Regula Naresh, Kostaras Vasileios, Johansson Silvia, Trampal Carlos, Lindström Elin, Lubberink Mark, Iyer Victor, Velikyan Irina, Sörensen Jens
Division of Radiology and Nuclear Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Divison of Oncology, Department of Immunology, Genetics and Pathology, Uppsala University Hospital, Uppsala, Sweden.
Eur J Hybrid Imaging. 2022 Mar 1;6(1):5. doi: 10.1186/s41824-022-00127-4.
F-NaF positron emission tomography/computed tomography (fluoride PET/CT) is considered the most sensitive technique to detect bone metastasis in prostate cancer (PCa). Ga-PSMA-11 (PSMA) PET/CT is increasingly used for staging of PCa. This study primarily aimed to compare the diagnostic performance of fluoride PET/CT and gallium-based PSMA PET/CT in identifying bone metastasis followed by a comparison of PSMA PET/CT with contrast-enhanced CT (CE-CT) in identifying soft tissue lesions as a secondary objective.
Twenty-eight PCa patients with high suspicion of disseminated disease following curative treatment were prospectively evaluated. PET/CT examinations using fluoride and PSMA were performed. All suspicious bone lesions were counted, and the tracer uptake was measured as standardized uptake values (SUV) for both tracers. In patients with multiple findings, ten bone lesions with highest SUV were selected from which identical lesions from both scans were considered for direct comparison of SUV. Soft tissue findings of local and lymph node lesions from CE-CT were compared with PSMA PET/CT.
Both scans were negative for bone lesions in 7 patients (25%). Of 699 lesions consistent with skeletal metastasis in 21 patients on fluoride PET/CT, PSMA PET/CT identified 579 lesions (83%). In 69 identical bone lesions fluoride PET/CT showed significantly higher uptake (mean SUV: 73.1 ± 36.8) compared to PSMA PET/CT (34.5 ± 31.4; p < 0.001). Compared to CE-CT, PSMA PET/CT showed better diagnostic performance in locating local (96% vs 61%, p = 0.004) and lymph node (94% vs 46%, p < 0.001) metastasis.
In this prospective comparative study, PSMA PET/CT detected the majority of bone lesions that were positive on fluoride PET/CT. Further, this study indicates better diagnostic performance of PSMA PET/CT to locate soft tissue lesions compared to CE-CT.
F-NaF正电子发射断层扫描/计算机断层扫描（氟化物PET/CT）被认为是检测前列腺癌（PCa）骨转移最敏感的技术。Ga-PSMA-11（PSMA）PET/CT越来越多地用于PCa的分期。本研究的主要目的是比较氟化物PET/CT和基于镓的PSMA PET/CT在识别骨转移方面的诊断性能，其次要目的是比较PSMA PET/CT与对比增强CT（CE-CT）在识别软组织病变方面的性能。
对28例根治性治疗后高度怀疑有播散性疾病的PCa患者进行前瞻性评估。使用氟化物和PSMA进行PET/CT检查。对所有可疑骨病变进行计数，并测量两种示踪剂的示踪剂摄取量，以标准化摄取值（SUV）表示。在有多发病变的患者中，从两种扫描中相同的病变中选择SUV最高的10个骨病变进行SUV的直接比较。将CE-CT的局部和淋巴结病变软组织结果与PSMA PET/CT进行比较。
7例患者（25%）的两种扫描骨病变均为阴性。在氟化物PET/CT上21例患者中与骨转移一致的699个病变中，PSMA PET/CT识别出579个病变（83%）。在69个相同的骨病变中，氟化物PET/CT的摄取明显高于PSMA PET/CT（平均SUV：73.1±36.8 vs 34.5±31.4；p<0.001）。与CE-CT相比，PSMA PET/CT在定位局部转移（96%对61%，p=0.004）和淋巴结转移（94%对46%，p<0.001）方面表现出更好的诊断性能。
在这项前瞻性比较研究中，PSMA PET/CT检测到了氟化物PET/CT上大多数呈阳性的骨病变。此外，本研究表明，与CE-CT相比，PSMA PET/CT在定位软组织病变方面具有更好的诊断性能。
