Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University, No. 126 Xiantai St, Changchun 130033, China.
AJR Am J Roentgenol. 2022 Sep;219(3):386-395. doi: 10.2214/AJR.21.27323. Epub 2022 Apr 20.
Bone scintigraphy (BS) using Tc-labeled methylene diphospho-nate (Tc-MDP) remains the recommended imaging modality for the detection of bone metastases in patients with prostate cancer (PCa). However, PET/CT using prostate-specific membrane antigen (PSMA) ligands is increasingly recognized as a means of evaluating disease extent in patients with PCa, including use as a possible stand-alone test in high-risk patients. The purpose of this study is to compare the diagnostic performance of Ga-PSMA-11 PET/CT with that of Tc-MDP BS for the detection of bone metastases in patients with PCa. The PubMed, Embase, and Cochrane Library databases were searched through October 2021 to identify studies reporting a head-to-head comparison of Ga-PSMA-11 PET/CT and Tc-MDP BS for the detection of bone metastases in patients with PCa. Only studies with a well-defined reference standard (including various combinations of imaging and/or clinical follow-up) were included. Pooled diagnostic performance was calculated using a bivariate random-effects model, and an AUC was derived for each test from hierarchic summary ROC analysis. The complementary roles of the two tests in identifying bone metastases in patients in whom one of the tests was negative were summarized. Six studies with 546 patients were included. Pooled sensitivity and specificity, respectively, were 98% (95% CI, 94-99%) and 97% (95% CI, 91-99%) for Ga-PSMA-11 PET/CT versus 83% (95% CI, 69-91%) and 68% (95% CI, 41-87%) for Tc-MDP BS. The AUC was 0.99 (95% CI, 0.96-1.00) for Ga-PSMA-11 PET/CT and 0.85 (95% CI, 0.81-0.87) for Tc-MDP BS. Among 408 patients from five included studies, Ga-PSMA-11 PET/CT correctly identified bone metastases in 43 of 193 patients (22.3%) with negative Tc-MDP BS results, whereas Tc-MDP BS correctly identified bone metastases in four of 210 patients (1.9%) with negative Ga-PSMA-11 PET/CT results. On a per-patient basis, the diagnostic performance of Ga-PSMA-11 PET/CT is superior to that of Tc-MDP BS for the detection of PCa bone metastases. Furthermore, Tc-MDP BS offers limited additional information in patients with negative Ga-PSMA-11 PET/CT results. According to current evidence, Tc-MDP BS is highly unlikely to be additive to Ga-PSMA-11 PET/CT in identifying bone metastases in patients with PCa.
骨闪烁扫描（BS）使用 Tc 标记的亚甲基二膦酸盐（Tc-MDP）仍然是检测前列腺癌（PCa）患者骨转移的推荐成像方式。然而，使用前列腺特异性膜抗原（PSMA）配体的 PET/CT 越来越被认为是评估 PCa 患者疾病范围的一种手段，包括在高危患者中作为可能的独立检测方法。本研究旨在比较 Ga-PSMA-11 PET/CT 与 Tc-MDP BS 检测 PCa 患者骨转移的诊断性能。通过 2021 年 10 月前的 PubMed、Embase 和 Cochrane 图书馆数据库搜索，确定了报告 Ga-PSMA-11 PET/CT 与 Tc-MDP BS 对头对头比较以检测 PCa 患者骨转移的研究。仅纳入了具有明确参考标准（包括各种影像学和/或临床随访组合）的研究。使用双变量随机效应模型计算汇总诊断性能，并从层次综合 ROC 分析中为每个测试推导 AUC。总结了两种测试在识别一种测试为阴性的患者的骨转移中的互补作用。纳入了 6 项共 546 例患者的研究。汇总的敏感性和特异性分别为 Ga-PSMA-11 PET/CT 为 98%（95%CI，94-99%）和 97%（95%CI，91-99%），而 Tc-MDP BS 为 83%（95%CI，69-91%）和 68%（95%CI，41-87%）。Ga-PSMA-11 PET/CT 的 AUC 为 0.99（95%CI，0.96-1.00），Tc-MDP BS 的 AUC 为 0.85（95%CI，0.81-0.87）。在来自五项纳入研究的 408 例患者中，Ga-PSMA-11 PET/CT 在 193 例 Tc-MDP BS 结果阴性的患者中正确识别了 43 例（22.3%）的骨转移，而 Tc-MDP BS 在 210 例 Ga-PSMA-11 PET/CT 结果阴性的患者中正确识别了 4 例（1.9%）的骨转移。基于每位患者，Ga-PSMA-11 PET/CT 检测 PCa 骨转移的诊断性能优于 Tc-MDP BS。此外，Tc-MDP BS 在 Ga-PSMA-11 PET/CT 结果阴性的患者中提供的信息有限。根据目前的证据，在识别 PCa 患者的骨转移方面，Tc-MDP BS 不太可能与 Ga-PSMA-11 PET/CT 相加。
