Department of Nuclear Medicine, New Taipei Municipal TuCheng Hospital (Built and Operated by Chang Gung Medical Foundation), New Taipei City, Taiwan; Department of Medical Imaging and Radiological Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
J Formos Med Assoc. 2021 Jan;120(1 Pt 3):688-696. doi: 10.1016/j.jfma.2020.07.029. Epub 2020 Jul 29.
BACKGROUND/PURPOSE: We sought to compare the diagnostic performances of Ga-PSMA-11 PET/CT and prostate/whole-abdomen multiparametric magnetic resonance imaging (PWAmpMRI) in Taiwanese patients with biochemically recurrent prostate cancer following robot-assisted radical prostatectomy.
Between June 2017 and December 2018, we prospectively enrolled 34 patients. Upon review of all available clinical and imaging data, a best valuable comparator (BVC) was defined on an individual basis in the light of a consensus reached by a multidisciplinary tumor board. Diagnostic positivity was investigated in relation to the different lesion types.
On a patient-based analysis, Ga-PSMA-11 PET/CT and PWAmpMRI showed a moderate agreement (kappa coefficient = 0.62). Ga-PSMA-11 PET/CT identified local recurrences, regional, and non-regional lymph node metastases, and bone metastases in 15, 10, 1, and 5 patients, respectively. Conversely, PWAmpMRI detected these lesions in 26, 8, 1, and 4 patients, respectively. When the BVC was used as reference standard, the positive diagnostic rates for local recurrences, regional lymph node metastases, non-regional lymph node metastases, and bone metastases were 57.7%, 90.9%, 100%, and 100%, respectively for Ga-PSMA-11 PET/CT, and 100%, 72.7%, 100%, and 80% for PWAmpMRI, respectively. The use of both PWAmpMRI and Ga-PSMA-11 PET/CT showed a complete diagnostic yield for detecting both local recurrence and systemic failure when PSA levels reached 0.5 ng/mL.
Due to urine radioactivity, Ga-PSMA-11 PET/CT performs less than PWAmpMRI on local recurrences. However, it can have a complementary diagnostic role in the detection of lymph node metastases and in identifying non-axial bone metastases beyond the PWAmpMRI scanning field.
背景/目的：我们旨在比较镓-PSMA-11 PET/CT 和前列腺/全腹部多参数磁共振成像（PWAmpMRI）在台湾接受机器人辅助根治性前列腺切除术后生化复发的前列腺癌患者中的诊断性能。
在 2017 年 6 月至 2018 年 12 月期间，我们前瞻性地招募了 34 名患者。在回顾所有可用的临床和影像学数据后，根据多学科肿瘤委员会达成的共识，在个体基础上定义了最佳有价值的比较器（BVC）。根据不同的病变类型研究了诊断阳性率。
在基于患者的分析中，镓-PSMA-11 PET/CT 和 PWAmpMRI 显示出中度一致性（kappa 系数= 0.62）。镓-PSMA-11 PET/CT 在 15、10、1 和 5 名患者中分别识别出局部复发、区域和非区域淋巴结转移以及骨转移。相反，PWAmpMRI 在 26、8、1 和 4 名患者中分别检测到这些病变。当使用 BVC 作为参考标准时，镓-PSMA-11 PET/CT 对局部复发、区域淋巴结转移、非区域淋巴结转移和骨转移的阳性诊断率分别为 57.7%、90.9%、100%和 100%，而 PWAmpMRI 分别为 100%、72.7%、100%和 80%。当 PSA 水平达到 0.5ng/mL 时，同时使用 PWAmpMRI 和镓-PSMA-11 PET/CT 可完全检测到局部复发和全身失败。
由于尿液放射性，镓-PSMA-11 PET/CT 在局部复发方面的表现逊于 PWAmpMRI。然而，它在检测淋巴结转移和识别超出 PWAmpMRI 扫描范围的非轴向骨转移方面具有补充诊断作用。
