镓前列腺特异性膜抗原 PET/MRI 与多参数 MRI 检测临床显著前列腺癌的诊断性能比较。
Diagnostic Performance of Ga Prostate-specific Membrane Antigen PET/MRI Compared with Multiparametric MRI for Detecting Clinically Significant Prostate Cancer.
机构信息
From the Division of Urology (D.M., Y.B., O.N., N.S., J.B.), Department of Nuclear Medicine (H.B., D.G.), and Department of Pathology (M.Y.), Rabin Medical Center, 39 Jabotinski Rd, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.M., H.B., D.G., J.B., L.D.); Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, Israel (H.B., D.G.); and Department of Nuclear Medicine, Sheba Medical Center, Tel Hashomer, Israel (L.D.).
出版信息
Radiology. 2021 Nov;301(2):379-386. doi: 10.1148/radiol.2021204093. Epub 2021 Aug 31.
Background Gallium 68 (Ga) prostate-specific membrane antigen (PSMA) PET/MRI may improve detection of clinically significant prostate cancer (CSPC). Purpose To compare the sensitivity and specificity of Ga-PSMA PET/MRI with multiparametric MRI for detecting CSPC. Materials and Methods Men with prostate specific antigen levels of 2.5-20 ng/mL prospectively underwent Ga-PSMA PET/MRI, including multiparametric MRI sequences, between June 2019 and March 2020. Imaging was evaluated independently by two radiologists by using the Prostate Imaging Reporting and Data System (PI-RADS) version 2.1. Sensitivity and specificity for CSPC (International Society of Urological Pathology grade group ≥ 2) were compared for Ga-PSMA PET/MRI and multiparametric MRI by using the McNemar test. Decision curve analysis compared the net benefit of each imaging strategy. Results Ninety-nine men (median age, 67 years; interquartile range, 62-71 years) were included; 79% (78 of 99) underwent biopsy. CSPC was detected in 32% (25 of 78). For CSPC, specificity was higher for Ga-PSMA PET/MRI than multiparametric MRI (76% [95% CI: 62, 86] vs 49% [95% CI: 35, 63], respectively; < .001). Sensitivity was similar (88% [95% CI: 69, 98] vs 92% [95% CI: 74, 99], respectively; > .99). For PI-RADS 3 lesions, specificity was also higher for Ga-PSMA PET/MRI than for multiparametric MRI: 86% (95% CI: 73, 95) versus 59% (95% CI: 43, 74), respectively ( = .002). Decision curve analysis showed that biopsies targeted to PSMA uptake increased the net benefit of multiparametric MRI only among PI-RADS 3 lesions. The net benefit of targeted biopsy for a PI-RADS 3 lesion with PSMA uptake was higher across all threshold probabilities over 8%. The net benefit of targeted biopsy was similar for PI-RADS 4 and 5 lesions, regardless of PSMA uptake. Conclusions Gallium 68 prostate-specific membrane antigen PET/MRI improved specificity for clinically significant prostate cancer compared with multiparametric MRI, particularly in Prostate Imaging Reporting and Data System grade 3 lesions. © RSNA, 2021 See also the editorial by Williams and Estes in this issue.
背景 镓 68（Ga）前列腺特异性膜抗原（PSMA）PET/MRI 可能提高临床显著前列腺癌（CSPC）的检出率。目的 比较 Ga-PSMA PET/MRI 与多参数 MRI 检测 CSPC 的敏感性和特异性。材料与方法 2019 年 6 月至 2020 年 3 月，前瞻性纳入前列腺特异性抗原水平为 2.5-20ng/mL 的男性，行 Ga-PSMA PET/MRI 检查，包括多参数 MRI 序列。由 2 位放射科医师独立使用前列腺影像报告和数据系统（PI-RADS）第 2.1 版进行影像学评估。采用 McNemar 检验比较 Ga-PSMA PET/MRI 和多参数 MRI 检测 CSPC（国际泌尿病理学会分级组≥2）的敏感性和特异性。决策曲线分析比较了每种成像策略的净获益。结果 共纳入 99 例男性（中位年龄，67 岁；四分位距，62-71 岁）；79%（78/99）行活检。检出 CSPC 32%（25/78）。对于 CSPC，Ga-PSMA PET/MRI 的特异性高于多参数 MRI（分别为 76%[95%CI：62，86]和 49%[95%CI：35，63]；<.001）。敏感性相似（分别为 88%[95%CI：69，98]和 92%[95%CI：74，99]；>.99）。对于 PI-RADS 3 病变，Ga-PSMA PET/MRI 的特异性也高于多参数 MRI：分别为 86%（95%CI：73，95）和 59%（95%CI：43，74）；=.002）。决策曲线分析显示，仅在 PI-RADS 3 病变中，针对 PSMA 摄取的活检靶向增加了多参数 MRI 的净获益。在所有阈值概率超过 8%的情况下，PI-RADS 3 病变且摄取 PSMA 的靶向活检的净获益更高。PI-RADS 4 和 5 病变的靶向活检净获益相似，而与 PSMA 摄取无关。结论 与多参数 MRI 相比，镓 68 前列腺特异性膜抗原 PET/MRI 提高了临床显著前列腺癌的特异性，特别是在前列腺影像报告和数据系统分级 3 病变中。
Zotero 插件