Meng Xiaoli, Ma Wenhui, Zhang Jingliang, Quan Zhiyong, Zhang Mingru, Ye Jiajun, Shu Jun, Ren Jing, Qin Weijun, Kang Fei, Wang Jing
Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Department of Urology, Xijing Hospital, Fourth Military Medical University, Xi'an, China.
Mol Imaging Biol. 2023 Oct;25(5):887-896. doi: 10.1007/s11307-023-01841-6. Epub 2023 Jul 25.
Our purpose was to compare the performance of prostate-specific membrane antigen (PSMA)-positron emission tomography (PET) traditional fixed threshold (FT) and newly established Prostate Imaging Reporting and Data System (PI-RADS)-based segmented threshold (ST) for diagnosing clinically significant prostate cancer (csPCa).
The study retrospectively included 218 patients who underwent multiparametric magnetic resonance imaging (mpMRI) and PSMA-PET examination for suspected prostate cancer (PCa) from January 2018 to November 2021. Lesions with Gleason score ≥ 3 + 4 were diagnosed as csPCa. In PSMA-PET maximum standardized uptake value (SUVmax), the FT for all the lesions and STs for lesions with different PI-RADS score for diagnosing csPCa were determined by receiver operating characteristic (ROC) curves analysis and compared with Z test. The McNemar test was used to compare sensitivity and specificity.
Among the 218 patients, there were 113 csPCa and 105 non-csPCa. The PSMA-PET FT was SUVmax > 5.3 (area under the curve, AUC = 0.842) and STs for PI-RADS 3/4/5 were SUVmax > 4.2/5.7/6.0 (AUCs = 0.870/0.867/0.882), respectively. The AUC of PSMA-PET ST was higher than that of PSMA-PET FT (0.872 vs. 0.842), especially for PI-RADS 3 (0.870 vs. 0.653). Multimodality diagnostic criteria combining PSMA-PET ST and PI-RADS scores of mpMRI was established and its AUC was higher than that of PSMA-PET ST (0.893 vs. 0.872) and significantly higher than that of PSMA-PET FT (0.893 vs. 0.842) with an improvement in sensitivity (93% vs. 78%, p < 0.05) without significantly sacrificing specificity (86% vs. 91%, p > 0.05).
For diagnosing csPCa, PI-RADS-based PSMA-PET segmented threshold achieved better performance than traditional fixed threshold, especially for PI-RADS 3 lesions. Multimodality diagnostic criteria demonstrated higher diagnostic performance than segmented threshold and significantly better than PSMA-PET fixed threshold for detecting csPCa.
我们的目的是比较前列腺特异性膜抗原（PSMA）-正电子发射断层扫描（PET）传统固定阈值（FT）和新建立的基于前列腺影像报告和数据系统（PI-RADS）的分段阈值（ST）在诊断临床显著性前列腺癌（csPCa）方面的表现。
本研究回顾性纳入了2018年1月至2021年11月期间因疑似前列腺癌（PCa）接受多参数磁共振成像（mpMRI）和PSMA-PET检查的218例患者。Gleason评分≥3+4的病变被诊断为csPCa。在PSMA-PET最大标准化摄取值（SUVmax）中，通过受试者操作特征（ROC）曲线分析确定所有病变诊断csPCa的FT以及不同PI-RADS评分病变的ST，并通过Z检验进行比较。采用McNemar检验比较敏感性和特异性。
在218例患者中，有113例csPCa和105例非csPCa。PSMA-PET的FT为SUVmax>5.3（曲线下面积，AUC=0.842），PI-RADS 3/4/5的ST分别为SUVmax>4.2/5.7/6.0（AUC分别为0.870/0.867/0.882）。PSMA-PET的ST的AUC高于PSMA-PET的FT（0.872对0.842），尤其是对于PI-RADS 3（0.870对0.653）。建立了结合PSMA-PET的ST和mpMRI的PI-RADS评分的多模态诊断标准，其AUC高于PSMA-PET的ST（0.893对0.872），且显著高于PSMA-PET的FT（(0.893对0.842），敏感性有所提高（93%对78%，p<0.05），而特异性没有显著牺牲（86%对91%，p>0.05）。
对于诊断csPCa，基于PI-RADS的PSMA-PET分段阈值比传统固定阈值表现更好，尤其是对于PI-RADS 3病变。多模态诊断标准在检测csPCa方面显示出比分段阈值更高的诊断性能，且显著优于PSMA-PET固定阈值。
