前列腺癌骨转移患者内分泌治疗后 99mTc-PSMA SPECT/CT 显像与前列腺特异抗原（PSA）和碱性磷酸酶（ALP）水平的相关性。

Association between 99mTc-PSMA SPECT/CT imaging and prostate-specific antigen (PSA) and alkaline phosphatase (ALP) levels post-endocrine therapy in patients with prostate cancer and bone metastases.

机构信息

Department of Nuclear Medicine, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai 201102, China; Department of Nuclear Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou 450003, China.

Department of Nuclear Medicine, Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou 450003, China.

出版信息

Rev Esp Med Nucl Imagen Mol (Engl Ed). 2024 Nov-Dec;43(6):500054. doi: 10.1016/j.remnie.2024.500054. Epub 2024 Sep 10.

DOI:10.1016/j.remnie.2024.500054

PMID:39260798

Abstract

AIM

To investigate the association between positive lesions detected by 99mTc-PSMA SPECT/CT and blood levels of prostate-specific antigen (PSA) and alkaline phosphatase (ALP) in patients with prostate cancer (PCa) and bone metastasis undergoing endocrine therapy.

METHODS

A retrospective analysis was performed on 43 patients diagnosed with PCa bone metastasis who underwent endocrine therapy. PSA, ALP, whole body bone imaging and 99mTc-PSMA SPECT/CT imaging were collected from all patients (Among them, 17 cases were re-examined 99mTc-PSMA SPECT/CT imaging). According to the results of the first 99mTc-PSMA SPECT/CT imaging for detecting bone metastasis, all cases were divided into two groups: positive group and negative group. The relationship between 99mTc-PSMA imaging and PSA and ALP was analyzed by ROC curve. Fisher exact probability method was used to examine the changes in imaging radioactivity uptake, PSA, and ALP levels in 17 patients after treatment, and P < 0.05 was statistically significant.

RESULTS

All 43 patients had different degrees of radioactive concentrations on whole-body bone imaging. The first 99mTc-PSMA SPECT/CT imaging showed positive bone metastases in 31 cases and negative bone metastases in 12 cases. ROC curve analysis of PSA and ALP, AUC were 0.778 and 0.770, respectively. When PSA > 1.13 ng/mL, 99mTc-PSMA SPECT/CT imaging diagnostic sensitivity was 93.55%, and specificity was 66.67%. When ALP was >86U/L, the diagnostic sensitivity of 99mTc-PSMA SPECT/CT imaging was 64.52%, and the specificity was 83.33%. In 17 cases, the PSA level decreased in 7 and increased in 10. There were 10 cases of increased ALP and 7 cases of decreased ALP levels. In the second 99mTc-PSMA imaging lesion, there were 9 cases with decreased or no uptake, and 8 cases with increased uptake or number of lesions. The changes in 99mTc-PSMA uptake by Fisher's exact probability method were statistically significant (P < 0.05, P = 0.006, and P = 0.006, respectively), and ALP level was not statistically significant (P = 0.563).

CONCLUSION

99mTc-PSMA SPECT/CT imaging can detect PCa bone metastases, which are related to PSA levels. When PSA > 1.13 ng/mL, the sensitivity of diagnosis and detection of positive bone metastases is higher, and when ALP is >86U/L, 99mTc-PSMA imaging has higher specificity.

摘要

目的

探讨 99mTc-PSMA SPECT/CT 检测阳性病变与前列腺癌（PCa）骨转移患者内分泌治疗期间前列腺特异性抗原（PSA）和碱性磷酸酶（ALP）血水平的相关性。

方法

回顾性分析 43 例经诊断为 PCa 骨转移并接受内分泌治疗的患者。所有患者均采集 PSA、ALP、全身骨显像和 99mTc-PSMA SPECT/CT 显像（其中 17 例复查 99mTc-PSMA SPECT/CT 显像）。根据首次 99mTc-PSMA SPECT/CT 骨转移检测结果，将所有病例分为阳性组和阴性组。通过 ROC 曲线分析 99mTc-PSMA 显像与 PSA 和 ALP 的关系。采用 Fisher 确切概率法检验 17 例患者治疗后影像学放射性摄取、PSA 和 ALP 水平的变化，P<0.05 为差异有统计学意义。

结果

43 例患者全身骨显像均有不同程度放射性浓聚。首次 99mTc-PSMA SPECT/CT 显像显示 31 例有阳性骨转移，12 例有阴性骨转移。PSA 和 ALP 的 ROC 曲线分析，AUC 分别为 0.778 和 0.770。当 PSA>1.13ng/mL 时，99mTc-PSMA SPECT/CT 显像诊断的灵敏度为 93.55%，特异度为 66.67%。当 ALP>86U/L 时，99mTc-PSMA SPECT/CT 显像的诊断灵敏度为 64.52%，特异度为 83.33%。17 例患者中，PSA 水平下降 7 例，升高 10 例。ALP 升高 10 例，降低 7 例。在第二次 99mTc-PSMA 显像病变中，有 9 例摄取减少或无摄取，8 例摄取增加或病变数量增加。Fisher 确切概率法对 99mTc-PSMA 摄取的变化有统计学意义（P<0.05，P=0.006，P=0.006），ALP 水平无统计学意义（P=0.563）。