Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
J Nucl Med. 2020 Feb;61(2):183-188. doi: 10.2967/jnumed.119.227793. Epub 2019 Aug 26.
Bone metastases in prostate cancer (PCa) have important prognostic significance, and imaging modalities used for PCa staging should have high sensitivity for detecting such lesions. Prostate-specific membrane antigen (PSMA)-targeted PET radiotracers are promising new agents for imaging PCa. We undertook a head-to-head comparison of PSMA-targeted 2-(3-{1-carboxy-5-[(6-F-fluoro-pyridine-3-carbonyl)-amino]-pentyl}-ureido)-pentanedioic acid (F-DCFPyL) PET to NaF PET to determine which modality was more sensitive for the detection of lesions suggestive of bone metastases in a group of patients with metastatic PCa. Patients with progressive, metastatic PCa were prospectively imaged with both F-DCFPyL and NaF PET/CT, with both scans occurring within 24 h of each other. A consensus 2-reader central review was performed to identify all bone lesions suggestive of sites of PCa involvement on both scans, and maximized SUVs corrected for body weight (SUV) and lean body mass (SUL) were recorded. Soft-tissue lesions were also noted on both scans, and SUV, SUL, and PSMA reporting and data system (RADS) version 1.0 scores were recorded. Data from the 2 scans were compared using a generalized estimating equation. In total, 16 patients meeting all inclusion criteria were enrolled in this study, and 15 of the 16 (93.8%) were imaged with both PET radiotracers. In total, 405 bone lesions suggestive of sites of PCa were identified on at least 1 scan. On F-DCFPyL PET/CT, 391 (96.5%) were definitively positive, 4 (1.0%) were equivocally positive, and 10 (2.5%) were negative. On NaF PET/CT, the corresponding values were 388 (95.8%), 4 (1.0%), and 13 (3.2%). Of the definitively negative lesions on F-DCFPyL PET, 8 of 10 (80.0%) were sclerotic and 2 of 10 (20.0%) were infiltrative or marrow-based. Additionally, 12 of 13 (92.3%) of the definitively negative lesions on NaF PET were infiltrative or marrow-based and 1 of 13 (7.7%) was lytic. Also identified were 78 PSMA-RADS-4, 17 PSMA-RADS-5, and 1 PSMA-RADS-3C soft-tissue lesions. PET/CT imaging using F-DCFPyL and NaF PET had nearly identical sensitivities for the detection of bone lesions in patients with metastatic PCa. As would be expected, PSMA-targeted PET provides more information on soft-tissue disease. There may be little additional value to imaging PCa patients with NaF after a PSMA-targeted PET scan has already been performed.
前列腺癌（PCa）的骨转移具有重要的预后意义，用于 PCa 分期的成像方式应该具有较高的灵敏度以检测此类病变。前列腺特异性膜抗原（PSMA）靶向的 PET 放射性示踪剂是一种很有前途的新型 PCa 成像剂。我们进行了 PSMA 靶向的 2-（3-{1-羧基-5-[(6-F-吡啶-3-羰基)-氨基]-戊基}-脲基）-戊二酸（F-DCFPyL）PET 与 NaF PET 的头对头比较，以确定哪种方式对一组转移性 PCa 患者的疑似骨转移病变的检测更敏感。 前瞻性地对患有进行性转移性 PCa 的患者进行 F-DCFPyL 和 NaF PET/CT 成像，两次扫描均在彼此 24 小时内进行。进行了由 2 位读者进行的共识中央审查，以确定两次扫描中所有疑似 PCa 受累部位的骨病变，并记录了经体重校正的最大标准化摄取值（SUV）和瘦体重校正的最大标准化摄取值（SUL）。还记录了两次扫描中的软组织病变，并记录了 SUV、SUL 和 PSMA 报告和数据系统（RADS）版本 1.0 评分。使用广义估计方程比较两次扫描的数据。 共有 16 名符合所有纳入标准的患者入组本研究，其中 15 名（93.8%）患者同时接受了两种 PET 放射性示踪剂的成像。总共在至少一次扫描中发现了 405 个疑似 PCa 部位的骨病变。在 F-DCFPyL PET/CT 上，391 个（96.5%）病变明确阳性，4 个（1.0%）病变可疑阳性，10 个（2.5%）病变阴性。在 NaF PET/CT 上，相应的值为 388（95.8%）、4（1.0%）和 13（3.2%）。在 F-DCFPyL PET 上明确为阴性的病变中，8 个（80.0%）为硬化性病变，10 个（20.0%）为浸润性或骨髓性病变。此外，在 NaF PET 上明确为阴性的病变中，12 个（92.3%）为浸润性或骨髓性病变，1 个（7.7%）为溶骨性病变。还发现了 78 个 PSMA-RADS-4、17 个 PSMA-RADS-5 和 1 个 PSMA-RADS-3C 软组织病变。 在转移性 PCa 患者中，使用 F-DCFPyL 和 NaF PET 的 PET/CT 成像对骨病变的检测具有几乎相同的敏感性。正如预期的那样，PSMA 靶向 PET 提供了更多关于软组织疾病的信息。在已经进行了 PSMA 靶向 PET 扫描后，对 PCa 患者进行 NaF 成像可能没有太多额外的价值。
