Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and
Department of Medical Imaging, Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; and.
J Nucl Med. 2021 Sep 1;62(9):1258-1263. doi: 10.2967/jnumed.120.258541. Epub 2021 Jan 30.
Accurate assessment of lymph node (LN) metastases in prostate cancer (PCa) patients is critical for prognosis and patient management. Both prostate-specific membrane antigen (PSMA) PET/CT and ferumoxtran-10 nanoparticle-enhanced MRI (nano-MRI) are imaging modalities with high potential to identify LN metastases in PCa patients. The aim of this study was to compare the results of these imaging technologies in terms of characteristics and anatomic localization of suspicious LNs in order to assess the feasibility of their complementary use for imaging in PCa patients. In total, 45 patients with either primary PCa ( = 8) or recurrence ( = 36) were included in this retrospective study. All patients underwent both Ga-PSMA PET/CT and nano-MRI between October 2015 and July 2017 within 3 wk. Both scans were performed at the same institution according to local clinical protocols. All scans were analyzed independently by experienced nuclear medicine physicians and radiologists. The size, anatomic location, and level of suspicion were determined for all visible LNs. Subsequently, the findings from Ga-PSMA PET/CT and nano-MRI were compared without respect to a reference standard. In total, 179 suspicious LNs were identified. Significantly more suspicious LNs per patient were detected by nano-MRI ( < 0.001): 160 were identified in 33 patients by nano-MRI, versus 71 in 25 patients by Ga-PSMA PET/CT. Of all suspicious LNs, 108 were identified only by nano-MRI (60%), 19 (11%) only by Ga-PSMA PET/CT, and 52 (29%) by both methods. The mean size of the suspicious LNs as identified by nano-MRI was significantly smaller (5.3 mm) than that by Ga-PSMA PET/CT (6.0 mm; = 0.006). The median level of suspicion did not differ significantly. Both modalities identified suspicious LNs in all anatomic regions of the pelvis. Both modalities identified suspicious LNs that were missed by the other. Both modalities identified suspicious LNs in all anatomic regions of the pelvis; however, nano-MRI appeared to be superior in detecting smaller suspicious LNs. These findings suggest that nano-MRI has a potential role as a complement to PSMA PET/CT. However, since the clinical implications of the different results are not well established yet, further investigation of this complementary use is encouraged.
准确评估前列腺癌（PCa）患者的淋巴结（LN）转移对于预后和患者管理至关重要。前列腺特异性膜抗原（PSMA）PET/CT 和铁载氧化铁纳米颗粒增强 MRI（nano-MRI）都是具有高潜力的成像方式，可以识别 PCa 患者的 LN 转移。本研究的目的是比较这些成像技术在可疑 LN 的特征和解剖定位方面的结果，以评估它们在 PCa 患者成像中的互补使用的可行性。
总共纳入了 45 例初发 PCa（n = 8）或复发（n = 36）患者进行这项回顾性研究。所有患者于 2015 年 10 月至 2017 年 7 月在 3 周内接受了 Ga-PSMA PET/CT 和 nano-MRI 检查。所有扫描均在同一机构根据当地临床方案进行。所有扫描均由经验丰富的核医学医师和放射科医师独立进行分析。确定了所有可见 LN 的大小、解剖位置和可疑程度。随后，在不考虑参考标准的情况下，比较了 Ga-PSMA PET/CT 和 nano-MRI 的检查结果。
总共发现了 179 个可疑的 LN。nano-MRI 检测到的可疑 LN 明显更多（<0.001）：nano-MRI 在 33 例患者中发现了 160 个可疑 LN，而 Ga-PSMA PET/CT 在 25 例患者中发现了 71 个可疑 LN。在所有可疑的 LN 中，只有 nano-MRI 发现了 108 个（60%），只有 Ga-PSMA PET/CT 发现了 19 个（11%），而两种方法都发现了 52 个（29%）。nano-MRI 确定的可疑 LN 的平均大小明显较小（5.3 毫米），而 Ga-PSMA PET/CT 确定的可疑 LN 大小为 6.0 毫米（ = 0.006）。可疑程度的中位数无显著差异。两种方法均在骨盆的所有解剖区域识别出可疑的 LN。
两种方法均识别出其他方法遗漏的可疑 LN。两种方法均在骨盆的所有解剖区域识别出可疑的 LN；然而，nano-MRI 在检测较小的可疑 LN 方面似乎更具优势。这些发现表明，nano-MRI 作为 PSMA PET/CT 的补充具有潜在作用。然而，由于不同结果的临床意义尚未得到充分确立，鼓励进一步研究这种互补性的使用。
