^(18)F-PSMA-1007与^(18)F-FDG PET/CT及多参数MRI在前列腺癌诊断中的对比研究  

Comparative study of ^(18)F-PSMA-1007,^(18)F-FDG PET/CT and mpMRI in the diagnosis of prostate cancer

作　　者：姜一逸 刘芙岑 李波良 王逸超 金民山 张俊[1] 戴慧[2] Jiang Yiyi;Liu Fucen;Li Boliang;Wang Yichao;Jin Minshan;Zhang Jun;Dai Hui(Department of Nuclear Medicine,the Affiliated Taizhou People′s Hospital of Nanjing Medical University,Taizhou 225300,China;Department of Radiology,the First Affiliated Hospital of Soochow University Institute of Medical Imaging,Soochow University,Suzhou 215006,China)

机构地区：[1]南京医科大学附属泰州人民医院核医学科,泰州225300 [2]苏州大学附属第一医院放射科、苏州大学影像医学研究所,苏州215006

出　　处：《中华核医学与分子影像杂志》2024年第3期147-152,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：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)。

摘　　要：目的比较^(18)F-前列腺特异膜抗原(PSMA)-1007 PET/CT、^(18)F-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^(18)F-PSMA-1007 PET/CT、^(18)F-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>20μg/L)对患者进行分组,比较各影像学参数的组间差异(Mann-WhitneyU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χ^(2)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≤20μg/L(n=5)和>20μg/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,^(18)F-PSMA-1007 PET/CT、^(18)F-FDG PET/CT、mpMRI对前列腺癌原发灶的检出率差异无统计学意义(χ^(2)=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(χ^(2)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。^(18)F-PSMA-1007 PET/CT较^(18)F-FDG PET/CT、mpMRI能检出更多的前列腺癌淋巴结Objective To compare the diagnostic efficacy of ^(18)F-prostate specific membrane antigen(PSMA)-1007 PET/CT,^(18)F-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 ^(18)F-PSMA-1007 PET/CT,^(18)F-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 coefficient(ADCmean),PSMA-SUVmax/ADCmin,PSMA-SUVmax/ADCmean,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;≤20μg/L vs>20μg/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.χ^(2) test and ROC curve analysis were used to compare the detection rate and diagnostic efficiency 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-SUVmax/ADCmean,PSMA-SUVmax,and ADCmin(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≤20μg/L(n=5)and>20μg/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 optimal cut-off value for PSMA-SUVmax/ADCmin in differentiating high-grade and low-grade PCa was determined to be 22.628×103.In the patient-based analysis,no statistical difference was found in the detection rate of PCa primary tumors among ^(18)F-PSMA-1007 PET/CT,^(18)F-FDG PET/CT,and mpMRI(χ^(2)=1.91,P=0.767).How

关 键 词：前列腺肿瘤 前列腺特异膜抗原 磁共振成像 正电子发射断层显像术 体层摄影术 X线计算机 氟脱氧葡萄糖F18 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学] R730.44