Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Nucl Med Commun. 2021 May 1;42(5):495-502. doi: 10.1097/MNM.0000000000001364.
To investigate the influence of colour scales on the interpretation of [68Ga]Ga-PSMA-11 PET/CT for the diagnosis of recurrent prostate cancer.
50 consecutive patients who underwent [68Ga]Ga-PSMA-11 PET/CT for recurrent prostate cancer were selected for this retrospective study. The scans were randomised, anonymised and read by five different readers first in the visually nonlinear colour scale 'PET-rainbow'. Scans were then rerandomised and read in the visually linear colour scale 'hot-metal new'. For each scan in each colour scale the numbers of pathological, equivocal and benign lesions were noted. Scans where the majority of readers (≥3) reported at least one PET-positive lesion were recorded as 'pathological'. Patient-level sensitivity was obtained by composite standard with 14.8 ± 1.2 months of follow-up.
Increased numbers of lesions per patient were reported for all readers in PET-rainbow compared to hot-metal new (37.4 ± 15.2 vs. 33.9 ± 16.4, respectively, P = 0.0005). On a per-patient basis, 43 scans were rated pathological in PET-rainbow, compared to 39 in hot-metal new. Follow-up was available for 30 patients confirming 26 pathological scans with positive follow-up in PET-rainbow, and 23 in hot-metal new. Three pathological scans were missed in hot-metal new. Patient-level sensitivity was higher for PET-rainbow (0.96) compared to hot-metal new (0.85). Inter-reader reliability was higher for hot-metal new (Fleiss κ = 0.76) compared to PET-rainbow (Fleiss κ = 0.60).
Use of PET-rainbow was associated with improved lesion detection and sensitivity compared to hot-metal new, although at cost of reduced inter-rater agreement. Consequently, the use of PET-rainbow for clinical routine and future studies involving [68Ga]Ga-PSMA-11 is recommended.
探讨颜色标尺对[68Ga]Ga-PSMA-11 PET/CT 诊断复发性前列腺癌的解读影响。
本回顾性研究纳入了 50 例连续接受[68Ga]Ga-PSMA-11 PET/CT 检查以诊断复发性前列腺癌的患者。扫描结果经随机、匿名处理后，由 5 位不同的读者首先在视觉非线性颜色标尺“PET-rainbow”下进行阅读。然后将扫描结果重新随机化，并在视觉线性颜色标尺“hot-metal new”下再次进行阅读。记录每种颜色标尺下的病理、可疑和良性病变数量。当多数（≥3 位）读者报告至少存在一处 PET 阳性病变时，将扫描结果标记为“病理”。通过 14.8±1.2 个月的随访获得患者水平的敏感度。
与 hot-metal new 相比，所有读者在 PET-rainbow 下报告的患者病变数量均有所增加（分别为 37.4±15.2 与 33.9±16.4，P=0.0005）。在患者水平上，43 次扫描在 PET-rainbow 下被评为病理，而在 hot-metal new 下为 39 次。30 例患者的随访结果可用，在 PET-rainbow 下，26 次扫描结果阳性且得到了后续证实，在 hot-metal new 下，23 次扫描结果阳性且得到了后续证实。hot-metal new 下漏诊了 3 例病理扫描。PET-rainbow 的患者水平敏感度（0.96）高于 hot-metal new（0.85）。hot-metal new 的观察者间信度（Fleiss κ=0.76）高于 PET-rainbow（Fleiss κ=0.60）。
与 hot-metal new 相比，使用 PET-rainbow 可提高病变检出率和敏感度，但降低了观察者间的一致性。因此，建议在临床常规及未来涉及[68Ga]Ga-PSMA-11 的研究中使用 PET-rainbow。
