68Ga-PSMA-11 PET/CT半定量指标对前列腺良恶性病变鉴别诊断的价值  

Value of semi-quantitative indices of 68Ga-PSMA-11 PET/CT in differential diagnosis of malignant and benign prostate lesions

作　　者：秦露平[1] 吕杰 李名钊[2] 李建芳[1] 谢良骏[1] 查悦明 蒋永泺 程木华[1] Qin Luping;Lyu Jie;Li Mingzhao;Li Jianfang;Xie Liangjun;Zha Yueming;Jiang Yongluo;Cheng Muhua(Department of Nuclear Medicine,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630, China;Department of Urology,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院核医学科,广州510630 [2]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华核医学与分子影像杂志》2019年第2期67-71,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的 探讨68Ga-前列腺特异膜抗原(PSMA)-11 PET/CT半定量指标对前列腺良恶性病变鉴别诊断的价值。 方法 回顾性分析2017年11月至2018年6月于本院行68Ga-PSMA-11 PET/CT检查的初诊患者30例(年龄52~86岁),检查前1周内检测血清总前列腺特异抗原(tPSA)和游离前列腺特异抗原(fPSA)。通过阈值自动分割法测量前列腺病灶68Ga-PSMA-11 PET半定量指标,包括病灶PSMA体积(VPSMA)、最大标准摄取值(SUVmax)、平均标准摄取值(SUVmean)、标准摄取值峰值(SUVpeak)及病灶PSMA总量(TLUPSMA)。采用Mann-Whitney u检验比较前列腺良恶性病变各指标的差异,用受试者工作特征(ROC)曲线获得鉴别前列腺良恶性病变的最佳阈值。 结果 经病理证实,19例为前列腺癌,11例为前列腺良性病变。前列腺良恶性病变患者之间的tPSA、SUVmax、SUVmean、SUVpeak及TLUPSMA差异均有统计学意义(u值:17.00~48.00,均P<0.05);而两者之间的fPSA、fPSA/tPSA及VPSMA差异均无统计学意义(u值:64.00~99.00,均P>0.05)。tPSA鉴别前列腺良恶性病变最佳阈值为18.30 μg/L,对应的灵敏度为13/17(2例患者PSA信息缺失),特异性为9/11,ROC曲线下面积(AUC)为0.743。SUVmax、SUVmean及SUVpeak鉴别前列腺良恶性病变最佳阈值为分别为5.50、3.09及3.56,对应灵敏度均为18/19,特异性均为9/11,AUC分别为0.902、0.907及0.919。TLUPSMA鉴别前列腺良恶性病变最佳阈值为54.81 cm3,对应灵敏度为14/19,特异性为9/11,AUC为0.804。 结论 68Ga-PSMA-11 PET/CT半定量指标SUVmax、SUVmean、SUVpeak及TLUPSMA对前列腺良恶性病变鉴别有价值,其中SUVpeak诊断效能可能更佳。Objective To evaluate the value of semi-quantitative indices of 68Ga-prostate specific membrane antigen (PSMA)-11 PET/CT in differentiating malignant and benign prostate lesions.Methods From November 2017 to June 2018, 30 patients (age: 52-86 years) who underwent 68Ga-PSMA-11 PET/CT imaging in the Third Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed, and the serum total prostate specific antigen (tPSA) and free prostate specific antigen (fPSA) were examined within 1 week before PET/CT imaging. Semi-quantitative indices of 68Ga-PSMA-11 PET/CT on prostate lesions were measured by automatic segmentation algorithm method, including PSMA-related lesion volume (VPSMA), maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), peak standardized uptake value (SUVpeak) and total lesion uptake value of PSMA (TLUPSMA). The indices were compared between malignant and benign prostate lesions, and the optimal cut-off values for differentiating malignant and benign prostate lesions were obtained by receiver operating characteristic (ROC) curve analysis.Results According to the pathological results, 19 patients had malignant lesions and 11 were with benign diseases. The differences of tPSA, SUVmax, SUVmean, SUVpeak and TLUPSMA between malignant and benign prostate lesions were statistically significant (u values: 17.00-48.00, all P<0.05), but there were no significant differences of fPSA, fPSA/tPSA and VPSMA between 2 groups (u values: 64.00-99.00, all P>0.05). The optimal cut-off value of tPSA was 18.30 μg/L for differentiating malignant and benign prostate lesions, with sensitivity of 13/17 (PSA of 2 patients were missing), specificity of 9/11 and area under curve (AUC) of 0.743. The optimal cut-off values of SUVmax, SUVmean and SUVpeak were 5.50, 3.09 and 3.56, respectively, with all corresponding sensitivity of 18/19, all specificity of 9/11, and AUC of 0.902, 0.907 and 0.919, respectively. The optimal cut-off value of TLUPSMA was 54.81 cm3, with sensitivity of 14/19,

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 诊断 鉴别 

分 类 号：R737.25[医药卫生—肿瘤]