18F-PSMA PET/CT联合多参数磁共振对前列腺癌分级的诊断价值  

Diagnostic value of 18F-prostate specific membrane antigen PET/CT combined with multiparametric-MRI in identifying the grade group of prostate cancer

作　　者：王淼 侯惠民[1] 王萱[1] 朱辉[2] 程昊[3] 李春媚 刘辰[4] 李慧[5] 张伟[6] 刘龙腾[6] 丁鑫[1] 张亚群 杨志[4] 王建业[1,7] 刘明[1,7] Wang Miao;Hou Huimin;Wang Xuan;Zhu Hui;Cheng Hao;Li Chunmei;Liu Chen;Li Hui;Zhang Wei;Liu Longteng;Ding Xin;Zhang Yaqun;Yang Zhi;Wang Jianye;Liu Ming(Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Nuclear Medicine,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing),Department of Nuclear Medicine,Peking University Cancer Hospital&Institute,Beijing 100142,China;Department of Nuclear Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Graduate School of Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院泌尿外科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院核医学科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]北京医院放射科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [4]北京大学肿瘤医院暨北京市肿瘤防治研究所核医学科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142 [5]北京大学第三医院核医学科,北京100191 [6]北京医院病理科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [7]中国医学科学院,北京协和医学院研究生院,北京100730

出　　处：《中华泌尿外科杂志》2022年第2期116-121,共6页Chinese Journal of Urology

基　　金：北京医院"121工程"项目(BJ-2015-138);中央高校基本科研业务费专项资金(3332020069);北京协和医学院研究生创新基金项目(2019-1002-87)。

摘　　要：目的探讨联合应用18F-前列腺特异性膜抗原(PSMA)PET/CT和多参数磁共振(mpMRI)检查对不同级别前列腺癌的诊断预测能力。方法回顾性分析2018年9月至2021年5月北京医院收治的49例经穿刺活检确诊为前列腺癌患者的病例资料,中位年龄68(64~75)岁。中位PSA水平14.74(7.75~24.19)ng/ml。穿刺前均行mpMRI检查。穿刺病理的国际泌尿病理协会(ISUP)分级分组1组6例(12.2%),2组16例(32.7%),3组12例(24.5%),≥4组15例(10.9%)。将患者分为ISUP分级分组高级别组(≥4组)和低级别组(1~3组),两组的中位年龄分别为65(62~76)岁和71(65~74)岁,中位PSA水平分别为15.11(6.63~42.86)ng/ml和12.31(7.94~18.25)ng/ml,差异均无统计学意义(P=0.334,P=0.448)。确诊前列腺癌后4周内均行18F-PSMA PET/CT检查。记录患者PET/CT检查主要病灶的最大标准化摄取值(SUVmax)和mpMRI检查主要病灶的最低表观弥散系数(ADCmin),并计算SUVmax/ADCmin比值,分析各参数与ISUP分级分组的相关性,比较不同级别分组的参数差异。通过受试者工作特征(ROC)曲线分析各参数对不同级别前列腺癌的诊断能力。结果本研究49例的ADCmin为(0.57±0.16)×10^(-3)mm^(2)/s,SUVmax为15.30±12.54,SUVmax/ADCmin比值为(29.69±23.72)×10^(3)。高级别组和低级别组的ADCmin分别为(0.54±0.20)×10^(-3)mm^(2)/s和(0.58±0.14)×10^(-3)mm^(2)/s,差异无统计学意义(P=0.411);SUVmax分别为21.97±14.83和12.36±10.30,SUVmax/ADCmin比值分别为(45.07±27.02)×10^(3)和(22.91±10.30)×10^(3),差异均有统计学意义(P=0.012,P=0.002)。SUVmax(r=0.501,P<0.001)和SUVmax/ADCmin比值(r=0.527,P<0.001)与ISUP分级分组呈正相关,ADCmin与ISUP分级分组呈负相关(r=-0.296,P=0.039)。ROC曲线结果显示,SUVmax/ADCmin比值、SUVmax、ADCmin的曲线下面积(AUC)分别为0.749、0.731、0.615。以SUVmax/ADCmin比值37.23×10^(3)为界值,诊断前列腺癌的敏感性和特异性分别为73.3%和85.3%。结论与单独应用PET/CT或mpMRI检查相比,联合18F-PSMA PObjective To investigate the diagnostic value of the combination of 18F-prostate specific membrane antigen(PSMA)PET/CT and multiparametric magnetic resonance imaging(mpMRI)in identifying the grade group of prostate cancer,using parameters derived from the two imaging modalities.Method Prostate cancer patients diagnosed by histopathology and received 18F-PSMA PET/CT and mpMRI during September 2018 to May 2021 in our hospital were retrospectively studied.The median age was 68(64-75),with the median PSA level of 14.74(7.75-24.19)ng/mL.All patients received mpMRI before biopsy.On biopsy,6(12.2%)patients had International Society of Urological Pathology grade group(ISUP GG)1 diseases,16(32.7%)had ISUP GG 2 diseases,12(24.5%)had ISUP GG 3 diseases,and 15(10.9%)had ISUP GG 4 or 5 diseases.Patients were then divided into high-grade group(ISUP 4-5)and low-grade group(ISUP 1-3).The median age of patients in high-grade group and low-grade group were 65(62-76)and 71(65-74),respectively.The PSA level in high-grade group and low-grade group were 15.11(6.63-42.86)ng/ml and 12.31(7.94-18.25)ng/ml,respectively.No significant differences were found in age and PSA level between the two groups(P=0.334,P=0.448).All patients underwent 18F-PSMA PET/CT within 4 weeks after biopsy.The maximum standardized uptake value(SUVmax)and the minimum apparent diffusion coefficient(ADCmin)were recorded,and the ratio of SUVmax/ADCminwere calculated.The correlation between the above parameters and ISUP grade group were analyzed.The diagnostic value of the parameters was evaluated by the receiver operating characteristic(ROC)curve.Results The data of 49 patients were analyzed.The average ADCminwas(0.57±0.16)×10^(-3) mm^(2)/s,with the average SUVmax and SUVmax/ADCmin of 15.30±12.54 and(29.69±23.72)×10^(3),respectively.Statistical differences were found in SUVmax(P=0.012)and SUVmax/ADCmin(P=0.002)between the high-and low-grade groups,while ADCmin(P=0.411)showed no statistical differences between the two groups.Significant positive correlations were

关 键 词：前列腺肿瘤 前列腺特异性膜抗原 正电子发射断层显像技术 多参数磁共振 肿瘤分级 

分 类 号：R737.25[医药卫生—肿瘤]