Qin Chunxia, Gai Yongkang, Liu Qingyao, Ruan Weiwei, Liu Fang, Hu Fan, Zhang Xiaoping, Lan Xiaoli
Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Key Laboratory of Molecular Imaging, Wuhan, China.
Front Med (Lausanne). 2021 May 13;8:657619. doi: 10.3389/fmed.2021.657619. eCollection 2021.
To analyze Ga-PSMA-617 PET/CT or PET/MR and delayed PET/MR images in patients diagnosed with or suspicion of prostate cancer, and to explore the optimal use of PET/CT and PET/MR for initial diagnosis and staging in prostate cancer. Images from conventional scan by Ga-PSMA whole-body PET/CT or PET/MR followed by delayed pelvic PET/MR were retrospectively analyzed. Prostatic Ga-PSMA uptake was measured as SUVmax1 (conventional scan 1 h post injection) and SUVmax2 (delayed scan 3 h post injection). Age, PSA levels, and SUVmax were compared between benign and malignant cases. The correlation of SUVmax1 and SUVmax2 was analyzed. Diagnostic performance was evaluated by ROC analysis. Fifty-six patients with 41 prostate cancers and 15 benign prostate lesions were enrolled. Fifty-three patients had paired conventional and delayed scans. Age, tPSA, fPSA levels, and SUVmax were significantly different between benign and malignant cases. A good correlation was found between SUVmax1 and SUVmax2. There was significant difference between SUVmax1 and SUVmax2 in the malignant group ( = 0.001). SUVmax1 had superior diagnostic performance than SUVmax2, SUVmax difference and PSA levels, with a sensitivity of 85.4%, a specificity of 100% and an AUC of 0.956. A combination of SUVmax1 with nodal and/or distant metastases and MR PI-RADS V2 score had a sensitivity and specificity of 100%. Delayed pelvic PET/MR imaging in 33 patients were found to be redundant because these patients had nodal and/or distant metastases which can be easily detected by PET/CT. PET/MR provided incremental value in 8 patients at early-stage prostate cancer based on precise anatomical localization and changes in lesion signal provided by MR. Combined Ga-PSMA whole-body PET/CT and pelvic PET/MR can accurately differentiate benign prostate diseases from prostate cancer and accurately stage prostate cancer. Whole-body PET/CT is sufficient for advanced prostate cancer. Pelvic PET/MR contributes to diagnosis and accurate staging in early prostate cancer. Imaging at about 1 h after injection is sufficient in most patients. NCT03756077. Registered 27 November 2018-Retrospectively registered, https://clinicaltrials.gov/show/NCT03756077.
分析镓 - PSMA - 617 PET/CT或PET/MR以及延迟PET/MR图像，用于诊断或疑似前列腺癌的患者，探讨PET/CT和PET/MR在前列腺癌初始诊断和分期中的最佳应用。回顾性分析镓 - PSMA全身PET/CT或PET/MR常规扫描后再进行盆腔延迟PET/MR的图像。测量前列腺的镓 - PSMA摄取量，即SUVmax1（注射后1小时常规扫描）和SUVmax2（注射后3小时延迟扫描）。比较良性和恶性病例的年龄、前列腺特异抗原（PSA）水平及SUVmax。分析SUVmax1和SUVmax2的相关性。通过ROC分析评估诊断性能。纳入56例患者，其中41例为前列腺癌病例和15例良性前列腺病变病例。53例患者有配对的常规扫描和延迟扫描。良性和恶性病例之间的年龄、总PSA（tPSA）、游离PSA（fPSA）水平及SUVmax存在显著差异。发现SUVmax1和SUVmax2之间具有良好相关性。恶性组中SUVmax1和SUVmax2之间存在显著差异（P = 0.001）。SUVmax1比SUVmax2、SUVmax差值及PSA水平具有更好的诊断性能，其敏感性为85.4%，特异性为100%，曲线下面积（AUC）为0.956。SUVmax1与淋巴结和/或远处转移以及磁共振成像前列腺影像报告和数据系统（MR PI-RADS）V2评分相结合，敏感性和特异性均为100%。发现33例患者的盆腔延迟PET/MR成像多余，因为这些患者有可通过PET/CT轻松检测到的淋巴结和/或远处转移。基于MR提供的精确解剖定位和病变信号变化，PET/MR为8例早期前列腺癌患者提供了额外价值。联合镓 - PSMA全身PET/CT和盆腔PET/MR能够准确区分良性前列腺疾病和前列腺癌，并准确对前列腺癌进行分期。全身PET/CT对晚期前列腺癌足够。盆腔PET/MR有助于早期前列腺癌的诊断和准确分期。大多数患者在注射后约1小时成像即可。NCT03756077。于2018年11月27日注册——回顾性注册，https://clinicaltrials.gov/show/NCT03756077 。
