Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York; Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Diagnostic Radiology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York.
J Am Coll Cardiol. 2019 Apr 2;73(12):1386-1394. doi: 10.1016/j.jacc.2018.10.076. Epub 2019 Mar 4.
Fluorine-18 sodium fluoride (NaF), a bone-seeking radiopharmaceutical used to detect osseous metastases, localizes in regions of microcalcification in atherosclerosis.
To determine if atherosclerosis of penile arteries plays a role in erectile dysfunction (ED), this study analyzed NaF images in prostate cancer patients.
NaF positron emission tomography-computed tomography bone scans were evaluated in 437 prostate cancer patients (age 66.6 ± 8.7 years). Their urologic histories were reviewed for prevalent ED (diagnosed before the scan date) or incident ED (no ED at first scan, but developed during 1-year follow-up); patients with no ED (neither before the scan nor during follow-up) were included as a control group. A semicircular region of interest was set on the dorsal one-half of the penis (to avoid residual excreted activity in the urethra) on 5 contiguous slices at the base of the penis on positron emission tomography-computed tomography coronal reconstructions, and the average standardized uptake value (SUVmax) was described as NaF uptake.
Of 437 patients, 336 (76.9%) had prevalent ED, 60 incident ED (13.7%), and 41 had no ED (9.4%). SUVmax in patients with prevalent (median 1.88; interquartile range [IQR]: 1.67 to 2.16) or incident (median 1.86; IQR: 1.72 to 2.08) ED was significantly higher than no ED (median 1.42; IQR: 1.25 to 1.54) patients (p < 0.001). After adjustment for other risk factors, the odds ratio of prevalent or incident ED was 25.2 (95% confidence interval: 9.5 to 67.0) for every 0.5-U increment in SUVmax with receptor operating characteristic area of 0.91 (95% confidence interval: 0.88 to 0.94).
NaF uptake in penile vessels suggests that atherosclerosis is associated with ED in prostate cancer patients. The importance of NaF uptake needs to be tested in noncancer subjects and cause-effect relationship needs to be established.
氟-18 氟化钠（NaF）是一种用于检测骨转移的亲骨性放射性药物，可定位于动脉粥样硬化中的微钙化区域。
为了确定阴茎动脉粥样硬化是否与勃起功能障碍（ED）有关，本研究分析了前列腺癌患者的 NaF 图像。
对 437 例前列腺癌患者（年龄 66.6±8.7 岁）进行 NaF 正电子发射断层扫描-计算机断层扫描骨扫描评估。回顾他们的泌尿科病史，以确定是否存在普遍存在的 ED（在扫描日期之前诊断）或新发 ED（首次扫描时无 ED，但在 1 年随访期间发生）；无 ED 的患者（扫描前和随访期间均无 ED）被纳入对照组。在正电子发射断层扫描-计算机断层扫描冠状重建的阴茎底部的 5 个连续切片上，设置一个半圆形的感兴趣区域（ROI），位于阴茎的背侧一半（以避免尿道中残留的排泄活性），并描述平均标准化摄取值（SUVmax）作为 NaF 摄取。
在 437 例患者中，336 例（76.9%）有普遍存在的 ED，60 例有新发 ED（13.7%），41 例无 ED（9.4%）。普遍存在 ED（中位数 1.88；四分位距 [IQR]：1.67 至 2.16）或新发 ED（中位数 1.86；IQR：1.72 至 2.08）患者的 SUVmax 明显高于无 ED（中位数 1.42；IQR：1.25 至 1.54）患者（p<0.001）。在校正其他危险因素后，SUVmax 每增加 0.5 个单位，普遍存在或新发 ED 的比值比为 25.2（95%置信区间：9.5 至 67.0），受体操作特征面积为 0.91（95%置信区间：0.88 至 0.94）。
阴茎血管中的 NaF 摄取表明动脉粥样硬化与前列腺癌患者的 ED 有关。需要在非癌症患者中验证 NaF 摄取的重要性，并建立因果关系。
