目的 探讨 18 氟标记前列腺特异性膜抗原-1007正电子发射计算机体层摄影(fluorine-18 prostate specific membrane antigen 1007-positron emission tomography/computed tomography,18F-PSMA-1007 PET/CT)与多参数磁共振成像(multi-parameter magnetic resonance imaging,mp-MRI)单独及联合对前列腺癌(prostate cancer,PCa)的检测效能,并比较最大标准化摄取值(maximum standardized uptake value,SUVmax)、表观弥散系数(apparent diffusion coefficient,ADC)、SUVmax/ADC、T1、T2、质子密度(proton density,PD)值与PCa病理分级的相关性.材料与方法 回顾性分析我院2020年4月至2022年9月疑似PCa并拟行穿刺活检或手术的患者病例,最终50例患者被纳入研究,其中42例确诊PCa.按照国际泌尿病理协会(International Society of Urological Pathology,ISUP)分级共分为5组,包括中高级别组(分级≥4)25例和低级别组(分级1～3)17例,比较不同分组的SUVmax、ADC及SUVmax/ADC的差异.采用Spearman相关分析SUVmax、ADC、SUVmax/ADC、T1、T2、PD值之间的相关性及分别与ISUP分级的相关性.以病理为金标准,分析 18F-PSMA-1007 PET/CT与mp-MRI单独及联合对前列腺良恶性的检测效能.绘制受试者工作特征(receiver operating characteristic,ROC)并计算曲线下面积(area under the curve,AUC)、敏感度和特异度,评价SUVmax、ADC、SUVmax/ADC及联合参数诊断效能,通过DeLong检验比较AUC间的差异.结果 PCa高级别组与低级别组的ADC值、SUVmax、SUVmax/ADC差异均有统计学意义(P均<0.001).50例患者的ADC值与SUVmax呈负相关性(r=-0.516,P<0.05),42例确诊PCa患者的ADC值与ISUP分级呈负相关(r=-0.616,P<0.05),SUVmax、SUVmax/ADC与ISUP分级呈正相关(r=0.549、0.639,P均<0.05).20例完成定量磁共振图像编译(magnetic resonance image compilation,MAGiC)序列患者T1、T2、PD值与ISUP分级无相关性(r=0.045、0.202、0.028,P均＞0.05);T1、T2值与ADC值呈正相关(r=0.616,r= 0.756,P均<0.05),PD值与ADC值呈负相关(r=-0.506,P<0.05).SUVmax与T1、T2、PD值没有明显相关性(r=-0.132,r=-0.422,r=0.230,P均>0.05).ROC曲线分析显示,SUVmax的AUC为0.940,差异有统计学意义(P<0.001),以7.80为临界值,诊断PCa的敏感度为83.33%,特异度为100.00%;ADC值的AUC为0.970,差异有统计学意义(P<0.001),以1.20×10-3 mm2/s为临界值,诊断PCa的敏感度为95.24%,特异度为87.50%;SUVmax/ADC的AUC为0.970,差异有统计学意义(P<0.001),以6.43×103 为临界值,诊断PCa的敏感度为90.48%,特异度为100%;SUVmax和ADC联合的AUC为0.976,差异有统计学意义(P<0.001),以0.85为临界值,诊断PCa的敏感度为90.48%,特异度为100.00%.结论 联合 18F-PSMA-1007 PET/CT与mp-MRI可以提高对PCa的诊断效能;ADC值、SUVmax及SUVmax/ADC能够区分低危与中高危PCa.
Study on the detection efficiency of 18F-PSMA-1007 PET/CT and mp-MRI in prostate cancer and its correlation with pathological grade
Objective:To explore the comparison of the detection efficacy of 18-fluoro-labeled prostate specific membrane antigen(18F-PSMA-1007)positron emission tomography(PET)/computed tomography(CT)and multi-parameter magnetic resonance imaging(mp-MRI)alone and combined with prostate cancer(PCa)and the correlation between maximum standardized uptake value(SUVmax),apparent diffusion coefficient(ADC),SUVmax/ADC,T1,T2,proton density(PD)value and pathological grade of PCa.Materials and Methods:A retrospective analysis was made on 50 patients suspected of PCa who were scheduled to undergo biopsy or surgery in our hospital from April 2020 to September 2022,of which 42 cases were diagnosed with PCa.According to the International Society of Urological Pathology(ISUP),the patients were divided into 5 groups.According to ISUP classification,there were 25 cases in high grade group(≥4 grade)and 17 cases in low grade group(1-3 grade).The differences of SUVmax,ADC and SUVmax/ADC in different grade groups were compared.Spearman correlation analysis was used to analyze the correlation among SUVmax value,ADC value,SUVmax/ADC,T1,T2,PD value and ISUP classification.Taking pathology as the gold standard,the efficacy of 18F-PSMA-1007 PET/CT and mp-MRI alone or in combination in the detection of benign and malignant prostate was analyzed.The diagnostic efficacy of SUVmax,ADC,SUVmax/ADC and combined parameters was evaluated by drawing receiver operating characteristic(ROC)and calculating the area under the curve(AUC),sensitivity and specificity,and the differences of AUC values were compared by DeLong test.Results:There were significant differences in ADC,SUVmax,SUVmax/ADC between high-grade group and low-grade group(all P<0.001).Correlation analysis showed that there was a negative correlation between ADC and SUVmax in 50 cases of prostate diseases(r=-0.516,P<0.05),a negative correlation between ADC and ISUP in 42 cases of diagnosed PCa(r=-0.616,P<0.05),and a positive correlation between SUVmax,SUVmax/ADC and ISUP(r=0.549,r=0.639,all P<0.05).Magnetic resonance image compilation(MAGiC)sequence was completed in 20 cases,in which T1,T2,PD values were not correlated with ISUP(r=0.045,r=0.202,r=0.028,all P>0.05),T1 and T2 values were positively correlated with ADC(r=0.616,r=0.756,all P<0.05),while PD values were negatively correlated with ADC(r=-0.506,P<0.05).There was no significant correlation between SUVmax and T1,T2,PD(r=-0.132,r=-0.422,r=0.230,all P>0.05).ROC curve analysis showed that the AUC of SUVmax was 0.940 and the difference was statistically significant(P<0.001).With SUVmax= 7.80 as the critical value,the sensitivity and specificity for the diagnosis of PCa were 83.33%and 100.00%,and the AUC of ADC was 0.970 and the difference was statistically significant(P<0.001).When ADC was 1.20×10-3 mm2/s,the sensitivity and specificity for the diagnosis of PCa were 95.24%and 87.50%,respectively.The AUC of SUVmax/ADC combined diagnosis of PCa was 0.970,and the difference was statistically significant(P<0.001).With SUVmax/ADC=6.43×103 as the critical value,the sensitivity and specificity of PCa diagnosis were 90.48%and 100.00%,respectively.The AUC of combining the two parameters was 0.976,and the difference was statistically significant(P<0.001).Taking 0.85 as the critical value,the sensitivity of diagnosing PCa was 90.48%,and the specificity was 100.00%.Conclusions:The combination of 18F-PSMA-1007 PET/CT and mp-MRI can improve the diagnostic efficiency of PCa.ADC value,SUVmax and SUVmax/ADC can distinguish between low-risk and medium-high-risk PCa.
万方数据
