turnover. The mechanisms of actions of the clinically available PET tracers are reviewed, as well as their role in the imaging of prostate cancer with reference to relevant guidelines and the technical and imaging pearls and pitfalls of these tracers. RSNA, 2017.
前列腺癌是全球男性中第二常见的癌症，其生物学行为范围广泛，从惰性低风险疾病到高度侵袭性的去势抵抗性前列腺癌。传统的计算机断层扫描、磁共振成像和骨闪烁显像对于检测淋巴结疾病和远处骨转移存在局限性。此外，现有局部和全身治疗选择的进展推动了对精确诊断和预后工具的需求，以便在前列腺癌患者管理的不同阶段优化个体化治疗方法。正电子发射断层扫描（PET）在前列腺癌评估中发挥着迅速演变的作用，尤其是在生化复发的情况下。氟-18（F）氟脱氧葡萄糖是应用最广泛的PET示踪剂，但存在局限性，特别是在惰性前列腺癌中。在过去十年中，几种具有特定分子靶点的PET示踪剂已进入临床应用领域。这些示踪剂包括F-氟化钠，它是成骨细胞活性的骨特异性生物标志物；F-胆碱和碳-11-胆碱，它们针对细胞膜代谢；镓-68-前列腺特异性膜抗原配体；以及最近的一种氨基酸类似物F-氟代环戊氨酸（反式-1-氨基-3-F-氟环丁烷-1-羧酸；也称为FACBC），它也针对细胞膜更新。本文综述了临床可用PET示踪剂的作用机制，以及它们在前列腺癌成像中的作用，并参考了相关指南以及这些示踪剂的技术和成像要点与陷阱。RSNA，2017年。
