摘要
目的 比较18F-前列腺特异膜抗原(PSMA)-1007 PET/CT、18F-FDG PET/CT及多参数MRI(mpMRI)显像对前列腺癌的诊断效能.方法 回顾性分析2021年4月至2022年9月在南京医科大学附属泰州人民医院病理确诊为前列腺癌、30 d内完成18F-PSMA-1007 PET/CT、18F-FDG PET/CT和mpMRI检查的22例患者[(72.6±6.2)岁]资料,收集其影像学参数:PSMA-SUVmax、FDG-SUVmax、最小表观弥散系数(ADCmin)、平均表观弥散系数(ADCmean)以及组合参数PSMA-SUVmax/ADCmin、PSMA-SUVmax/ADCmean、FDG-SUVmax/ADCmin、FDG-SUVmax/ADCmean.分别按国际泌尿病理协会(ISUP)分级(≤3和＞3)及血清总前列腺特异抗原(TPSA;≤20和＞20 μg/L)对患者进行分组,比较各影像学参数的组间差异(Mann-Whitney U检验或两独立样本t检验),采用ROC曲线分析各参数对不同级别前列腺癌的诊断能力.使用x2检验及ROC曲线分析比较三者对前列腺癌原发灶、淋巴结和骨转移的检出率和诊断效能.结果 ISUP≤3(n=6)和＞3(n=16)组患者间PSMA-SUVmax/ADCmin、PSMA-SUVmax/ADCmean、PSMA-SUVmax、ADCmin差异均有统计学意义(z 值:-2.65～-2.36,t=3.60,P值:0.002～0.018).TPSA≤20 μg/L(n=5)和＞20 μg/L(n=17)组患者各指标间差异均无统计学意义(z 值:-1.76～-1.45,t 值:-1.19 和 1.28,均 P＞0.05).PSMA-SUVmax/ADCmin鉴别诊断高低级别前列腺癌的最佳阈值为22.628×103.基于患者研究,18F-PSMA-1007 PET/CT、18F-FDG PET/CT、mpMRI对前列腺癌原发灶的检出率差异无统计学意义(x2=1.91,P=0.767);三者对淋巴结、骨转移的检出率分别为 72.73％(16/22)、59.09％(13/22)、36.36％(8/22)及 81.82％(18/22)、63.64％(14/22)、45.45％(10/22),差异均有统计学意义(x2 值:6.03 和 6.29,P 值:0.049 和 0.043).18 F-PSMA PET/CT 较 mpMRI 上调了约 36.36％(8/22)的N分期、40.91％(9/22)的 M 分期.结论 PSMA-SUVmax/ADCmin在鉴别诊断高低级别前列腺癌方面是有价值的参数o18F-PSMA-1007 PET/CT较18F-FDG PET/CT、mpMRI能检出更多的前列腺癌淋巴结和骨转移灶且诊断效能更高,推荐用于NM分期.
Abstract
Objective To compare the diagnostic efficacy of 18F-prostate specific membrane anti-gen(PSMA)-1007 PET/CT,18F-FDG PET/CT and multi-parameter MRI(mpMRI)in prostate cancer(PCa).Methods Retrospective analysis was conducted on data from 22 patients((72.6±6.2)years)with pathologically confirmed PCa in the Affiliated Taizhou People's Hospital of Nanjing Medical University between April 2021 and September 2022.All patients underwent 18F-PSMA-1007 PET/CT,18F-FDG PET/CT,and mpMRI examination within 30 d,and the imaging parameters were collected,including PSMA-SUVmax,FDG-SUVmax,minimum apparent diffusion coefficient(ADCmin),mean apparent diffusion coeffi-cient(ADCmean),PSMA-SUVmax/ADCmin,PSMA-SUVmax/ADCmem,FDG-SUVmax/ADCmin,FDG-SUVmax/ADCmean.Patients were divided into groups based on the International Society of Urological Pathology(ISUP)grading(≤3 vs＞3)and serum total prostate specific antigen(TPSA;≤20 μg/L vs＞20 μg/L),and differences of imaging parameters between groups were compared(Mann-Whitney U test or independent-sample t test).ROC curves were generated to evaluate the diagnostic ability of each parameter for different levels of PCa.x2 test and ROC curve analysis were used to compare the detection rate and diagnostic efficien-cy of three imaging methods for primary focus,lymph node metastasis,and bone metastasis in PCa.Results Differences were found between ISUP≤3(n=6)and＞3(n=16)groups in PSMA-SUVmax/ADCmin,PSMA-SUV/ADCmean,PSMA-SUVmax,and ADC min(z values:from-2.65 to-2.36,t=3.60,P values:0.002-0.018).But there was no significant difference found between TPSA≤20 µg/L(n=5)and＞20 μg/L(n=17)groups in all indices(z values:from-1.76 to-1.45,t values:-1.19 and 1.28,all P＞0.05).The op-timal cut-off value for PSMA-SUVmax/ADCmin in differentiating high-grade and low-grade PCa was deter-mined to be 22.628×103.In the patient-based analysis,no statistical difference was found in the detection rate of PCa primary tumors among 18F-PSMA-1007 PET/CT,18F-FDG PET/CT,and mpMRI(x2=1.91,P=0.767).However,the detection rates of lymph node and bone metastasis among three imaging methods were significantly different(72.73％(16/22),59.09％(13/22),36.36％(8/22)and 81.82％(18/22),63.64％(14/22),45.45％(10/22);x2 values:6.03,6.29;P values:0.049,0.043).18F-PSMA-1007 PET/CT resulted in a 36.36％(8/22)increase in N stage and the 40.91％(9/22)increase in M stage com-pared to mpMRI.Conclusions PSMA-SUVmax/ADCmin is a valuable parameter for differentiating high-grade and low-grade PCa.18F-PSMA-1007 PET/CT demonstrates superior detection rate of PCa lymph node and bone metastasis compared to 18F-FDG PET/CT and mpMRI,and exhibits higher diagnostic efficiency,so it can be recommended for NM staging in patients with PCa.
基金项目
国家自然科学基金(81971573)
姑苏卫生青年拔尖人才项目(GSWS2020019)
泰州市科技支撑计划(TS202006)
万方数据