Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, China.
Department of Urology, San Glovanni Battista Hospital, Città della Salute Scienza and University of Turin, Turin, Italy.
J Nucl Med. 2019 Jul;60(7):944-949. doi: 10.2967/jnumed.118.221010. Epub 2018 Dec 14.
Our purpose was to explore whether Ga-PSMA PET/CT alone (PET/CT) or in combination with multiparametric MRI (PET/MRI) can improve the detection of clinically significant prostate cancer (PCa). We retrospectively enrolled 54 patients who underwent both MRI and PET/CT before radical prostatectomy. Regions of interest on MR images, PET/CT images, and pathologic images were marked. A lesion was defined as a region of interest marked on images obtained with any of the 3 modalities. All lesions were characterized using the prostate imaging reporting and data system (PI-RADS), the molecular imaging PSMA expression score, and the pathologic results and analyzed. Diagnostic performance was analyzed by receiver-operating-characteristic analysis. Specific improvement for lesions with different PI-RADS scores was analyzed using the net reclassification index (NRI). In total, 90 lesions from 54 patients were analyzed, among which 66 lesions represented clinically significant PCa. Receiver-operating-characteristic analysis showed PET/MRI to perform better than MRI in detecting clinically significant PCa (change in area under the curve, 0.06; 95% confidence interval, 0.01-0.12; < 0.05). With the calculated cutoff, PET/MRI performed significantly better than MRI (NRI, 21.9%; < 0.01), with an improvement in sensitivity (89% vs. 76%, < 0.01) at no sacrifice of specificity (96% vs. 88%, > 0.05). Improvement in diagnosing clinically significant PCa occurred for lesions classified as PI-RADS 3 (NRI, 66.7%; < 0.01). PET/MRI improves the detection of clinically significant PCa for PI-RADS 3 lesions.
我们的目的是探讨 Ga-PSMA PET/CT 单独（PET/CT）或与多参数 MRI（PET/MRI）联合是否可以提高对临床显著前列腺癌（PCa）的检测。我们回顾性地招募了 54 名在根治性前列腺切除术前同时接受 MRI 和 PET/CT 检查的患者。在 MR 图像、PET/CT 图像和病理图像上标记感兴趣区域。将病灶定义为任何 3 种模态之一获得的图像上标记的感兴趣区域。使用前列腺成像报告和数据系统（PI-RADS）、分子成像 PSMA 表达评分以及病理结果对所有病灶进行特征描述，并进行分析。通过接收者操作特征分析评估诊断性能。使用净重新分类指数（NRI）分析不同 PI-RADS 评分病灶的具体改善情况。总共分析了 54 名患者的 90 个病灶，其中 66 个病灶代表临床显著 PCa。接收者操作特征分析显示，PET/MRI 在检测临床显著 PCa 方面优于 MRI（曲线下面积变化，0.06；95%置信区间，0.01-0.12；<0.05）。使用计算的截止值，PET/MRI 显著优于 MRI（NRI，21.9%；<0.01），在不牺牲特异性（96%对 88%；>0.05）的情况下，敏感性提高（89%对 76%；<0.01）。PI-RADS 3 类病变的诊断能力显著提高（NRI，66.7%；<0.01）。PET/MRI 提高了 PI-RADS 3 类病变临床显著 PCa 的检出率。
