Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstr. 18, 3010, Bern, Switzerland.
Eur Radiol. 2021 Oct;31(10):8030-8039. doi: 10.1007/s00330-021-07870-5. Epub 2021 Apr 15.
To investigate the impact of digital PET/CT on diagnostic certainty, patient-based sensitivity and interrater reliability.
Four physicians retrospectively evaluated two matched cohorts of patients undergoing [Ga]Ga-PSMA-11 PET/CT on a digital (dPET/CT n = 65) or an analogue scanner (aPET/CT n = 65) for recurrent prostate cancer between 11/2018 and 03/2019. The number of equivocal and pathological lesions as well as the frequency of discrepant findings and the interrater reliability for the two scanners were compared.
dPET/CT detected more lesions than aPET/CT (p < 0.001). A higher number of pathological scans were observed for dPET/CT (83% vs. 57%, p < 0.001). The true-positive rate at follow-up was 100% for dPET/CT compared to 84% for aPET/CT (p < 0.001). The proportion of lesions rated as non-pathological as a total of all PSMA-avid lesions detected for dPET/CT was comparable to aPET/CT (61.8% vs. 57.0%, p = 0.99). Neither a higher rate of diagnostically uncertain lesions (11.5% dPET/CT vs. 13.7% aPET/CT, p = 0.95) nor discrepant scans (where one or more readers differed in opinion as to whether the scan is pathological) were observed (18% dPET/CT vs. 17% aPET/CT, p = 0.76). Interrater reliability for pathological lesions was excellent for both scanner types (Cronbach's α = 0.923 dPET/CT; α = 0.948 aPET/CT) and interrater agreement was substantial for dPET/CT (Krippendorf's α = 0.701) and almost perfect in aPET/CT (α = 0.802).
A higher detection rate for pathological lesions for dPET/CT compared with aPET/CT in multiple readers was observed. This improved sensitivity was coupled with an improved true-positive rate and was not associated with increased diagnostic uncertainty, rate of non-specific lesions, or reduced interrater reliability.
• New generation digital scanners detect more cancer lesions in men with prostate cancer. • When using digital scanners, the doctors are able to diagnose prostate cancer lesions with better certainty • When using digital scanners, the doctors do not disagree with each other more than with other scanner types.
研究数字 PET/CT 对诊断确定性、基于患者的敏感性和观察者间可靠性的影响。
四位医生回顾性评估了两组在 2018 年 11 月至 2019 年 3 月期间因复发性前列腺癌接受[Ga]Ga-PSMA-11 PET/CT 的患者，一组为数字（dPET/CT）（n = 65），另一组为模拟扫描仪（aPET/CT）（n = 65）。比较两种扫描仪的可疑病变和病理病变数量，以及不一致发现的频率和观察者间的可靠性。
dPET/CT 比 aPET/CT 检测到更多的病变（p < 0.001）。dPET/CT 观察到更多的病理扫描（83%比 57%，p < 0.001）。dPET/CT 的随访时的真阳性率为 100%，而 aPET/CT 为 84%（p < 0.001）。dPET/CT 检测到的所有 PSMA 阳性病变中，被评为非病理性病变的比例与 aPET/CT 相似（61.8%比 57.0%，p = 0.99）。未观察到诊断不确定病变的比例更高（dPET/CT 为 11.5%，aPET/CT 为 13.7%，p = 0.95）或不一致的扫描（一个或多个观察者对扫描是否为病理性有不同意见）（dPET/CT 为 18%，aPET/CT 为 17%，p = 0.76）。两种扫描仪类型的病理病变观察者间可靠性均为优秀（Cronbach's α = 0.923 dPET/CT；α = 0.948 aPET/CT），dPET/CT 的观察者间一致性为显著（Krippendorf's α = 0.701），aPET/CT 为近乎完美（α = 0.802）。
与 aPET/CT 相比，多位观察者的 dPET/CT 检测到更多的病理性病变。这种敏感性的提高伴随着真阳性率的提高，且与增加的诊断不确定性、非特异性病变的比例或观察者间可靠性的降低无关。
新一代数字扫描仪可检测到更多患有前列腺癌男性的癌症病变。
使用数字扫描仪时，医生能够更确定地诊断前列腺癌病变。
使用数字扫描仪时，医生之间的意见分歧不会比其他扫描仪类型更多。
