Amorim Barbara J, Prabhu Vinay, Marco Sara S, Gervais Debra, Palmer Willian E, Heidari Pedram, Vangel Mark, Saylor Philip J, Catalano Onofrio A
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
Eur J Nucl Med Mol Imaging. 2020 Jan;47(1):105-114. doi: 10.1007/s00259-019-04506-1. Epub 2019 Sep 6.
F-Fluciclovine is indicated for evaluation of suspected prostate cancer (PCa) biochemical recurrence. There are few studies investigating fluciclovine with PET/MR and none evaluated osseous metastases. Our aim was to assess the performance of F-fluciclovine PET/MR (fluciclovine-PET/MR) for detecting osseous metastases in patients with castration-resistant prostate cancer (CRPC). We also investigated possible correlations between SUVmax and ADCmean.
We evaluated 8 patients with CRPC metastatic to bones, some before and some after radium therapy, who underwent 13 fluciclovine-PET/MR studies. We analyzed the performance of radionuclide bone scan (RBS), MR alone, fluciclovine-PET alone, and fluciclovine-PET/MR in detecting osseous metastases. Lesion size, characteristics (early sclerotic, late sclerotic, mixed, lytic), SUVmax, and ADCmean were assessed. The reference standard was a combination of clinical information and correlation with both prior and follow-up imaging.
Of 347 metastatic bony lesions in 13 studies, 238/347 (68%) were detected by fluciclovine-PET alone, 286/347 (82%) by RBS, 344/347 (99%) by MR alone, and 347/347 (100%) by fluciclovine-PET/MR. Fluciclovine-PET/MR and MR had the best performance (p < 0.001). There was no statistically significant difference between fluciclovine-PET/MR and MR alone (p = 0.25). Fluciclovine-PET had a lower detection rate especially with late sclerotic lesions (p < 0.001). There was a moderate inverse correlation between lesion SUVmax and ADCmean (r = - 0.49; p < 0.001).
This study suggests that fluciclovine-PET/MR and MR have high sensitivity for detecting osseous metastases in CRPC. Fluciclovine-PET alone underperformed in detecting late sclerotic lesions. The inverse correlation between SUVmax and ADCmean suggests a possible relationship between tumor metabolism and cellularity.
F-氟西克洛维可用于评估疑似前列腺癌（PCa）的生化复发情况。很少有研究对氟西克洛维联合正电子发射断层扫描/磁共振成像（PET/MR）进行调查，且尚无研究评估其对骨转移的诊断价值。我们的目的是评估F-氟西克洛维PET/MR（氟西克洛维-PET/MR）在检测去势抵抗性前列腺癌（CRPC）患者骨转移方面的性能。我们还研究了最大标准摄取值（SUVmax）与平均表观扩散系数（ADCmean）之间可能存在的相关性。
我们评估了8例发生骨转移的CRPC患者，部分患者在镭治疗前后接受了13次氟西克洛维-PET/MR检查。我们分析了放射性核素骨扫描（RBS）、单纯磁共振成像（MR）、单纯氟西克洛维-PET以及氟西克洛维-PET/MR在检测骨转移方面的性能。评估了病变大小、特征（早期硬化、晚期硬化、混合、溶骨性）、SUVmax和ADCmean。参考标准是临床信息与先前及后续影像学检查结果的综合。
在13项研究中的347个骨转移病变中，单纯氟西克洛维-PET检测出238/347（68%），RBS检测出286/347（82%），单纯MR检测出344/347（99%），氟西克洛维-PET/MR检测出347/347（100%）。氟西克洛维-PET/MR和MR的性能最佳（p < 0.001）。氟西克洛维-PET/MR与单纯MR之间无统计学显著差异（p = 0.25）。氟西克洛维-PET的检测率较低，尤其是对晚期硬化性病变（p < 0.001）。病变SUVmax与ADCmean之间存在中度负相关（r = -0.49；p < 0.001）。
本研究表明，氟西克洛维-PET/MR和MR在检测CRPC骨转移方面具有高敏感性。单纯氟西克洛维-PET在检测晚期硬化性病变方面表现欠佳。SUVmax与ADCmean之间的负相关表明肿瘤代谢与细胞密度之间可能存在关联。
