^(18)F-MD-PSMA PET/CT显像在中高危前列腺癌初始分期中的应用价值  

Role of ^(18)F-MD-PSMA PET/CT in initial stage of intermediate and high risk prostate cancer

作　　者：严叶青 梁胜[1] 杨斌[2] 邹仁健[1] 马玉飞 蔡利生 王辉[1] 傅宏亮[1] YAN Yeqing;LIANG Sheng;YANG Bin;ZOU Renjian;MA Yufei;CAI Lisheng;WANG Hui;FU Hongliang(Department of Nuclear Medicine,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Urology,Tenth People′s Hospital of Tongji University,Shanghai 200072,China;National Institutes of Health,Bethesda 20816,USA)

机构地区：[1]上海交通大学医学院附属新华医院核医学科,上海200092 [2]同济大学附属第十人民医院泌尿外科,上海200072 [3]美国国立卫生研究院,贝塞斯达20816,美国

出　　处：《上海交通大学学报（医学版）》2023年第7期873-881,共9页Journal of Shanghai Jiao tong University:Medical Science

基　　金：国家自然科学基金青年基金(82001856)。

摘　　要：目的·评估^(18)F-MD-PSMA PET/CT在中高风险前列腺癌(prostate cancer,PCa)患者初始分期中的应用价值。方法·对2017年9月至2022年6月在上海交通大学医学院附属新华医院就诊的67例中高危PCa患者采用^(18)F-MD-PSMA PET/CT进行初步分期;患者在^(18)F-MD-PSMA PET/CT检查前2周内接受常规成像(conventional imaging,CI),包括多参数磁共振成像(multi-parameter magnetic resonance imaging,mp-MRI)和全身骨显像(bone scintigraphy,BS),其中25例患者同期进行了^(18)F-FDG PET/CT检查。评估^(18)F-MD-PSMA PET/CT对初始分期的灵敏度(sensitivity,SEN)、特异度(specificity,SPEC)、阳性预测值(positive predictive value,PPV)、阴性预测值(negative predictive value,NPV)及准确率(accuracy,ACU),并将结果与^(18)F-FDG PET/CT、mp-MRI和BS的结果进行对比。以术后病理的T、N分期结果及临床随访的骨转移结果为参考标准进行Kappa一致性检验,分析^(18)F-MD-PSMA PET/CT及CI在诊断原发灶累及范围、区域淋巴结转移、骨转移方面与参考标准的一致性,计算Kappa系数,并进行比较。结果·在67例PCa患者中,38例接受了根治性前列腺切除术并且有完整的病理学诊断资料,其中分别有27例和1例患者同时接受了区域淋巴结清扫术和扩大盆腔淋巴结清扫术,以病理结果作为诊断金标准。mp-MRI和^(18)F-MD-PSMA PET/CT诊断包膜内病灶的检出率均为100%,诊断双侧腺叶内病灶的SEN分别为26.3%和63.2%,SPEC均为75.0%。与病理结果进行Kappa一致性检验,结果显示^(18)F-MD-PSMA PET/CT诊断包膜外侵犯(extraprostatic extension,EPE)、精囊腺侵犯(seminal vesicle invasion,SVI)、膀胱颈侵犯(bladder neck invasion,BNI)的一致性均高于mp-MRI。Fisher确切概率法显示,2种检查方法诊断EPE、SVI的SEN(P=0.226,P=0.491)和SPEC(P=1.000,P=0.342),以及诊断BNI的SEN(均P=1.000)比较,差异均无统计学意义。在诊断淋巴结转移方面,基于淋巴结数量分析,^(18)F-MD-PSMA PET/CT与病理�Objective·To evaluate the role of ^(18)F-MD-PSMA PET/CT in the initial stage of patients with moderate and high risk prostate cancer(PCa).Methods·A total of 67 patients with moderate and high risk PCa who were treated in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from September 2017 to June 2022 were initially staged by ^(18)F-MD-PSMA PET/CT.Conventional imaging(CI),including multi-parameter magnetic resonance imaging(mp-MRI)and bone scintigraphy(BS),were performed within two weeks before ^(18)F-MD-PSMA PET/CT.Twenty-five patients underwent ^(18)F-FDG PET/CT at the same time.The sensitivity(SEN),specificity(SPEC),positive predictive value(PPV),negative predictive value(NPV)and accuracy(ACU)of ^(18)FMD-PSMA PET/CT in the initial stage were evaluated,and the results were compared with those of ^(18)F-FDG PET/CT,mp-MRI and BS.The consistency of ^(18)F-MD-PSMA PET/CT and CI in terms of primary lesion,regional lymph node metastasis and bone metastasis was evaluated by Kappa consistency test refering to the postoperative pathological T and N staging results and bone metastasis results of clinical follow-up.Kappa coefficient was calculated and compared.Results·Of the 67 patients with PCa,38 patients underwent radical prostatectomy and had completed pathological data,with 27 patients undergoing regional lymphadenectomy and 1 patient undergoing expanded pelvic lymphadenectomy at the same time.The pathological results were obtained as gold standard.The detection rates of mp-MRI and ^(18)F-MD-PSMA PET/CT in diagnosing intrathecal lesions were both 100%.The SENs in diagnosing bilateral intralobular lesions were 26.3%and 63.2%,respctively;the SPECs were both 75.0%.The Kappa consistency test showed that the consistency of ^(18)F-MD-PSMA PET/CT in diagnosis of extracapsular extension(EPE),seminal vesicle invasion(SVI),and bladder neck invasion(BNI)was higher than that of mp-MRI.Fisher′s exact test showed that there were no statistically significant differences in SEN(P=0.226,P=0.491)and SPEC(P=1.000,P

关 键 词：前列腺癌 初始分期 ^(18)F-MD-PSMA PET/CT 多参数磁共振成像 全身骨显像 

分 类 号：R445.6[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]