多参数MRI联合^(68)Ga-PSMA PET/CT诊断临床显著性前列腺癌  

Multi-parametric MRI combined with 68Ga-PSMA PET/CT for the diagnosis of clinically significant prostate cancer

作　　者：孟小丽 康飞 全志永 张明如 王敏 韩婷婷 舒俊 任静 杨卫东 汪静 Meng Xiaoli;Kang Fei;Quan Zhiyong;Zhang Mingru;Wang Min;Han Tingting;Shu Jun;Ren Jing;Yang Weidong;Wang Jing(Department of Nuclear Medicine,the First Affiliated Hospital of the Air Force Medical University,Xi′an 710032,China;Department of Radiology,the First Affiliated Hospital of the Air Force Medical University,Xi′an 710032,China)

机构地区：[1]空军军医大学第一附属医院核医学科,西安710032 [2]空军军医大学第一附属医院放射科,西安710032

出　　处：《中华核医学与分子影像杂志》2024年第1期25-29,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：国家自然科学基金(82122033)。

摘　　要：目的探索多参数MRI(mpMRI)联合^(68)Ga-前列腺特异膜抗原(PSMA)PET/CT是否可以提高对临床显著性前列腺癌(csPCa)的检测效能。方法回顾性分析2021年1月至2022年11月怀疑前列腺癌于空军军医大学第一附属医院行mpMRI及^(68)Ga-PSMA PET/CT显像的152例患者[年龄(68.5±8.5)岁]的临床及影像学资料。使用经直肠超声引导的活组织检查(简称活检)的组织病理学结果作为"金标准"。活检结果Gleason评分(GS)≥3+4分的病灶诊断为csPCa, 活检阴性或GS评分6分的病灶为非csPCa。mpMRI图像由2位放射科医师采用前列腺影像报告和数据系统(PI-RADS)2.1版本进行评估。^(68)Ga-PSMA PET/CT采用SUV_(max)评价前列腺病变的显像剂摄取程度。采用两独立样本t检验、Mann-WhitneyU检验和χ^(2)检验比较2组间的差异, 再行多因素logistic回归分析。利用ROC曲线分析各因素单独及联合诊断的效能, 并通过Delong检验加以比较。结果纳入csPCa组患者85例, 非csPCa组患者67例。单因素分析显示PI-RADS评分、前列腺特异抗原(PSA)和SUV_(max)在csPCa组和非csPCa组间差异均有统计学意义(χ^(2)=68.06, U值:-7.66、-8.98;均P<0.001)。多因素logistic回归分析显示PI-RADS评分[比值比(OR)=3.424, 95%CI:1.651~7.100]和SUV_(max)(OR=1.931, 95%CI:1.403~2.658)为csPCa的预测因素(均P<0.001)。ROC曲线显示, mpMRI和PET/CT诊断的csPCa最佳阈值分别为PI-RADS 4分和SUV_(max) 5.6, 准确性分别为80%(122/152)[AUC=0.789(95%CI:0.711~0.866), 灵敏度91%(77/85), 特异性67%(45/67)]和87%(132/152)[AUC=0.876(95%CI:0.817~0.936), 灵敏度81%(69/85), 特异性94%(63/67)]。在构建的4种联合预测模型中, PI-RADS 5分或PI-RADS 3~4分且SUV_(max)>5.6诊断csPCa的效能高于mpMRI和PET/CT单独及其他3种联合预测模型(z值:2.01~3.64, 均P<0.05), 准确性达91%(138/152)[AUC=0.910(95%CI:0.857~0.962), 灵敏度89%(76/85), 特异性93%(62/67)]。结论 MpMRI联合^(68)Ga-PSMA PET/CT明显提高了对csPCa的检测, 主�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 significant prostate cancer(csPCa).Methods Clinical and imaging data of 152 patients(age(68.5±8.5)years)who underwent mpMRI and ^(68)Ga-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 retrospectively 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 negative biopsy or GS 6 were diagnosed with non-csPCa.MpMRI was evaluated independently by two radiologists according to the Prostate Imaging Reporting and Data System(PI-RADS)version 2.1.The radioactive uptake of ^(68)Ga-PSMA PET/CT in prostate lesions was evaluated by SUV_(max).The independent-sample t test,Mann-Whitney U test andχ^(2) test were used to compare differences between the two groups,and then multivariate logistic regression analysis was performed.ROC curves analysis was used to analyze the diagnostic efficacies 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 SUV_(max) were significantly different between the csPCa group and the non-csPCa group(χ^(2)=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 SUV_(max)(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 SUV_(max).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:

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 磁共振成像 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]