Chen Qiaochu, Dong Liang, Xu Lian, Zhao Haitao, Li Lianghua, Huang Gang, Liu Jianjun, Chen Ruohua
Department of Nuclear Medicine, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, 200127, China.
Department of Urology, School of Medicine, Ren Ji Hospital, Shanghai Jiao Tong University, Shanghai, China.
Eur J Nucl Med Mol Imaging. 2025 Mar;52(4):1249-1256. doi: 10.1007/s00259-024-06980-8. Epub 2024 Nov 14.
Enhanced lesion detection in prostate cancer is observed with late [ Ga]Ga-PSMA-11 PET/CT imaging compared to standard [ Ga]Ga-PSMA-11 PET/CT imaging (50-100 min p.i.). However, the poor image quality of late imaging using short axial field of view (SAFOV) PET/CT has hindered its sole clinical adoption. Conversely, the image quality of late imaging with a long axial field of view (LAFOV) [ Ga]Ga-PSMA-11 PET/CT fulfills clinical diagnostic requirements. Nonetheless, the diagnostic efficacy of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis and its impact on treatment decisions, compared to standard LAFOV [ Ga]Ga-PSMA-11 PET/CT, remains unclear. This study aims to compare the rate of PET positivity between late and standard LAFOV [ Ga]Ga-PSMA-11 PET/CT and to evaluate the influence of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis on treatment decisions relative to standard scans.
From January 2021 to April 2024, 127 patients with biochemical recurrence of prostate cancer post-radical prostatectomy were enrolled to undergo both standard and late LAFOV [ Ga]Ga-PSMA-11 PET/CT scans at Shanghai Renji Hospital. We compared the rate of PET positivity between the two modalities at the patient level and across different anatomical regions. We assessed the added diagnostic value of late LAFOV [ Ga]Ga-PSMA-11 PET/CT and its impact on modifying patient treatment plans.
The image quality of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis in all patients met clinical diagnostic requirements. The rate of PET positivity of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis were significantly higher than those of standard LAFOV [ Ga]Ga-PSMA-11 PET/CT (80.31% [102/127] vs. 65.35% [83/127]; P < 0.001). Late LAFOV [ Ga]Ga-PSMA-11 PET/CT demonstrated higher lesion SUVmax (16.69 ± 16.42 vs. 11.91 ± 10.72, P < 0.001) and TBR (6.26 ± 7.21 vs. 3.44 ± 3.57, P < 0.001) compared to standard LAFOV scans. Additionally, 14.17% (18/127) of patients experienced changes in their treatment regimen due to the superior detection capabilities of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to the standard scan.
The rate of PET positivity of late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis compared to standard LAFOV [ Ga]Ga-PSMA-11 PET/CT highlight its potential as a valuable diagnostic tool for biochemically recurrent prostate cancer. This study paves the way for using late LAFOV [ Ga]Ga-PSMA-11 PET/CT with forced diuresis for prostate cancer imaging in daily clinical practice, facilitating more accurate and timely diagnoses.
与标准的[镓]镓-PSMA-11 PET/CT成像（注射后50 - 100分钟）相比，延迟[镓]镓-PSMA-11 PET/CT成像可提高前列腺癌病灶的检测率。然而，使用短轴视野（SAFOV）PET/CT进行延迟成像时图像质量较差，阻碍了其在临床中的单独应用。相反，长轴视野（LAFOV）[镓]镓-PSMA-11 PET/CT的延迟成像质量满足临床诊断要求。尽管如此，与标准LAFOV[镓]镓-PSMA-11 PET/CT相比，延迟LAFOV[镓]镓-PSMA-11 PET/CT在强制利尿情况下的诊断效能及其对治疗决策的影响仍不明确。本研究旨在比较延迟和标准LAFOV[镓]镓-PSMA-11 PET/CT的PET阳性率，并评估延迟LAFOV[镓]镓-PSMA-11 PET/CT在强制利尿情况下相对于标准扫描对治疗决策的影响。
2021年1月至2024年4月，127例前列腺癌根治术后生化复发的患者在上海仁济医院接受标准和延迟LAFOV[镓]镓-PSMA-11 PET/CT扫描。我们在患者层面和不同解剖区域比较了两种模式下的PET阳性率。我们评估了延迟LAFOV[镓]镓-PSMA-11 PET/CT的附加诊断价值及其对修改患者治疗计划的影响。
所有患者在强制利尿情况下延迟LAFOV[镓]镓-PSMA-11 PET/CT的图像质量均满足临床诊断要求。延迟LAFOV[镓]镓-PSMA-11 PET/CT在强制利尿情况下的PET阳性率显著高于标准LAFOV[镓]镓-PSMA-11 PET/CT（80.31%[102/127]对65.35%[83/127]；P＜0.001）。与标准LAFOV扫描相比，延迟LAFOV[镓]镓-PSMA-11 PET/CT显示出更高的病灶SUVmax（16.69±16.42对11.91±10.72，P＜0.001）和TBR（6.26±7.21对3.44±3.57，P＜0.001）。此外，14.17%（18/127）的患者由于延迟LAFOV[镓]镓-PSMA-11 PET/CT在强制利尿情况下比标准扫描具有更强的检测能力，其治疗方案发生了改变。
与标准LAFOV[镓]镓-PSMA-11 PET/CT相比，延迟LAFOV[镓]镓-PSMA-11 PET/CT在强制利尿情况下的PET阳性率突出了其作为生化复发前列腺癌有价值诊断工具的潜力。本研究为在日常临床实践中使用延迟LAFOV[镓]镓-PSMA-11 PET/CT进行强制利尿的前列腺癌成像铺平了道路，有助于更准确、及时地进行诊断。
