99mTc-HYNIC-PSMA SPECT/CT imaging in diagnosis and risk stratification of prostate cancer
Objective To observe the detection of primary focus and metastatic focus of prostate cancer by 99mTc-HYNIC-PSMA SPECT/CT imaging,and to explore the application value in the diagnosis and risk stratification of prostate cancer.Methods Totally 131 patients with prostate cancer underwent 99mTc-HYNIC-PSMA SPECT/CT imaging in Henan Provincial People's Hospital from November 2018 to June 2023.The positive rate of PSMA SPECT/CT imaging was assessed.The primary focus(prostate)and metastatic focus(internal and external pelvic lymph nodes,bone and lung)were detected by PSMA SPECT/CT imaging.The maximum standardized uptake value(SUVmax)of the primary focus was recorded.In 131 patients,110 received pelvic MRI scan to compare the detection rates of primary focus,pelvic lymph node metastasis and bone metastasis by PSMA SPECT/CT imaging and by pelvic MRI scan,and 32 patients received bone imaging to compare the bone metastasis detection rates by PSMA SPECT/CT imaging versus bone imaging.According to the D'Amico prostate cancer risk assessment criteria,131 patients were divided into different serum prostate-specific antigen(PSA)level and Gleason score subgroups,and the detection rate of metastatic focus and the SUVmax of primary focus were compared among PSA＜10,10-20 and＞20 μg/L groups,and between Gleason score ≤7 and＞7 groups.The Spearman correlation method was used to analyze the correlations of SUVmax of primary focus with serum PSA level and Gleason score in PSMA SPECT/CT imaging-positive patients.The ROC curve was plotted to evaluate the efficiency of SUVmax of primary focus on predicting metastasis in PSMA SPECT/CT imaging-positive patients.Results Among 131 prostate cancer patients,121 had positive PSMA SPECT/CT imaging(92.4％).The PAS level was higher in PSMA SPECT/CT imaging-positive patients[48.01(15.75,135.25)μg/L]than that in PSMA SPECT/CT imaging-negative patients[11.33(7.10,18.07)μg/L](Z=-3.667,P＜0.001).Sixty-three of the 121 PSMA SPECT/CT imaging-positive patients were detected metastatic focus,and the detection rates of lymph node metastasis,internal pelvic lymph node metastasis,external pelvic lymph node metastasis,bone metastasis,and lung metastasis were 36.6％,35.9％,14.5％,35.1％and 5.3％,respectively.In 110 patients undergoing pelvic MRI scan,the detection rates of internal pelvic lymph node metastasis and bone metastasis were higher by PSMA SPECT/CT imaging(38.2％,33.6％)than those by MRI(25.5％,20.9％)(x2=4.107,P=0.043;x2=4.492,P=0.034),and there was no significant difference in the primary focus detection rate by PSMA SPECT/CT imaging(92.7％)compared with that by MRI(95.5％)(x2=0.736,P=0.391).In 32 patients undergoing bone imaging,there was no significant difference in the detection rate of bone metastasis by PSMA SPECT/CT imaging(46.9％)compared with that by bone imaging(40.6％)(x2=0.254,P=0.614).The detection rates of internal pelvic lymph node metastasis,external pelvic lymph node metastasis and bone metastasis by PSMA SPECT/CT imaging were lower in PSA＜10 μg/L group and PSA 10-20 μg/L group than those in PSA＞20 μg/L group(P＜0.05),showed no significant differences between PSA＜10 μg/L group PSA 10-20 μg/L group(P＞0.05),and were lower in Gleason ≤7 group than those in Gleason＞7 group(P＜0.05).The detection rate of lung metastasis by PSMA SPECT/CT imaging showed no significant difference in patients with different PSA levels and Gleason scores(P＞0.05).The SUVmax of primary focus increased sequentially in PSA＜10,10-20 and＞20 μg/L groups[3.52(2.91,6.12),4.81(3.25,8.83),9.34(6.70,13.58)](H=21.340,P＜0.001),and was lower in Gleason ≤7 group[4.76(2.97,7.94)]than that in Gleason＞7 group[9.11(6.04,13.57)](Z=-4.167,P＜0.001).The SUVmax of primary focus in PSMA SPECT/CT imaging-positive patients was positively correlated with the serum PSA level and Gleason score(r=0.500,P＜0.001;r=0.386,P＜0.001).The SUVmax of primary focus was higher in PSMA SPECT/CT imaging-positive patients with detected metastasis[9.84(7.58,14.39)]than that in those without detected metastasis[5.67(3.25,9.00)](Z=-4.576,P＜0.001).When the optimal cut-off value of the SUVmax of primary focus was 6.98,the AUC for predicting metastasis in PSMA SPECT/CT image-positive patients was 0.742(95％CI:0.654-0.831,P＜0.001),with a sensitivity of 81.0％and a specificity of 63.8％.Conclusions 99mTc-HYNIC-PSMA SPECT/CT imaging has a high value to the diagnosis of primary focus and metastatic focus of prostate cancer.The large SUVmax of primary focus indicates a high risk stratification of prostate cancer.The SUVmax of primary focus contributes to the prediction of metastasis of prostate cancer and assessing risk stratification.
NETL
NSTL
万方数据
