Argow Moritz J, Hupfeld Sebastian, Schenke Simone A, Neumann Sophie, Damm Romy, Vogt Johanna, Guer Melis, Wuestemann Jan, Schostak Martin, Fischbach Frank, Kreissl Michael C
Devision of Radiology, Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany.
Department of Ophthalmology, University Hospital Brandenburg a.d.H., Medical University Brandenburg Theodor Fontane, 14770 Brandenburg an der Havel, Germany.
Diagnostics (Basel). 2025 May 28;15(11):1358. doi: 10.3390/diagnostics15111358.
While multi-parametric magnetic resonance imaging (mpMRI) is known to be a specific and reliable modality for the diagnosis of non-metastatic prostate cancer (PC), positron emission tomography (PET) using Ga labeled ligands targeting the prostate-specific membrane antigen (PSMA) is known for its reliable detection of prostate cancer, being the most sensitive modality for the assessment of the extra-prostatic extension of the disease and the establishment of a diagnosis, even before biopsy. : Here, we compared these modalities in regards to the localization of intraprostatic cancer lesions prior to local HDR brachytherapy. : A cohort of 27 patients received both mpMRI and PSMA-PET/CT. Based on 24 intraprostatic segments, two readers each scored the risk of tumor-like alteration in each imaging modality. The detectability was evaluated using receiver operating characteristic (ROC) analysis. The histopathological findings from biopsy were used as the gold standard in each segment. In addition, we applied a patient-based "congruence" concept to quantify the interobserver and intermodality agreement. : For the ROC analysis, we included 447 segments (19 patients), with their respective histological references. The two readers of the MRI reached an AUC of 0.770 and 0.781, respectively, with no significant difference ( = 0.75). The PET/CT readers reached an AUC of 0.684 and 0.608, respectively, with a significant difference ( < 0.001). The segment-wise intermodality comparison showed a significant superiority of MRI (AUC = 0.815) compared to PET/CT (AUC = 0.690) ( = 0.006). Via a patient-based analysis, a superiority of MRI in terms of relative agreement with the biopsy result was observed ( = 19 patients). We found congruence scores of 83% (MRI) and 76% (PET/CT, = 0.034), respectively. Using an adjusted "near total agreement" score (adjacent segments with positive scores of 4 or 5 counted as congruent), we found an increase in the agreement, with a score of 96.5% for MRI and 92.7% for PET/CT, with significant difference ( = 0.024). : This study suggests that in a small collective of low-/intermediate risk prostate cancer, mpMRI is superior for the detection of intraprostatic lesions as compared to PSMA-PET/CT. We also found a higher relative agreement between MRI and biopsy as compared to that for PET/CT. However, further studies including a larger number of patients and readers are necessary to draw solid conclusions.
虽然多参数磁共振成像（mpMRI）是诊断非转移性前列腺癌（PC）的一种特异且可靠的方法，但使用靶向前列腺特异性膜抗原（PSMA）的镓标记配体的正电子发射断层扫描（PET）以其对前列腺癌的可靠检测而闻名，它是评估疾病前列腺外扩展和进行诊断（甚至在活检之前）最敏感的方法。在此，我们比较了这些方法在局部高剂量率近距离放疗前前列腺内癌灶定位方面的情况。27例患者同时接受了mpMRI和PSMA-PET/CT检查。基于24个前列腺内节段，两名阅片者分别对每种成像方法中肿瘤样改变的风险进行评分。使用受试者工作特征（ROC）分析评估可检测性。活检的组织病理学结果用作每个节段的金标准。此外，我们应用基于患者的“一致性”概念来量化观察者间和方法间的一致性。对于ROC分析，我们纳入了447个节段（19例患者）及其各自的组织学参考。MRI的两名阅片者的AUC分别为0.770和0.781，无显著差异（=0.75）。PET/CT阅片者的AUC分别为0.684和0.608，有显著差异（<0.001）。节段性方法间比较显示，与PET/CT（AUC = 0.690）相比，MRI具有显著优势（AUC = 0.815）（=0.006）。通过基于患者的分析，观察到MRI在与活检结果的相对一致性方面具有优势（=19例患者）。我们发现一致性评分分别为83%（MRI）和76%（PET/CT，=0.034）。使用调整后的“近乎完全一致”评分（相邻节段阳性评分为4或5计为一致），我们发现一致性有所提高，MRI评分为96.5%，PET/CT评分为92.7%，有显著差异（=0.024）。本研究表明，在一小群低/中危前列腺癌患者中，与PSMA-PET/CT相比，mpMRI在检测前列腺内病变方面更具优势。我们还发现，与PET/CT相比，MRI与活检之间的相对一致性更高。然而，需要进一步纳入更多患者和阅片者的研究才能得出确凿结论。
