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.
NETL
NSTL
万方数据
