Department of Nuclear Medicine, Assuta Medical Centers, 20 Habarzel Street, 6971028, Tel Aviv, Israel.
Sackler School of Medicine, Tel Aviv University, P.O. Box 39040, 6997801, Tel Aviv, Israel.
Eur Radiol. 2020 Jan;30(1):328-336. doi: 10.1007/s00330-019-06353-y. Epub 2019 Jul 22.
Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer.
This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen's kappa test.
Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings.
Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement.
• Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR. • Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer. • Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.
尽管前列腺特异性膜抗原（PSMA）-PET/MR 比 PSMA-PET/CT 具有优势，但由于其扫描时间相对较长且 PET 衰减校正效果不理想，因此需要仔细评估这种类型研究的最合适设置。我们评估了在接受前列腺癌初始评估的患者中，PSMA-PET/MR 与 PSMA-PET/CT 之间的病灶一致性。
这是一项连续接受盆腔 PSMA-PET/MR 检查后再行全身 PSMA-PET/CT 检查的经组织学活检证实的前列腺癌患者的前瞻性研究。所有明显的 PSMA 摄取病灶均在 PSMA-PET/CT 上进行计数，并结合 CT 或 MR 进行相关性分析。分析包括前列腺内病灶、包膜侵犯、精囊受累以及淋巴结和骨转移。还分析了 PSMA-PET/CT 视野外的偶然和显著发现。使用 Cohen's kappa 检验评估 PSMA-PET/CT 和 PSMA-PET/MR 检查结果之间的一致性。
对 140 例患者（平均年龄 67.3±8.2 岁）进行了图像分析。PSMA PET/CT 与 PSMA-PET/MR 对前列腺内 PSMA 摄取灶（K=0.85）和盆腔淋巴结（K=0.98）的一致性非常好，对 PSMA 摄取骨转移（K=0.76）的一致性较好，对前列腺包膜侵犯（K=0.25）和精囊侵犯（K=0.31）的一致性一般。12 例患者（8.5%）有偶然发现，2 例患者（1.4%）有临床显著发现。
有限的盆腔 PSMA-PET/MR 在检测前列腺局部区域、淋巴结和骨骼 PSMA 摄取病灶方面与 PET/CT 具有非常好的一致性，在包膜侵犯和精囊侵犯方面优于 PET/CT。
与全身 PSMA-PET/CT 相比，有限的盆腔 PSMA-PET/MR 更有利于检测局限性疾病的扩展，这主要得益于 MR 的高软组织分辨率。
有限的盆腔 PSMA-PET/MR 可能有助于对经组织学活检证实的前列腺癌进行初始评估。
有必要进一步研究有限的盆腔 PSMA-PET/MR 在特定人群中的筛查和主动监测中的作用。
