评估前列腺癌患者行前列腺切除术治疗后（生化复发率<0.5ng/ml），采用整合[F]F-PSMA-1007 PET/MR 评估局部和全身复发的检出率。治疗意义。
To evaluate the detection rate of local and whole-body recurrence by integrated [F]F-PSMA-1007 PET/MR assessment of prostate cancer patients treated with prostatectomy with very low biochemical recurrence (<0.5ng/ml). Therapeutic implications.
机构信息
CETIR ASCIRES, C/Viladomat 299, Spain.
CETIR ASCIRES, C/Viladomat 299, Spain.
出版信息
Rev Esp Med Nucl Imagen Mol (Engl Ed). 2024 Sep-Oct;43(5):500037. doi: 10.1016/j.remnie.2024.500037. Epub 2024 Jul 14.
OBJECTIVE
To analyse the efficacy of integrated assessment of [F]F-PSMA-1007 PET/MRI on the early detection of local recurrence (LR) for prostate cancer patients with PSA levels <0.5ng/ml after radical prostatectomy. To assess the location of recurrence so that therapy may be tailored to patient.
METHODS
Prospective study including 35 patients with prostate cancer (PCa), who were referred for a [F]F-PSMA-1007 PET/MR after prostatectomy with a very initial PSA value increase (PSA<0,5ng/ml). Simultaneous acquisition in a PET/MRI hybrid equipment (SIGNA-GE), 1h after administration of 370%±10% MBq of [F]F-PSMA-1007: Prostate selective imaging (20min): multiparametric PET+MRI (MRImp): DIXON, T1, T2, diffusion sequences post-gadolinium administration. Whole body image (30min): PET+MRI: DIXON, T1, T2, diffusion, STIR sequences. A nuclear physician and a radiologist jointly reviewed the studies: In order to assess LR, the "Prostate Imaging for Recurrence Reporting" system was used on MRI, as well as the Likert scale on the PET prostate imaging. The remaining lesions were classified as N1 and M1a.
RESULTS
PET/MRI was positive in 25 patients (71,4%) and negative in 10 patients (28,6%). RL was detected in 15 patients (42.9%): in 2 (5.7%) MRI was superior; in 3 (8.6%) PET was superior; integrated PET/MRI showed improved results in 5 patients (14.3%) for the detection of LR. Location of recurrences: LR in 11 patients (44.0%); N1 in 10 (40.0%); LR+N1 (8.0%) in 2; LR+N1+M1a in 2 (8.0%). In 20 patients (80%) the PET/MRI findings allowed radioguided radiotherapy implementation (11 on LR, and 9 on N1), whereas hormonal treatment was decided in 5 patients (20%) due to multimetastases/spread disease.
CONCLUSION
[F]F-PSMA-1007 PET/MRI has a 71.4% recurrence detection rate after prostatectomy with PSA<0.5ng/ml. Its combined PET and MRI study increases the detection of LR by 14.3%, with a high N1+M1a detection rate (56%), allowing radioguided radiotherapy in 80% of patients.
目的
分析在 PSA 水平<0.5ng/ml 后行根治性前列腺切除术的前列腺癌患者中，使用 [F]F-PSMA-1007 PET/MRI 综合评估对局部复发（LR）早期检测的疗效。评估复发位置，以便针对患者进行治疗。
方法
前瞻性研究纳入 35 例前列腺癌（PCa）患者，这些患者在前列腺切除术后因 PSA 值轻度升高（PSA<0.5ng/ml）而被转诊行 [F]F-PSMA-1007 PET/MRI。在 PET/MRI 混合设备（SIGNA-GE）中同时采集，在注射 370%±10%MBq 的 [F]F-PSMA-1007 后 1 小时：前列腺特异性成像（20 分钟）：多参数 PET+MRI（MRImp）：DIXON、T1、T2、钆后扩散序列。全身图像（30 分钟）：PET+MRI：DIXON、T1、T2、扩散、STIR 序列。一名核医学医师和一名放射科医师共同对研究进行了评估：为了评估 LR，使用 MRI 的“前列腺成像复发报告”系统以及 PET 前列腺成像的 Likert 量表。其余病变被归类为 N1 和 M1a。
结果
25 例患者（71.4%）的 PET/MRI 为阳性，10 例患者（28.6%）为阴性。15 例患者（42.9%）检测到 RL：2 例（5.7%）MRI 更优；3 例（8.6%）PET 更优；5 例（14.3%）综合 PET/MRI 对 LR 的检测显示出改善结果。复发位置：11 例（44.0%）患者发生 LR；10 例（40.0%）患者发生 N1；2 例（8.6%）患者发生 LR+N1；2 例（8.0%）患者发生 LR+N1+M1a。20 例患者（80%）的 PET/MRI 检查结果允许进行放射性引导放疗（11 例 LR，9 例 N1），而 5 例患者（20%）由于多发转移/疾病扩散决定进行激素治疗。
结论
在 PSA<0.5ng/ml 后行根治性前列腺切除术的患者中，[F]F-PSMA-1007 PET/MRI 的复发检测率为 71.4%。其结合 PET 和 MRI 研究使 LR 的检测率提高了 14.3%，同时具有较高的 N1+M1a 检出率（56%），可使 80%的患者接受放射性引导放疗。
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