University of Toronto, Toronto, Canada
Royal Marsden Hospital, London, United Kingdom.
J Nucl Med. 2019 Sep;60(9):1253-1258. doi: 10.2967/jnumed.118.225185. Epub 2019 Mar 22.
Our purpose was to assess whether the addition of data from multiparametric pelvic MRI (mpMR) and whole-body MRI (wbMR) to the interpretation of F-fluoromethylcholine (F-FCH) or Ga-HBED-CC PSMA-11 (Ga-PSMA) PET/CT (=PET) improves the detection of local tumor recurrence or of nodal and distant metastases in patients after radical prostatectomy with biochemical failure. The current analysis was performed as part of a prospective, multicenter trial on F-FCH or Ga-PSMA PET, mpMR, and wbMR. Eligible men had an elevated level of prostate-specific antigen (PSA) (>0.2 ng/mL) and high-risk features (Gleason score > 7, PSA doubling time < 10 mo, or PSA > 1.0 ng/mL) with negative or equivocal conventional imaging results. PET was interpreted with mpMR and wbMR in consensus by 2 radiologists and compared with prospective interpretation of PET or MRI alone. Performance measures of each modality (PET, MRI, and PET/mpMR-wbMR) were compared for each radiotracer and each individual patient (for F-FCH, or Ga-PSMA for patients who had Ga-PSMA PET) and to a composite reference standard. There were 86 patients with PET (F-FCH [ = 76] and/or Ga-PSMA [ = 26]) who had mpMR and wbMR. Local tumor recurrence was detected in 20 of 76 (26.3%) on F-FCH PET/mpMR, versus 11 of 76 (14.5%) on F-FCH PET ( = 0.039), and in 11 of 26 (42.3%) on Ga-PSMA PET/mpMR, versus 6 of 26 (23.1%) on Ga-PSMA PET ( = 0.074). Per patient, PET/mpMR was more often positive for local tumor recurrence than PET ( = 0.039) or mpMR ( = 0.019). There were 20 of 86 patients (23.3%) with regional nodal metastases on both PET/wbMR and PET ( = 1.0) but only 12 of 86 (14%) on wbMR ( = 0.061). Similarly, there were more nonregional metastases detected on PET/wbMR than on PET ( = 0.683) or wbMR ( = 0.074), but these differences did not reach significance. Compared with the composite reference standard for the detection of disease beyond the prostatic fossa, PET/wbMR, PET, and wbMR had sensitivity of 50%, 50%, and 8.3%, respectively, and specificity of 97.1%, 97.1%, and 94.1%, respectively. Interpretation of PET/mpMR resulted in a higher detection rate for local tumor recurrence in the prostatic bed in men with biochemical failure after radical prostatectomy. However, the addition of wbMR to F-FCH or Ga-PSMA PET did not improve detection of regional or distant metastases.
我们的目的是评估在接受根治性前列腺切除术且生化复发的患者中，将多参数盆腔 MRI（mpMRI）和全身 MRI（wbMRI）的数据添加到 F-氟甲基胆碱（F-FCH）或 Ga-HBED-CC PSMA-11（Ga-PSMA）PET/CT（=PET）的解读中是否可以提高局部肿瘤复发或局部淋巴结和远处转移的检出率。当前分析是一项前瞻性、多中心 F-FCH 或 Ga-PSMA PET、mpMRI 和 wbMRI 研究的一部分。符合条件的患者前列腺特异性抗原（PSA）水平升高（>0.2ng/ml）且具有高危特征（Gleason 评分>7、PSA 倍增时间<10 个月或 PSA>1.0ng/ml），且常规影像学检查结果阴性或不确定。2 位放射科医生对 PET 进行了共识解读，同时结合了 mpMRI 和 wbMRI，并与 PET 或 MRI 单独的前瞻性解读进行了比较。比较了每种放射性示踪剂和每位患者（F-FCH 或 Ga-PSMA 对于接受 Ga-PSMA PET 的患者）以及综合参考标准的每种模态（PET、MRI 和 PET/mpMR-wbMR）的性能指标。有 86 名接受 PET（F-FCH[=76]和/或 Ga-PSMA[=26]）的患者进行了 mpMRI 和 wbMRI 检查。在 F-FCH PET/mpMR 中，20/76（26.3%）患者检测到局部肿瘤复发，而在 F-FCH PET 中为 11/76（14.5%）（=0.039），在 Ga-PSMA PET/mpMR 中，11/26（42.3%）患者检测到局部肿瘤复发，而在 Ga-PSMA PET 中为 6/26（23.1%）（=0.074）。每例患者中，PET/mpMR 检测到局部肿瘤复发的阳性率高于 PET（=0.039）或 mpMR（=0.019）。在 PET/wbMR 和 PET 上均检测到 20/86（23.3%）患者存在区域淋巴结转移（=1.0），但在 wbMR 上仅检测到 12/86（14%）（=0.061）。同样，在 PET/wbMR 上检测到的非区域转移也多于 PET（=0.683）或 wbMR（=0.074），但这些差异没有达到统计学意义。与检测前列腺窝以外疾病的综合参考标准相比，PET/wbMR、PET 和 wbMR 的敏感性分别为 50%、50%和 8.3%，特异性分别为 97.1%、97.1%和 94.1%。PET/mpMR 的解读提高了生化复发后接受根治性前列腺切除术患者前列腺床局部肿瘤复发的检出率。然而，将 wbMRI 添加到 F-FCH 或 Ga-PSMA PET 中并未提高对局部或远处转移的检出率。
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