Hu Biyao, Yu Haonan, Pan Meijie, Yang Hailei, Xing Xiling, Li Dong, Yao Shaobo, Chen Qiusong
Department of PET/CT Diagnostic, Tianjin Key Lab of Functional Imaging & Tianjin Institute of Radiology, Tianjin Medical University General Hospital, Tianjin, China.
The Clinical Research and Translational Center, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
Front Oncol. 2025 Apr 11;15:1515653. doi: 10.3389/fonc.2025.1515653. eCollection 2025.
Delayed PET/CT imaging with Ga-PSMA-11 is valuable in the detection of primary prostate (PCa) lesions and the differentiation of suspicious lesions. However, F-FDG PET/CT has been overlooked due to its low sensitivity to PCa during routine examination. This study aimed to compare the clinical impact of PSMA and FDG in delayed PET/CT imaging in PCa diagnosis.
Between 2019 and 2024, 65 PCa patients who underwent early (1 h post-injection) and delayed (3 h p.i.) PSMA and FDG scans were retrospectively analyzed. The delayed scans were conducted to clarify unclear findings in early scans or to increase the tumor lesions uptake in negative early scans. All patients were asked to drink 1 L of water between early and delayed scans. The number of primary and metastatic lesions, sensitivity, specificity, diagnostic accuracy, lesions changes in SUV of early and delayed scans were evaluated. Correlation between SUV and Gleason score as well as SUV and PSA for PCa primary lesions diagnosis were analyzed.
Overall, 83 and 84 lesions characteristic for PCa in 65 patients clearly presented at 1 h and 3 h p.i. in PSMA scans, respectively. 30 and 45 lesions characteristic for PCa in 65 patients clearly presented at 1 h and 3 h p.i. in FDG scans. The 3-hour delayed imaging of FDG found more primary foci than 1-hour imaging but was much less able to detect metastatic foci than PSMA. PSMA was more sensitive than FDG in delayed imaging (96.15% vs. 84.21%), and the diagnostic accuracy for primary foci was higher for PSMA than FDG in delayed imaging (83.87% vs. 73.91%). However, FDG delayed imaging greatly improved the diagnostic accuracy for primary PCa compared to early imaging (73.91% vs.53.33%). PSMA SUV of both 1 h and 3 h p.i. were correlated with the Gleason score PSA, but FDG SUV only showed a correlation with PSA at 3 h p.i.
PSMA PET/CT at 3 h p.i. detected the most lesions characteristic of primary PCa, and it showed higher uptake and contrast than FDG. However, to some extent, FDG delayed PET/CT imaging is still important in primary PCa diagnosis, particularly in hospitals without PSMA.
使用镓标记的前列腺特异性膜抗原（Ga-PSMA-11）进行延迟正电子发射断层扫描/计算机断层扫描（PET/CT）成像在原发性前列腺癌（PCa）病变检测及可疑病变鉴别中具有重要价值。然而，在常规检查中，由于氟代脱氧葡萄糖（F-FDG）PET/CT对PCa的敏感性较低，一直未受到重视。本研究旨在比较PSMA和FDG在延迟PET/CT成像中对PCa诊断的临床影响。
回顾性分析2019年至2024年间65例接受早期（注射后1小时）和延迟（注射后3小时）PSMA及FDG扫描的PCa患者。进行延迟扫描是为了明确早期扫描中不清晰的发现，或增加早期扫描为阴性时肿瘤病变的摄取。所有患者在早期和延迟扫描之间被要求饮用1升水。评估原发性和转移性病变的数量、敏感性、特异性、诊断准确性、早期和延迟扫描中病变SUV的变化。分析SUV与Gleason评分以及SUV与PCa原发性病变诊断的PSA之间的相关性。
总体而言，65例患者中分别有83个和84个PCa特征性病变在PSMA扫描的注射后1小时和3小时清晰显示。65例患者中分别有30个和45个PCa特征性病变在FDG扫描的注射后1小时和3小时清晰显示。FDG的3小时延迟成像发现的原发性病灶比1小时成像更多，但检测转移性病灶的能力远低于PSMA。PSMA在延迟成像中比FDG更敏感（96.15%对84.21%），延迟成像中PSMA对原发性病灶的诊断准确性高于FDG（83.87%对73.91%）。然而，与早期成像相比，FDG延迟成像大大提高了原发性PCa的诊断准确性（73.91%对53.33%）。注射后1小时和3小时的PSMA SUV均与Gleason评分PSA相关，但FDG SUV仅在注射后3小时与PSA相关。
注射后3小时的PSMA PET/CT检测到的原发性PCa特征性病变最多，且显示出比FDG更高的摄取和对比度。然而，在一定程度上，FDG延迟PET/CT成像在原发性PCa诊断中仍然很重要，特别是在没有PSMA的医院。
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