Department of Diagnostic Radiology, University of Turku, Kiinamyllynkatu 4-8, P.O. Box 52, FI-20521, Turku, Finland.
Department of Radiology, University of Massachusetts Medical School - Baystate, Springfield, MA, USA.
Eur J Nucl Med Mol Imaging. 2018 Mar;45(3):355-364. doi: 10.1007/s00259-017-3875-1. Epub 2017 Nov 16.
The purpose of this study was to evaluate F-FACBC PET/CT, PET/MRI, and multiparametric MRI (mpMRI) in detection of primary prostate cancer (PCa).
Twenty-six men with histologically confirmed PCa underwent PET/CT immediately after injection of 369 ± 10 MBq F-FACBC (fluciclovine) followed by PET/MRI started 55 ± 7 min from injection. Maximum standardized uptake values (SUV) were measured for both hybrid PET acquisitions. A separate mpMRI was acquired within a week of the PET scans. Logan plots were used to calculate volume of distribution (V). The presence of PCa was estimated in 12 regions with radical prostatectomy findings as ground truth. For each imaging modality, area under the curve (AUC) for detection of PCa was determined to predict diagnostic performance. The clinical trial registration number is NCT02002455.
In the visual analysis, 164/312 (53%) regions contained PCa, and 41 tumor foci were identified. PET/CT demonstrated the highest sensitivity at 87% while its specificity was low at 56%. The AUC of both PET/MRI and mpMRI significantly (p < 0.01) outperformed that of PET/CT while no differences were detected between PET/MRI and mpMRI. SUV and V of Gleason score (GS) >3 + 4 tumors were significantly (p < 0.05) higher than those for GS 3 + 3 and benign hyperplasia. A total of 442 lymph nodes were evaluable for staging, and PET/CT and PET/MRI demonstrated true-positive findings in only 1/7 patients with metastatic lymph nodes.
Quantitative F-FACBC imaging significantly correlated with GS but failed to outperform MRI in lesion detection. F-FACBC may assist in targeted biopsies in the setting of hybrid imaging with MRI.
本研究旨在评估 F-FACBC PET/CT、PET/MRI 和多参数 MRI（mpMRI）在检测原发性前列腺癌（PCa）中的作用。
26 名经组织学证实患有 PCa 的男性患者在注射 369±10MBq F-FACBC（氟尿苷）后立即进行 PET/CT 检查，然后在注射后 55±7 分钟开始进行 PET/MRI。对两种混合 PET 采集的最大标准化摄取值（SUV）进行测量。在 PET 扫描后一周内采集单独的 mpMRI。使用 Logan 图计算分布容积（V）。根据根治性前列腺切除术的结果，使用 12 个区域估计 PCa 的存在情况作为金标准。为每种成像方式确定曲线下面积（AUC）以预测诊断性能。临床试验注册号为 NCT02002455。
在视觉分析中，164/312（53%）个区域包含 PCa，共发现 41 个肿瘤病灶。PET/CT 的灵敏度最高，为 87%，但其特异性较低，为 56%。PET/MRI 和 mpMRI 的 AUC 均明显（p<0.01）优于 PET/CT，而 PET/MRI 和 mpMRI 之间无差异。Gleason 评分（GS）>3+4 肿瘤的 SUV 和 V 明显（p<0.05）高于 GS 3+3 和良性增生。共评估了 442 个淋巴结进行分期，只有 1/7 例有转移性淋巴结的患者 PET/CT 和 PET/MRI 显示出真正的阳性结果。
定量 F-FACBC 成像与 GS 显著相关，但在病灶检测方面未能优于 MRI。F-FACBC 可能有助于在 MRI 杂交成像的基础上进行靶向活检。
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