评估前列腺癌的前列腺外扩展：MRI与PSMA-PET/CT的实用整合

Evaluating extraprostatic extension of prostate cancer: pragmatic integration of MRI and PSMA-PET/CT.

作者信息

Woo Sungmin, Freedman Daniel, Becker Anton S, Leithner Doris, Charbel Charlotte, Mayerhoefer Marius E, Friedman Kent P, Tong Angela, Wise David R, Taneja Samir S, Zelefsky Michael J, Vargas Hebert Alberto

机构信息

Department of Radiology, NYU Langone Health, New York, USA.

Department of Medicine, Perlmutter Cancer Center, NYU Langone Medical Center, New York, USA.

出版信息

Abdom Radiol (NY). 2025 Apr 19. doi: 10.1007/s00261-025-04948-2.

DOI:10.1007/s00261-025-04948-2

PMID:40252100

Abstract

PURPOSE

To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa).

METHODS

Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021-2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUV. Three pragmatic integrated approaches were tested: (1) Integration of Likert scales (positive if either or both MRI and PSMA-PET/CT were positive); (2) P score (framework combining PI-RADS + PRIMARY); and (3) combining MRI morphological information with PSMA-PET/CT functional information (upgrading suspicion of lesions with LCC below cutoff if SUV>12). Diagnostic performance was tested with receiver operating characteristic (ROC) curves and compared using DeLong and McNemar tests.

RESULTS

67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61-0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71-0.92) with cutoff of ≥ 1.7 cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, p = 0.02] and 87.5% [14/16, p > 0.99]). This approach upgraded suspicion in 8 patients with LCC < 1.7 cm due to SUV>12 among which 87.5% (7/8) were corrected upgraded and had pathological EPE.

CONCLUSION

Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used.

摘要

目的

探索将MRI和PSMA-PET/CT相结合用于评估前列腺癌（PCa）前列腺外侵犯（EPE）的实用方法。

方法

纳入2021年至2024年期间连续接受多参数MRI和PSMA-PET/CT检查，随后接受根治性前列腺切除术的新诊断PCa患者。两种检查方式评估的影像参数包括：大小、包膜接触长度（LCC）、李克特量表（MRI EPE分级/PSMA李克特量表）、PI-RADS/PRIMARY评分以及SUV。测试了三种实用的综合方法：（1）李克特量表综合法（若MRI和PSMA-PET/CT其中之一或两者均为阳性则判定为阳性）；（2）P评分（结合PI-RADS和PRIMARY的框架）；（3）将MRI形态学信息与PSMA-PET/CT功能信息相结合（若SUV>12，则将LCC低于临界值病变的可疑度升级）。使用受试者工作特征（ROC）曲线测试诊断性能，并使用德龙检验和麦克尼马尔检验进行比较。

结果

纳入67名男性（中位年龄66岁），其中76.1%（51/67）存在EPE。ROC曲线下面积（AUC）为0.61 - 0.82；基于MRI的LCC得出最高AUC为0.82（0.71 - 0.92），临界值为≥1.7 cm。综合李克特量表（MRI EPE分级/PSMA李克特量表）显示敏感性为80.4%（41/51），特异性为31.3%（5/16）。P评分（PI-RADS/PRIMARY）显示敏感性为31.3%（16/51），特异性为87.5%（14/16）。将MRI形态学信息与PSMA-PET/CT功能信息相结合，敏感性和特异性分别为80.4%（41/51）和81.2%（13/16），与单独基于MRI的LCC相比，敏感性显著更高，但特异性无显著差异（分别为66.7% [34/51，p = 0.02]和87.5% [14/16，p > 0.99]）。该方法将8例LCC < 1.7 cm患者的可疑度升级，原因是SUV>12，其中87.5%（7/8）经校正后升级且存在病理EPE。