Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Nuclear Medicine, INF 400, 69120, Heidelberg, Germany.
Eur J Nucl Med Mol Imaging. 2019 Oct;46(11):2289-2297. doi: 10.1007/s00259-019-04438-w. Epub 2019 Jul 27.
So far, there have been very few studies which provide a direct comparison between MRI and PSMA-ligand PET/CT for the detection of recurrent prostate cancer (rPC). This present study therefore aims to provide further clinical data in order to resolve this urgent clinical question, and thereby strengthen clinical recommendations.
A retrospective analysis was performed for patients who were scanned at our institution with whole-body PSMA-PET/CT (tracer: 68Ga-PSMA-11) between January 2017 and September 2018 in order to detect rPC. Amongst them, 43 underwent an additional pelvic MRI within 2 months. Both modalities were compared as follows: a consensus read of the PET data was performed by two nuclear physicians. All lesions were recorded with respect to their type and localization. The same process was conducted by two radiologists for pelvic MRI. Thereafter, both modalities were directly compared for every patient and lesion.
Overall, 30/43 patients (69.8%) presented with a pathologic MRI and 38/43 (88.4%) with a pathologic PSMA-PET/CT of the pelvis. MRI detected 53 pelvic rPC lesions (13 of them classified as "uncertain") and PSMA-PET/CT detected 75 pelvic lesions (three classified as "uncertain"). The superiority of PSMA-PET/CT was statistically significant only if uncertain lesions were classified as false-positive.
PSMA-PET/CT detected more pelvic lesions characteristic for rPC when compared to MRI. In order to detect rPC, a potential future scenario could be conducting first a PSMA-PET/CT. Combining the advantages of both modalities in hybrid PET/MRI scanners would be an ideal future scenario.
迄今为止，很少有研究对 MRI 和 PSMA 配体 PET/CT 检测复发性前列腺癌（rPC）进行直接比较。因此，本研究旨在提供更多的临床数据，以解决这一迫切的临床问题，并为临床建议提供支持。
对 2017 年 1 月至 2018 年 9 月在我院接受全身 PSMA-PET/CT（示踪剂：68Ga-PSMA-11）扫描以检测 rPC 的患者进行回顾性分析。其中，43 例患者在 2 个月内接受了额外的盆腔 MRI 检查。对两种方法进行了如下比较：由两名核医学医师对 PET 数据进行共识解读。记录所有病变的类型和位置。两名放射科医师对盆腔 MRI 进行了相同的处理。然后，对每位患者和每个病变进行直接比较两种模态。
总体而言，30/43 例患者（69.8%）的 MRI 检查结果为阳性，38/43 例患者（88.4%）的 PSMA-PET/CT 检查结果为阳性。MRI 检测到 53 个盆腔 rPC 病变（其中 13 个为“不确定”），PSMA-PET/CT 检测到 75 个盆腔病变（3 个为“不确定”）。只有当不确定病变被归类为假阳性时，PSMA-PET/CT 的优势才有统计学意义。
与 MRI 相比，PSMA-PET/CT 检测到更多与 rPC 相关的盆腔病变。为了检测 rPC，未来的潜在方案可能是先进行 PSMA-PET/CT 检查。在混合 PET/MRI 扫描仪中结合两种模态的优势将是一种理想的未来方案。
