Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
J Nucl Med. 2019 Sep;60(9):1221-1227. doi: 10.2967/jnumed.118.220111. Epub 2019 Mar 8.
F-fluorodihydrotestosterone (F-FDHT) PET/CT potentially provides a noninvasive method for assessment of androgen receptor expression in patients with metastatic castration-resistant prostate cancer (mCRPC). The objective of this study was to assess simplified methods for quantifying F-FDHT uptake in mCRPC patients and to assess effects of tumor perfusion on these F-FDHT uptake metrics. Seventeen mCRPC patients were included in this prospective observational multicenter study. Test and retest 30-min dynamic F-FDHT PET/CT scans with venous blood sampling were performed in 14 patients. In addition, arterial blood sampling and dynamic O-HO scans were obtained in a subset of 6 patients. Several simplified methods were assessed: Patlak plots; SUV normalized to body weight (SUV), lean body mass (SUV), whole blood (SUV), parent plasma activity concentration (SUV), area under the parent plasma curve (SUV), and area under the whole-blood input curve (SUV); and SUV corrected for sex hormone-binding globulin levels (SUV). Results were correlated with parameters derived from full pharmacokinetic F-FDHT and O-HO. Finally, the repeatability of individual quantitative uptake metrics was assessed. Eighty-seven F-FDHT-avid lesions were evaluated. F-FDHT uptake was best described by an irreversible 2-tissue-compartment model. Replacing the continuous metabolite-corrected arterial plasma input function with an image-derived input function in combination with venous sample data provided similar results ( = 0.98). Patlak and SUV showed an excellent correlation ( > 0.9). SUV showed a moderate correlation to ( = 0.70, presumably due to fast F-FDHT metabolism. When calculating SUV, correlation to improved ( = 0.88). The repeatability of full kinetic modeling parameters was inferior to that of simplified methods (repeatability coefficients > 36% vs. < 28%, respectively). F-FDHT uptake showed minimal blood flow dependency. F-FDHT kinetics in mCRPC patients are best described by an irreversible 2-tissue-compartment model with blood volume parameter. SUV showed a near-perfect correlation with the irreversible 2-tissue-compartment model analysis and can be used for accurate quantification of F-FDHT uptake in whole-body PET/CT scans. In addition, SUV could potentially be used as an even simpler method to quantify F-FDHT uptake when less complex scanning protocols and accuracy are required.
F-氟去氢睾酮（F-FDHT）正电子发射断层扫描/计算机断层扫描（PET/CT）可能为评估转移性去势抵抗性前列腺癌（mCRPC）患者的雄激素受体表达提供一种非侵入性方法。本研究的目的是评估简化 mCRPC 患者 F-FDHT 摄取的定量方法，并评估肿瘤灌注对这些 F-FDHT 摄取指标的影响。
这项前瞻性观察性多中心研究纳入了 17 例 mCRPC 患者。14 例患者进行了测试和复测 30 分钟的 F-FDHT PET/CT 动态扫描和静脉血取样。此外，6 例患者的亚组还进行了动脉血取样和动态 O-HO 扫描。评估了几种简化方法：Patlak 图；SUV 与体重（SUV）、瘦体重（SUV）、全血（SUV）、母血浆活性浓度（SUV）、母血浆曲线下面积（SUV）和全血输入曲线下面积（SUV）标准化；以及根据性激素结合球蛋白水平校正的 SUV（SUV）。结果与来自完整药代动力学 F-FDHT 和 O-HO 的参数相关。最后，评估了各个定量摄取指标的重复性。
评估了 87 个 F-FDHT 阳性病灶。F-FDHT 摄取最好用不可逆的 2 组织室模型来描述。用图像衍生的输入函数代替连续代谢校正的动脉血浆输入函数，同时结合静脉样本数据，提供了类似的结果（=0.98）。Patlak 和 SUV 具有极好的相关性（>0.9）。SUV 与（=0.70 有中度相关性，可能是由于 F-FDHT 快速代谢。当计算 SUV 时，与（的相关性提高（=0.88）。全动力学建模参数的重复性不如简化方法（重复性系数>36%对<28%）。F-FDHT 摄取显示出最小的血流依赖性。mCRPC 患者的 F-FDHT 动力学最好用不可逆的 2 组织室模型加血容量参数来描述。SUV 与不可逆的 2 组织室模型分析具有近乎完美的相关性，可用于全身 PET/CT 扫描中 F-FDHT 摄取的准确量化。此外，当需要更简单的扫描方案和准确性时，SUV 可能可作为更简单的量化 F-FDHT 摄取的方法。
