Zarzour Jessica G, Galgano Sam, McConathy Jonathan, Thomas John V, Rais-Bahrami Soroush
Department of Radiology, University of Alabama at Birmingham, Birmingham, AL 35249, United States.
World J Radiol. 2017 Oct 28;9(10):389-399. doi: 10.4329/wjr.v9.i10.389.
Accurate nodal staging at the time of diagnosis of prostate cancer is crucial in determining a treatment plan for the patient. Pelvic lymph node dissection is the most reliable method, but is less than perfect and has increased morbidity. Cross sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) are non-invasive tools that rely on morphologic characteristics such as shape and size of the lymph nodes. However, lymph nodes harboring metastatic disease may be normal sized and non-metastatic lymph nodes may be enlarged due to reactive hyperplasia. The optimal strategy for preoperative staging remains a topic of ongoing research. Advanced imaging techniques to assess lymph nodes in the setting of prostate cancer utilizing novel MRI contrast agents as well as positron emission tomography (PET) tracers have been developed and continue to be studied. Magnetic resonance lymphography utilizing ultra-small super paramagnetic iron oxide has shown promising results in detection of metastatic lymph nodes. Combining MRL with diffusion-weighted imaging may also improve accuracy. Considerable efforts are being made to develop effective PET radiotracers that are performed using hybrid-imaging systems that combine PET with CT or MRI. PET tracers that will be reviewed in this article include [F]fluoro-D-glucose, sodium [F]fluoride, [F]choline, [C]choline, prostate specific membrane antigen binding ligands, [C]acetate, [F]fluciclovine, gastrin releasing peptide receptor ligands, and androgen binding receptors. This article will review these advanced imaging modalities and ability to detect prostate cancer metastasis to lymph nodes. While more research is needed, these novel techniques to image lymph nodes in the setting of prostate cancer show a promising future in improving initial lymph node staging.
前列腺癌诊断时准确的淋巴结分期对于确定患者的治疗方案至关重要。盆腔淋巴结清扫术是最可靠的方法，但并不完美，且发病率会增加。计算机断层扫描（CT）和磁共振成像（MRI）等横断面成像技术是依赖淋巴结形态特征（如形状和大小）的非侵入性工具。然而，存在转移病灶的淋巴结可能大小正常，而非转移性淋巴结可能因反应性增生而肿大。术前分期的最佳策略仍是一个正在研究的课题。利用新型MRI造影剂以及正电子发射断层扫描（PET）示踪剂来评估前列腺癌患者淋巴结的先进成像技术已经得到开发并仍在继续研究。利用超小超顺磁性氧化铁的磁共振淋巴造影在检测转移性淋巴结方面已显示出有前景的结果。将磁共振淋巴造影与扩散加权成像相结合也可能提高准确性。人们正在做出巨大努力来开发有效的PET放射性示踪剂，这些示踪剂通过将PET与CT或MRI相结合的混合成像系统来进行检测。本文将回顾的PET示踪剂包括[F]氟代-D-葡萄糖、[F]氟化钠、[F]胆碱、[C]胆碱、前列腺特异性膜抗原结合配体、[C]乙酸盐、[F]氟西克洛维、胃泌素释放肽受体配体以及雄激素结合受体。本文将回顾这些先进的成像方式以及检测前列腺癌转移至淋巴结的能力。虽然还需要更多研究，但这些用于前列腺癌患者淋巴结成像的新技术在改善初始淋巴结分期方面显示出了有前景的未来。
