Hong Cheng William, Behr Spencer C, Jiang Fei, Wang Yingbing, Houshmand Sina, Hope Thomas A
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143, USA.
Helen Diller Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA 94143, USA.
J Clin Med. 2025 Mar 8;14(6):1833. doi: 10.3390/jcm14061833.
: Patients with metastatic castration-resistant prostate cancer (mCRPC) who have Prostate-Specific Membrane Antigen (PSMA)-negative disease have inferior outcomes with radioligand therapy (RLT). The objective of this study is to assess the added value of whole-body (WB) diffusion-weighted imaging (DWI) to PSMA PET for identifying PSMA-negative disease, which is important for risk stratification. : Consecutive PSMA PET/MRI exams at our institution, which included WB DWI in patients with mCRPC, were retrospectively reviewed. For both WB DWI and PSMA PET, two independent readers scored 14 anatomic locations, which were considered positive only if both readers identified lesions. The proportion of patients with mismatched disease was summarized descriptively for each anatomic location and overall. The inter-reader agreement was computed with intra-class correlation coefficients (ICCs). : The study included 41 patients (with a mean age of 71.9 years), and WB DWI identified PSMA-negative lesions in 24% of patients. PSMA PET had higher agreement than DWI, although both had good agreement (ICC: 0.87 and 0.72, respectively). The median overall survival was 442 days in those with mismatched disease vs. 523 days in those without, although this difference is not statistically significant ( = 0.49). : The addition of WB DWI to PSMA PET can identify PSMA-negative disease, which could alter patient management.
患有转移性去势抵抗性前列腺癌（mCRPC）且前列腺特异性膜抗原（PSMA）阴性疾病的患者接受放射性配体治疗（RLT）的预后较差。本研究的目的是评估全身（WB）扩散加权成像（DWI）对PSMA正电子发射断层扫描（PET）在识别PSMA阴性疾病方面的附加价值，这对风险分层很重要。：对我们机构连续进行的PSMA PET/MRI检查进行回顾性分析，这些检查包括mCRPC患者的WB DWI。对于WB DWI和PSMA PET，两名独立阅片者对14个解剖部位进行评分，只有当两名阅片者都识别出病变时才被视为阳性。对每个解剖部位和总体上疾病不匹配患者的比例进行描述性总结。阅片者间的一致性通过组内相关系数（ICC）计算。：该研究纳入了41例患者（平均年龄71.9岁），WB DWI在24%的患者中识别出PSMA阴性病变。PSMA PET的一致性高于DWI，尽管两者的一致性都很好（ICC分别为0.87和0.72）。疾病不匹配患者的中位总生存期为442天，而无疾病不匹配患者为523天，尽管这种差异无统计学意义（P = 0.49）。：在PSMA PET基础上增加WB DWI可以识别PSMA阴性疾病，这可能会改变患者的管理。
