Asa Sertac, Ozgur Eren, Uslu-Besli Lebriz, Ince Burak, Sager Sait, Demirdag Cetin, Guner Ekrem, Sayman Haluk B, Bakir Baris, Sonmezoglu Kerim
Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa.
Department of Radiology, University of Health Sciences, İstanbul Training and Research Hospital.
Nucl Med Commun. 2023 Jan 1;44(1):65-73. doi: 10.1097/MNM.0000000000001637. Epub 2022 Nov 16.
Bone metastasis is essential in patients with prostate cancer (PCa) as it determines prognosis and survival. Hybrid PET/MRI allows simultaneous acquisition of PET and MRI data, thus combining the strength of both technologies allows the detection of bone marrow metastases that are missed by PET/CT. In this retrospective study, we aimed to evaluate the diagnostic efficiency of hybrid PET/MRI with Ga-68 prostate-specific membrane antigen (PSMA) in detecting skeletal metastases in newly diagnosed PCa patients and compared the effectiveness of stand-alone PSMA PET reviewing versus stand-alone whole-body (WB) MRI evaluation. We also investigated the effect of the interpretation of all PET/MR data together on clinical management.
We studied 74 newly diagnosed PCa patients who underwent PSMA PET/MRI for staging purposes. At first, PET and MRI were evaluated separately for bone lesions on a patient-and-lesion basis and then a further joint PSMA PET/MRI interpretation was made.
Patient-based sensitivity, specificity, positive predictive value, negative predictive value and accuracy analysis for bone metastasis was, respectively, 1.0, 0.83, 0.54, 1.0, 0.86 for PET; 0.75, 0.96, 0.81, 0.95, 0.93 for WB MRI and 0.91, 0.95, 0.78, 0,98, 0.94 for PET/MRI. The combined PET/MRI evaluation changed the clinical impact in 13.5% of patients (eight correct and two wrong decisions) compared to PET stand-alone interpretation.
PSMA PET imaging showed superior sensitivity to WB MRI in detecting bone metastases in newly diagnosed PCa patients, whereas WB MRI has superior specificity and PPV. Furthermore, the specificity and PPV of joint PET/MRI evaluation are better than PSMA PET alone. Despite the longer acquisition period, adding WB MRI sequences to PSMA PET imaging appears beneficial for PCa patient management.
骨转移在前列腺癌（PCa）患者中至关重要，因为它决定预后和生存。PET/MRI 一体机能够同时采集 PET 和 MRI 数据，将两种技术的优势结合起来可检测出 PET/CT 遗漏的骨髓转移灶。在这项回顾性研究中，我们旨在评估 Ga-68 前列腺特异性膜抗原（PSMA）PET/MRI 一体机在新诊断的 PCa 患者中检测骨转移的诊断效率，并比较单独的 PSMA PET 检查与单独的全身（WB）MRI 评估的有效性。我们还研究了一起解读所有 PET/MR 数据对临床管理的影响。
我们研究了 74 例因分期目的接受 PSMA PET/MRI 检查的新诊断 PCa 患者。首先，在患者和病灶基础上分别对 PET 和 MRI 的骨病变进行评估，然后进一步对 PSMA PET/MRI 进行联合解读。
基于患者的骨转移敏感性、特异性、阳性预测值、阴性预测值和准确性分析，PET 分别为 1.0、0.83、0.54、1.0、0.86；WB MRI 分别为 0.75、0.96、0.81、0.95、0.93；PET/MRI 分别为 0.91、0.95、0.78、0.98、0.94。与单独的 PET 解读相比，联合 PET/MRI 评估在 13.5%的患者中改变了临床影响（8 个正确和 2 个错误决策）。
在新诊断的 PCa 患者中，PSMA PET 成像在检测骨转移方面显示出比 WB MRI 更高的敏感性，而 WB MRI 具有更高的特异性和阳性预测值。此外，联合 PET/MRI 评估的特异性和阳性预测值优于单独的 PSMA PET。尽管采集时间更长，但在 PSMA PET 成像中添加 WB MRI 序列似乎对 PCa 患者的管理有益。
