18F-PSMA PET/CT是否是评估治疗后患者复发性/残留性脑肿瘤状态的可靠成像方式？

Is 18F-PSMA PET/CT a reliable imaging modality to evaluate the status of recurrent/residual brain tumors in post-treatment patients?

作者信息

Jain Tarun Kumar, Vohra Mansha, Sharma Bhawani Shanker, Loyal Anushree, Sharma Priya, Meet Patel, Dhal Shikha, Mishra Vineet, Verma Jitendra Singh, Tyagi Surabhi, Malhotra Hemant

机构信息

Department of Nuclear Medicine, Mahatma Gandhi medical college & hospital, Jaipur, 302022, Rajasthan, India.

Department of Neurosurgery, Mahatma Gandhi medical college & hospital, Jaipur, 302022, Rajasthan, India.

出版信息

J Neurooncol. 2025 Jul 31. doi: 10.1007/s11060-025-05167-x.

DOI:10.1007/s11060-025-05167-x

PMID:40745076

Abstract

BACKGROUND

Brain tumors are the most challenging malignancies. The existing investigational and treatment modalities have a few drawbacks with high rate of recurrence / residual tumoral tissue. Positron Emitting Tomography combined with computed tomography (PET-CT) is a widely used imaging modality for oncology and non-oncological purposes with fluorine-18-floruodeoxyglucose (18 F-FDG) being the most familiar radiotracer. Physiological uptake of FDG in brain parenchyma makes it a challenging task to currently delineate the residual/ recurrent brain tumors which brings us to investigate new radiotracers.

OBJECTIVE

The purpose of present study is to identify the role of 18 fluoride labelled Prostate Specific Membrane Antigen (PSMA) in residual recurrent brain malignancies and compared the PSMA PET-CT scan with standard conventional imaging in same purpose.

METHODS

This was a prospective study and patients were enrolled after underwent treatment (surgery and /or concurrent chemoradiotherapy). In order to detection of the residual recurrent disease, 18 F PSMA PET-CT as well as conventional imaging modalities were performed. We calculated the diagnostic performance of the PSMA PET-CT and also compared with standard conventional imaging modalities.

RESULTS

Thirty-one patients were included in the study. Out of 31 patients, 23 (~ 74.2%) patients were positive on PSMA PET-CT scan and 18 (~ 58.06%) were on conventional imaging (CI) for residual recurrent mitotic disease. The calculated sensitivity, specificity, PPV, NPV and diagnostic yields for PSMA PET-CT and CI were 96%, 88%, 96%, 88% and 93.5% and 83%, 50%, 83%, 50% and 74.2% respectively. In our study, among 31 patients, 22 patients underwent MRI imaging in form of convention imaging and calculated sensitivity, specificity, PPV, NPV and diagnostic yields for MRI was 81%, 42.85%, 76.5%, 50% and 77.3% respectively. Among these 22 patients, MRI with PSMA PET-CT scan was discordant in 7 patients (27.3%).

CONCLUSION

18 F-PSMA PET-CT imaging has higher diagnostic yield then existing conventional diagnostic modalities with capability to rule out extracranial lesions and inherent-potential of being utilised as theragnostic moiety.

摘要

背景

脑肿瘤是最具挑战性的恶性肿瘤。现有的研究和治疗方式存在一些缺点，复发率/残留肿瘤组织率较高。正电子发射断层扫描结合计算机断层扫描（PET-CT）是一种广泛用于肿瘤学和非肿瘤学目的的成像方式，氟-18-氟脱氧葡萄糖（18F-FDG）是最常见的放射性示踪剂。脑实质中FDG的生理性摄取使得目前描绘残留/复发性脑肿瘤成为一项具有挑战性的任务，这促使我们研究新的放射性示踪剂。

目的

本研究的目的是确定18氟标记的前列腺特异性膜抗原（PSMA）在残留复发性脑恶性肿瘤中的作用，并将PSMA PET-CT扫描与用于相同目的的标准传统成像进行比较。

方法

这是一项前瞻性研究，患者在接受治疗（手术和/或同步放化疗）后入组。为了检测残留复发性疾病，进行了18F PSMA PET-CT以及传统成像方式检查。我们计算了PSMA PET-CT的诊断性能，并与标准传统成像方式进行了比较。

结果

31名患者纳入研究。在31名患者中，23名（约74.2%）患者的PSMA PET-CT扫描显示残留复发性有丝分裂疾病呈阳性，18名（约58.06%）患者的传统成像（CI）显示阳性。PSMA PET-CT和CI的计算敏感性、特异性、阳性预测值、阴性预测值和诊断率分别为96%、88%、96%、88%和93.5%以及83%、50%、83%、50%和74.2%。在我们的研究中，31名患者中有22名患者接受了传统成像形式的MRI检查，MRI的计算敏感性、特异性、阳性预测值、阴性预测值和诊断率分别为81%、42.85%、76.5%、50%和77.3%。在这22名患者中，7名患者（27.3%）的MRI与PSMA PET-CT扫描结果不一致。