Radzina Maija, Tirane Mara, Roznere Lilita, Zemniece Liene, Dronka Laura, Kalnina Marika, Mamis Edgars, Biederer Juergen, Lietuvietis Vilnis, Freimanis Arvis, Vjaters Egils
Riga Stradins University, Radiology Research Laboratory Riga, Latvia.
Riga Stradins University Nuclear Medicine Clinic Riga, Latvia.
Am J Nucl Med Mol Imaging. 2020 Apr 15;10(2):106-118. eCollection 2020.
Anatomical and functional imaging plays a decisive role for detection and staging, of prostate cancer both primarily and post-treatment. While multiparametric MRI offers anatomic imaging with excellent soft tissue contrast, hybrid imaging based on positron emission tomography in combination with computed tomography (PET/CT) contributes functional imaging capacities. Since Ga-PSMA-11 was expected to be more efficient than the prior Choline-based PET radiotracers, it was the aim of the study to evaluate the diagnostic performance of the Ga-PSMA-11 PET/CT and multiparametric MRI in patients with recurrent prostate cancer and low PSA levels. 32 out of a cohort of 128 prostate cancer patients with biochemical relapse were referred for Ga-PSMA-11 PET/CT, MRI and bone scintigraphy. According to the histopathologically or clinically defined reference standard all results were classified as true positive, false positive, true negative or false negative. Local recurrence was present in 11/32 patients, lymph node metastases - in 13/32 patients and, bone metastases - in 6/32 patients. Against the standard of reference, sensitivity, specificity and accuracy for local recurrence of PET/CT were 63.6 %; 73.7%; 77.8%, respectively. MRI reached 90.9%; 94.7%; 92.3%, respectively. For local lymph node metastases PET/CT - 83.3%; 80.0% and 90.6%, respectively. MRI - 41.7%; 94.4%; 72.0%, respectively. For evaluation of bone metastases in PET/CT - 83.3%; 92.0%; 71.0%, respectively. Bone scintigraphy - 50.0%; 84.0%; 77.4%, respectively. In conclusion, mpMRI offered the better diagnostic accuracy in the detection of local recurrence and while PSMA PET/CT was superior in the detection of distant and lymph node metastases.
解剖学和功能成像在前列腺癌的检测和分期中起着决定性作用，无论是在初始阶段还是治疗后。多参数MRI提供具有出色软组织对比度的解剖成像，基于正电子发射断层扫描与计算机断层扫描相结合的混合成像（PET/CT）则提供功能成像能力。由于预计镓-PSMA-11比先前基于胆碱的PET放射性示踪剂更有效，因此本研究的目的是评估镓-PSMA-11 PET/CT和多参数MRI在复发性前列腺癌且PSA水平较低患者中的诊断性能。128例生化复发的前列腺癌患者中有32例被转诊进行镓-PSMA-11 PET/CT、MRI和骨闪烁显像。根据组织病理学或临床定义的参考标准，所有结果被分类为真阳性、假阳性、真阴性或假阴性。32例患者中，11例存在局部复发，13例有淋巴结转移，6例有骨转移。与参考标准相比，PET/CT对局部复发的敏感性、特异性和准确性分别为63.6%、73.7%、77.8%。MRI分别达到90.9%、94.7%、92.3%。对于局部淋巴结转移，PET/CT分别为83.3%、80.0%和90.6%。MRI分别为41.7%、94.4%、72.0%。对于PET/CT评估骨转移，分别为83.3%、92.0%、71.0%。骨闪烁显像分别为50.0%、84.0%、77.4%。总之，多参数MRI在检测局部复发方面具有更好的诊断准确性，而PSMA PET/CT在检测远处和淋巴结转移方面更具优势。
