Abrahamsen Bendik S, Tandstad Torgrim, Aksnessæther Bjørg Y, Bogsrud Trond V, Castillejo Miguel, Hernes Eivor, Johansen Håkon, Keil Thomas M I, Knudtsen Ingerid S, Langørgen Sverre, Selnæs Kirsten M, Bathen Tone F, Elschot Mattijs
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
The Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
J Magn Reson Imaging. 2025 Jan;61(1):466-477. doi: 10.1002/jmri.29386. Epub 2024 Apr 28.
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) can change management in a large fraction of patients with biochemically recurrent prostate cancer (BCR).
To investigate the added value of PET to MRI and CT for this patient group, and to explore whether the choice of the PET paired modality (PET/MRI vs. PET/CT) impacts detection rates and clinical management.
Retrospective.
41 patients with BCR (median age [range]: 68 [55-78]).
FIELD STRENGTH/SEQUENCE: 3T, including T1-weighted gradient echo (GRE), T2-weighted turbo spin echo (TSE) and dynamic contrast-enhanced GRE sequences, diffusion-weighted echo-planar imaging, and a T1-weighted TSE spine sequence. In addition to MRI, [F]PSMA-1007 PET and low-dose CT were acquired on the same day.
Images were reported using a five-point Likert scale by two teams each consisting of a radiologist and a nuclear medicine physician. The radiologist performed a reading using CT and MRI data and a joint reading between radiologist and nuclear medicine physician was performed using MRI, CT, and PET from either PET/MRI or PET/CT. Findings were presented to an oncologist to create intended treatment plans. Intrareader and interreader agreement analysis was performed.
McNemar test, Cohen's κ, and intraclass correlation coefficients. A P-value <0.05 was considered significant.
7 patients had positive findings on MRI and CT, 22 patients on joint reading with PET/CT, and 18 patients joint reading with PET/MRI. For overall positivity, interreader agreement was poor for MR and CT (κ = 0.36) and almost perfect with addition of PET (PET/CT κ = 0.85, PET/MRI κ = 0.85). The addition of PET from PET/CT and PET/MRI changed intended treatment in 20 and 18 patients, respectively. Between joint readings, intended treatment was different for eight patients.
The addition of [F]PSMA-1007 PET/MRI or PET/CT to MRI and CT may increase detection rates, could reduce interreader variability, and may change intended treatment in half of patients with BCR.
3 TECHNICAL EFFICACY: Stage 3.
前列腺特异性膜抗原（PSMA）正电子发射断层扫描（PET）可改变很大一部分生化复发前列腺癌（BCR）患者的治疗方案。
研究PET相对于MRI和CT在该患者群体中的附加价值，并探讨PET联合模式（PET/MRI与PET/CT）的选择是否会影响检测率和临床治疗。
回顾性研究。
41例BCR患者（中位年龄[范围]：68岁[55 - 78岁]）。
场强/序列：3T，包括T1加权梯度回波（GRE）、T2加权快速自旋回波（TSE）和动态对比增强GRE序列、扩散加权回波平面成像以及T1加权TSE脊柱序列。除MRI外，同一天还进行了[F]PSMA - 1007 PET和低剂量CT检查。
由两个团队使用五点李克特量表对图像进行报告，每个团队由一名放射科医生和一名核医学医生组成。放射科医生使用CT和MRI数据进行解读，放射科医生和核医学医生联合使用PET/MRI或PET/CT的MRI、CT和PET数据进行解读。将结果提交给肿瘤学家以制定预期治疗方案。进行了阅片者内和阅片者间一致性分析。
McNemar检验、Cohen's κ以及组内相关系数。P值<0.05被认为具有统计学意义。
7例患者在MRI和CT上有阳性发现，22例患者在PET/CT联合解读时有阳性发现，18例患者在PET/MRI联合解读时有阳性发现。对于总体阳性情况，MR和CT的阅片者间一致性较差（κ = 0.36），加入PET后几乎达到完美一致（PET/CT κ = 0.85，PET/MRI κ = 0.85）。分别有20例和18例患者因加入PET/CT和PET/MRI的PET而改变了预期治疗方案。在联合解读之间，8例患者的预期治疗方案不同。
在MRI和CT基础上加入[F]PSMA - 1007 PET/MRI或PET/CT可能会提高检测率，减少阅片者间的变异性，并可能改变一半BCR患者的预期治疗方案。
3 技术效能：3级
