基于前列腺特异性膜抗原（PSMA）的F-DCFPyL PET/CT与盆腔多参数MRI在前列腺癌患者盆腔病变检测中的比较。
Comparison of PSMA-based F-DCFPyL PET/CT and pelvic multiparametric MRI for lesion detection in the pelvis in patients with prostate cancer.
作者信息
Nguyen Trinh T, Bhosale Priya R, Xu Guofan, Pan Tinsu, Wei Peng, Lu Yang
机构信息
Department of Nuclear Medicine, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center Houston, United States.
Department of Abdominal Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center Houston, United States.
出版信息
Am J Nucl Med Mol Imaging. 2022 Dec 15;12(6):166-179. eCollection 2022.
PURPOSE
To directly compare the performance of pelvic mpMRI versus recently approved and increasingly used PSMA-based F-DCFPyL PET/CT in intermediate-high risk and biochemical recurrent prostate cancer patient cohort while exploring their potential differing applications in specific clinical scenarios.
METHODS
A retrospective analysis was performed on patients who had F-DCFPyL PET/CT and pelvic mpMRI done from September 2021 to January 2022 at a single institution. The inclusion criteria were paired exams within a 3-month interval. Exclusion criteria were intervening treatment between exams, a change in PSA by more than 50% and absolute difference more than 1 ng/mL, or concurrent history of other malignancy. Abnormal lesions on these 2 imaging exams were reviewed with the identification of concordant and discordant imaging findings. The findings were verified by pathology or other imaging techniques within minimal 5-month clinical follow-up.
RESULTS
A total of 57 patients with 57 paired exams were included. The rate of concordant exams was 43/57 or 75.4%. Lesion-based analyses of sensitivity, specificity, PPV and NPV for mpMRI and F-DCFPyL PET/CT in the prostate bed were 96%, 94%, 98%, 89% and 96%, 100%, 100%, 90% respectively. For pelvic lymph node metastases, the sensitivity, specificity, PPV and NPV for mpMRI and F-DCFPyL PET/CT were 52%, 100%, 100%, 55% and 100%, 100%, 100%, 100% respectively. For bone metastases, the sensitivity, specificity, PPV and NPV for mpMRI and F-DCFPyL PET/CT were 86%, 73%, 50%, 94% and 100%, 98%, 95%, 100% respectively. Exact McNemar's test for paired data suggested that in diagnostic performance between F-DCFPyL PET/CT and mpMRI was not statistically significant in prostate bed (-value = 1.00), but significantly in pelvic lymph nodes (-value < 0.0001) and bone lesions (-value = 0.0026).
CONCLUSION
Our study demonstrated that PSMA-based F-DCFPyL PET/CT and pelvic mpMRI have a good concordance rate in the detection of primary or recurrence prostate disease and can have complementary roles in the clinical assessment of the prostate bed lesions. However, there are key differences in their performance, with the notably superior performance of PSMA-based F-DCFPyL PET/CT in the detection of small metastatic nodal disease and bone metastases.
目的
在中高危和生化复发前列腺癌患者队列中，直接比较盆腔磁共振成像（mpMRI）与近期获批且使用日益广泛的基于前列腺特异性膜抗原（PSMA）的F-DCFPyL正电子发射断层扫描/计算机断层扫描（PET/CT）的性能，同时探索它们在特定临床场景中的潜在不同应用。
方法
对2021年9月至2022年1月在单一机构进行F-DCFPyL PET/CT和盆腔mpMRI检查的患者进行回顾性分析。纳入标准为在3个月间隔内进行的配对检查。排除标准为检查期间进行干预性治疗、前列腺特异抗原（PSA）变化超过50%且绝对差值超过1 ng/mL，或有其他恶性肿瘤的并发病史。对这两种影像学检查中的异常病变进行了回顾，以识别一致和不一致的影像学表现。这些发现通过至少5个月的临床随访中的病理或其他影像学技术进行了验证。
结果
共纳入57例患者的57对配对检查。检查结果一致率为43/57，即75.4%。在前列腺床中，mpMRI和F-DCFPyL PET/CT基于病变的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为96%、94%、98%、89%和96%、100%、100%、90%。对于盆腔淋巴结转移，mpMRI和F-DCFPyL PET/CT的敏感性、特异性、PPV和NPV分别为52%、100%、100%、55%和100%、100%、100%、100%。对于骨转移，mpMRI和F-DCFPyL PET/CT的敏感性、特异性、PPV和NPV分别为86%、73%、50%、94%和100%、98%、95%、100%。对配对数据进行的精确McNemar检验表明，F-DCFPyL PET/CT和mpMRI在前列腺床的诊断性能上差异无统计学意义（P值 = 1.00），但在盆腔淋巴结（P值 < 0.0001）和骨病变（P值 = 0.0026）方面差异有统计学意义。
结论
我们的研究表明，基于PSMA的F-DCFPyL PET/CT和盆腔mpMRI在检测原发性或复发性前列腺疾病方面有良好的一致率，并且在前列腺床病变的临床评估中可以起到互补作用。然而，它们的性能存在关键差异，基于PSMA的F-DCFPyL PET/CT在检测小转移淋巴结疾病和骨转移方面表现明显更优。
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