多参数MRI联合68Ga-PSMA PET/CT诊断临床显著性前列腺癌
Multi-parametric MRI combined with 68Ga-PSMA PET/CT for the diagnosis of clinically significant prostate cancer
孟小丽 1康飞 1全志永 1张明如 1王敏 1韩婷婷 1舒俊 2任静 2杨卫东 1汪静1
作者信息
- 1. 空军军医大学第一附属医院核医学科,西安 710032
- 2. 空军军医大学第一附属医院放射科,西安 710032
- 折叠
摘要
目的 探索多参数MRI(mpMRI)联合68Ga-前列腺特异膜抗原(PSMA)PET/CT是否可以提高对临床显著性前列腺癌(csPCa)的检测效能.方法 回顾性分析2021年1月至2022年11月怀疑前列腺癌于空军军医大学第一附属医院行mpMRI及68Ga-PSMA PET/CT显像的152例患者[年龄(68.5±8.5)岁]的临床及影像学资料.使用经直肠超声引导的活组织检查(简称活检)的组织病理学结果作为"金标准".活检结果Gleason评分(GS)≥3+4分的病灶诊断为csPCa,活检阴性或GS评分6分的病灶为非csPCa.mpMRI图像由2位放射科医师采用前列腺影像报告和数据系统(PI-RADS)2.1版本进行评估.68Ga-PSMA PET/CT采用SUVmax评价前列腺病变的显像剂摄取程度.采用两独立样本t检验、Mann-Whitney U检验和x2检验比较2组间的差异,再行多因素logistic回归分析.利用ROC曲线分析各因素单独及联合诊断的效能,并通过Delong检验加以比较.结果 纳入csPCa组患者85例,非csPCa组患者67例.单因素分析显示PI-RADS评分、前列腺特异抗原(PSA)和SUVmax在csPCa组和非csPCa组间差异均有统计学意义(x2=68.06,U值:-7.66、-8.98;均P＜0.001).多因素 logistic 回归分析显示 PI-RADS 评分[比值比(OR)=3.424,95％CI:1.651～7.100]和 SUVmax(OR=1.931,95％CI:1.403～2.658)为 csPCa 的预测因素(均 P＜0.001).ROC 曲线显示,mpMRI 和PET/CT诊断的csPCa最佳阈值分别为PI-RADS 4分和SUVmax 5.6,准确性分别为80％(122/152)[AUC=0.789(95％CI:0.711～0.866),灵敏度 91％(77/85),特异性 67％(45/67)]和 87％(132/152)[AUC=0.876(95％CI:0.817～0.936),灵敏度 81％(69/85),特异性 94％(63/67)].在构建的 4 种联合预测模型中,PI-RADS 5分或PI-RADS 3～4分且SUVmax＞5.6诊断csPCa的效能高于mpMRI和PET/CT单独及其他3种联合预测模型(z值:2.01～3.64,均P＜0.05),准确性达91％(138/152)[AUC=0.910(95％CI:0.857～0.962),灵敏度 89％(76/85),特异性 93％(62/67)].结论 MpMRI 联合68Ga-PSMA PET/CT明显提高了对csPCa的检测,主要是改善了 mpMRI中PI-RADS 3～4分病变的风险分层.
Abstract
Objective To explore whether multi-parametric MRI(mpMRI)combined with 68 Ga-prostate specific membrane antigen(PSMA)PET/CT can improve the detection efficiency of clinically sig-nificant prostate cancer(csPCa).Methods Clinical and imaging data of 152 patients(age(68.5±8.5)years)who underwent mpMRI and 68Ga-PSMA PET/CT examination for suspected prostate cancer in the First Affiliated Hospital of the Air Force Medical University from January 2021 to November 2022 were retro-spectively analyzed,with the histopathological results from transrectal ultrasound guided biopsy as reference.Lesions with Gleason scores(GS)≥3+4 from the biopsy were diagnosed with csPCa,and lesions with neg-ative biopsy or GS 6 were diagnosed with non-csPCa.MpMRI was evaluated independently by two radiolo-gists according to the Prostate Imaging Reporting and Data System(PI-RADS)version 2.1.The radioactive uptake of 68Ga-PSMA PET/CT in prostate lesions was evaluated by SUVmax.The independent-sample t test,Mann-Whitney U test and x2 test were used to compare differences between the two groups,and then multi-variate logistic regression analysis was performed.ROC curves analysis was used to analyze the diagnostic ef-ficacies of individual and combined factors and Delong test was used.Results There were 85 csPCa and 67 non-csPCa confirmed.Prostate specific antigen(PSA),PI-RADS score and SUVmax were significantly differ-ent between the csPCa group and the non-csPCa group(x2=68.06,U values:-7.66,-8.98,all P＜0.001).Multivariate logistic regression analysis indicated that PI-RADS score(odds ratio(OR)=3.424,95％CI:1.651-7.100)and SUVmax(OR=1.931,95％CI:1.403-2.658)were independent predictors of csPCa(both P＜0.001).ROC curves analysis revealed that the cut-off value for diagnosing csPCa was 4 for PI-RADS score and 5.6 for SUVmax.The accuracy of mpMRI and PET/CT alone in csPCa diagnosis was 80％(122/152)(AUC of 0.789(95％CI:0.711-0.866)with the sensitivity and specificity of 91％(77/85)and 67％(45/67)),and 87％(132/152)(AUC of 0.876(95％CI:0.817-0.936)with the sensitivity and specificity of 81％(69/85)and 94％(63/67)),respectively.Several joint models incorporating 68 Ga-PSMA PET/CT with mpMRI data were investigated,the model of PI-RADS 5 or PI-RADS 3-4 and SUVmax＞5.6 showed better performance than mpMRI and PET/CT alone and other joint models(z values:2.01-3.64,all P＜0.05),with the accuracy of 91％(138/152)(AUC of 0.910(95％CI:0.857-0.962)with the sensitivity and specificity of 89％(76/85)and 93％(62/67)).Conclusion MpMRI combined with 68Ga-PSMA PET/CT can significantly improve the detection efficiency of csPCa,with the principal effect being im-proved in risk stratification of PI-RADS 3-4 lesions in mpMRI.
关键词
前列腺肿瘤/前列腺特异膜抗原/同位素标记/镓放射性同位素/正电子发射断层显像术/体层摄影术,X线计算机/磁共振成像Key words
Prostatic neoplasms/Prostate-specific membrane antigen/Isotope labeling/Gallium radioisotopes/Positron-emission tomography/Tomography,X-ray computed/Magnetic resonance imaging引用本文复制引用
出版年
2024
NETL
NSTL
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