多参数 MRI 与 Ga-PSMA-11 PET/MRI 对前列腺癌患者包膜外侵犯和精囊侵犯的诊断准确性比较。

Diagnostic Accuracy of Multiparametric MRI versus Ga-PSMA-11 PET/MRI for Extracapsular Extension and Seminal Vesicle Invasion in Patients with Prostate Cancer.

机构信息

From the Institute of Diagnostic and Interventional Radiology (U.J.M., A.S.B., K.S., A.M.H., C.S.R., O.F.D.), Department of Nuclear Medicine (U.J.M., I.A.B., J.M.), Department of Pathology and Molecular Pathology (N.J.R., J.H.R.), and Department of Urology (D.E.), University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich 8091, Switzerland; and Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland (I.A.B.).

出版信息

Radiology. 2019 Nov;293(2):350-358. doi: 10.1148/radiol.2019190687. Epub 2019 Sep 10.

DOI:10.1148/radiol.2019190687

PMID:31502937

Abstract

Background Recent studies have reported the additive value of combined gallium 68 (Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (hereafter called Ga-PSMA-11) PET/MRI for the detection and localization of primary prostate cancer compared with multiparametric MRI. Purpose To compare the diagnostic accuracy and interrater agreement of multiparametric MRI and Ga-PSMA-11 PET/MRI for the detection of extracapsular extension (ECE) and seminal vesicle infiltration (SVI) in patients with prostate cancer. Materials and Methods Retrospective analysis of 40 consecutive men who underwent multiparametric MRI and Ga-PSMA-11 PET/MRI within 6 months for suspected prostate cancer followed by radical prostatectomy between April 2016 and July 2018. Four readers blinded to clinical and histopathologic findings rated the probability of ECE and SVI at multiparametric MRI and PET/MRI by using a five-point Likert-type scale. The prostatectomy specimen served as the reference standard. Accuracy was assessed with a multireader multicase analysis and by calculating reader-average areas under the receiver operating characteristics curve (AUCs), sensitivity, and specificity for ordinal and dichotomized data in a region-specific and patient-specific approach. Interrater agreement was assessed with the Fleiss multirater κ. Results For multiparametric MRI versus PET/MRI in ECE detection, respectively, AUC, sensitivity, and specificity in the region-specific analysis were 0.67 and 0.75 ( .07), 28% (21 of 76) and 47% (36 of 76) ( .09), and 94% (529 of 564) and 90% (509 of 564) ( .007). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.66 and 0.73 ( .19), 46% (22 of 48) and 69% (33 of 48) ( .04), and 75% (84 of 112) and 67% (75 of 112) ( .19), respectively. For multiparametric MRI versus PET/MRI in SVI detection, respectively, AUC, sensitivity, and specificity of the region-specific analysis were 0.66 and 0.74 ( .21), 35% (seven of 20) and 50% (10 of 20) ( .25), and 98% (295 of 300) and 94% (282 of 300) ( < .001). For the patient-specific analysis, AUC, sensitivity, and specificity were 0.65 and 0.79 ( .25), 35% (seven of 20) and 55% (11 of 20) ( .20), and 98% (137 of 140) and 94% (131 of 140) ( .07), respectively. Interrater reliability for multiparametric MRI versus PET/MRI did not differ for ECE (κ, 0.46 vs 0.40; = .24) and SVI (κ, 0.23 vs 0.33; = .39). Conclusion Our results suggest that gallium 68 (Ga)-labeled Glu-urea-Lys (Ahx)-HBED-CC ligand targeting the prostate-specific membrane antigen (PSMA) (Ga-PSMA-11) PET/MRI and multiparametric MRI perform similarly for local staging of prostate cancer in patients with intermediate-to-high-risk prostate cancer. The increased sensitivity of Ga-PSMA-11 PET/MRI for the detection of extracapsular disease comes at the cost of a slightly reduced specificity. © RSNA, 2019.

摘要

背景最近的研究报告称，与多参数 MRI 相比，前列腺特异性膜抗原（PSMA）靶向的镓 68（Ga）标记的 Glu-urea-Lys（Ahx）-HBED-CC 配体（简称 Ga-PSMA-11）PET/MRI 在检测和定位原发性前列腺癌方面具有附加价值。目的比较多参数 MRI 和 Ga-PSMA-11 PET/MRI 对疑似前列腺癌患者检测包膜外延伸（ECE）和精囊侵犯（SVI）的诊断准确性和观察者间一致性。材料与方法回顾性分析了 40 例 2016 年 4 月至 2018 年 7 月期间接受多参数 MRI 和 Ga-PSMA-11 PET/MRI 检查且随后接受根治性前列腺切除术的连续男性患者。4 位观察者在不知临床和组织病理学结果的情况下，使用 5 分李克特量表对多参数 MRI 和 PET/MRI 上 ECE 和 SVI 的概率进行评分。前列腺切除术标本作为参考标准。采用多读者多病例分析评估准确性，并计算读者平均受试者工作特征曲线（ROC）下面积（AUC）、敏感性和特异性，对区域和个体患者进行有序和二分类数据的分析。采用 Fleiss 多观察者 κ 评估观察者间一致性。结果多参数 MRI 与 PET/MRI 在 ECE 检测中的比较结果为：区域分析中分别为 0.67 和 0.75（.07）、28%（76 例中的 21 例）和 47%（76 例中的 36 例）（.09）、94%（564 例中的 529 例）和 90%（564 例中的 509 例）（.007）；个体患者分析中分别为 0.66 和 0.73（.19）、46%（48 例中的 22 例）和 69%（48 例中的 33 例）（.04）、75%（112 例中的 84 例）和 67%（112 例中的 75 例）（.19）。多参数 MRI 与 PET/MRI 在 SVI 检测中的比较结果为：区域分析中分别为 0.66 和 0.74（.21）、35%（20 例中的 7 例）和 50%（20 例中的 10 例）（.25）、98%（300 例中的 295 例）和 94%（300 例中的 282 例）（ <.001）；个体患者分析中分别为 0.65 和 0.79（.25）、35%（20 例中的 7 例）和 55%（20 例中的 11 例）（.20）、98%（140 例中的 137 例）和 94%（140 例中的 131 例）（.07）。ECE（κ，0.46 对 0.40； =.24）和 SVI（κ，0.23 对 0.33； =.39）的多参数 MRI 与 PET/MRI 的观察者间可靠性无差异。结论我们的研究结果表明，与多参数 MRI 相比，镓 68（Ga）标记的 Glu-urea-Lys（Ahx）-HBED-CC 配体靶向前列腺特异性膜抗原（PSMA）（Ga-PSMA-11）PET/MRI 对中高危前列腺癌患者的前列腺癌局部分期具有相似的作用。Ga-PSMA-11 PET/MRI 检测包膜外疾病的敏感性增加是以特异性略有降低为代价的。 ©2019 RSNA。