F-DCFPyL PET/MR 多参数成像检测临床显著前列腺癌。
Detection of clinically significant prostate cancer with F-DCFPyL PET/multiparametric MR.
机构信息
Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital & Women's College Hospital, University of Toronto, 610 University Ave, Suite 3-920, Toronto, ON, M5G 2M9, Canada.
Department of Surgery, Division of Urology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.
出版信息
Eur J Nucl Med Mol Imaging. 2021 Oct;48(11):3702-3711. doi: 10.1007/s00259-021-05355-7. Epub 2021 Apr 12.
PURPOSE
To assess whether F-DCFPyL PET/multiparametric (mp)MR contributes to the diagnosis of clinically significant (cs) prostate cancer (PCa) compared to mpMR in patients with suspicion of PCa, or patients being considered for focal ablative therapies (FT).
PATIENTS AND METHODS
This ethics review board-approved, prospective study included 55 men with suspicion of PCa and negative systematic biopsies or clinically discordant low-risk PCa (n = 21) or those being considered for FT (n = 34) who received F-DCFPyL PET/mpMR. Each modality, PET, mpMR, and PET/MR (using the PROMISE classification), was assessed independently. All suspicious lesions underwent PET/MR-ultrasound fusion biopsies.
RESULTS
There were 45/55 patients (81.8%) that had histologically proven PCa and 41/55 (74.5%) were diagnosed with csPCa. Overall, 61/114 lesions (53.5%) identified on any modality were malignant; 49/61 lesions (80.3%) were csPCa. On lesion-level analysis, for detection of csPCa, the sensitivity of PET was higher than that of mpMR and PET/MR (86% vs 67% and 69% [p = 0.027 and 0.041, respectively]), but at a lower specificity (32% vs 85% and 86%, respectively [p < 0.001]). The performance of MR and PET/MR was comparable. For identification of csPCa in PI-RADS ≥ 3 lesions, the AUC (95% CI) for PET, mpMR, and PET/MR was 0.75 (0.65-0.86), 0.69 (0.56-0.82), and 0.78 (0.67-0.89), respectively. The AUC for PET/MR was significantly larger than that of mpMR (p = 0.04).
CONCLUSION
PSMA PET detects more csPCa than mpMR, but at low specificity. The performance PET/MR is better than mpMR for detection of csPCa in PI-RADS ≥ 3 lesions.
CLINICAL REGISTRATION
NCT03149861.
目的
评估 F-DCFPyL PET/多参数（mp）磁共振成像（MR）与 mpMR 相比，在疑似前列腺癌（PCa）患者或考虑局部消融治疗（FT）的患者中，是否有助于诊断临床显著（cs）前列腺癌（PCa）。
方法
本研究经伦理审查委员会批准，为前瞻性研究，共纳入 55 名疑似 PCa 且系统活检阴性或临床不一致的低危 PCa 患者（n=21）或考虑 FT 患者（n=34），这些患者均接受 F-DCFPyL PET/mpMR 检查。单独评估每种检查方式，包括 PET、mpMR 和 PET/MR（采用 PROMISE 分类）。对所有可疑病灶进行 PET/MR-超声融合活检。
结果
55 例患者中 45 例（81.8%）经组织学证实为 PCa，41 例（74.5%）诊断为 csPCa。总体而言，61/114 种（53.5%）任何检查方式确定的病灶为恶性；49/61 种（80.3%）为 csPCa。在病灶水平分析中，对于 csPCa 的检测，PET 的敏感性高于 mpMR 和 PET/MR（86%比 67%和 69%[p=0.027 和 0.041]），但特异性较低（32%比 85%和 86%[p<0.001]）。MR 和 PET/MR 的性能相当。对于 PI-RADS≥3 级病变中 csPCa 的识别，PET、mpMR 和 PET/MR 的 AUC（95%CI）分别为 0.75（0.65-0.86）、0.69（0.56-0.82）和 0.78（0.67-0.89）。PET/MR 的 AUC 明显大于 mpMR（p=0.04）。
结论
PSMA PET 比 mpMR 检测到更多的 csPCa，但特异性较低。在 PI-RADS≥3 级病变中，PET/MR 对 csPCa 的检测性能优于 mpMR。
临床注册
NCT03149861。
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