^(18)F-AlF-P16-093 PET联合多参数MRI在前列腺癌原发灶诊断中的应用:基于穿刺病理学的头对头研究  

Application of ^(18)F-AlF-P16-093 PET combined with multiparametric MRI in the diagnosis of primary prostate cancer lesions:a head-to-head comparative study based on needle biopsy pathology

作　　者：柯渺 刘锦慧 钟少楠 张静[1] 李名钊 古迪 赵睿玥 王欣璐 Ke Miao;Liu Jinhui;Zhong Shaonan;Zhang Jing;Li Mingzhao;Gu Di;Zhao Ruiyue;Wang Xinlu(Department of Nuclear Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Urology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第一医院核医学科,广州510000 [2]广州医科大学附属第一医院泌尿外科,广州510000

出　　处：《中华核医学与分子影像杂志》2024年第9期533-538,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

基　　金：广东省基础与应用基础研究基金项目(2022A1515110941);广州市科技计划项目(2023A04J1196,2024A03J1228)。

摘　　要：目的评估新型前列腺特异膜抗原(PSMA)靶向PET显像剂^(18)F-AlF-P16-093联合多参数MRI(mpMRI)对前列腺癌(PCa)的诊断效能, 并探讨其在指导经会阴穿刺活组织检查(简称活检)中的应用。方法回顾性分析2023年8月至2024年3月在广州医科大学附属第一医院接受^(18)F-AlF-P16-093 PET/CT和mpMRI检查的36例确诊为PCa患者(年龄68~76岁)的临床病理资料。在病灶水平上, 以穿刺活检病理结果作为"金标准", 根据前列腺穿刺活检定位图像将全前列腺分割为12区, 应用PET/CT和mpMRI分别进行影像学评估比较。采用Phi系数分析mpMRI评分、PET/CT评分与病理诊断结果之间的相关性, 采用ROC曲线分析诊断效能, 采用logistic回归分析出血对图像判读的影响。结果 ^(18)F-AlF-P16-093 PET/CT与病理诊断结果呈中度正相关(Phi=0.415, P<0.001), 优于mpMRI(Phi=0.338, P<0.001)。PET/CT单模态诊断效能均优于mpMRI, 其中PET+T_(2)加权成像(WI)+弥散WI(DWI)和PET+T_(2)WI+DWI+表观弥散系数(ADC)组合的诊断特异性超过90%, 阳性预测值超过80%。穿刺出血对mpMRI、PET/CT诊断PCa结果无明显影响[比值比(OR):0.463~0.785, 均P>0.05]。结论 ^(18)F-AlF-P16-093 PET/CT在PCa病灶检出和诊断效能上优于mpMRI, ^(18)F-AlF-P16-093 PET联合mpMRI可进一步提高诊断特异性和阳性预测值, 对前列腺靶向活检有指导意义。ObjectiveTo evaluate the diagnostic efficacy of the novel prostate specific membrane antigen(PSMA)-targeted PET imaging agent ^(18)F-AlF-P16-093 in combination with multiparametric MRI(mpMRI)for prostate cancer(PCa),and to explore its application in guiding transperineal puncture biopsy.MethodsA retrospective analysis was conducted on the clinical and pathological data of 36 patients diagnosed as PCa(age:68-76 years)who underwent ^(18)F-AlF-P16-093 PET/CT and mpMRI examinations at the First Affiliated Hospital of Guangzhou Medical University from August 2023 to March 2024.The entire prostate was divided into 12 regions based on biopsy localization.Imaging evaluations were performed using PET/CT and mpMRI at the lesion level,with biopsy pathology as the gold standard.The correlations between mpMRI scores,PET/CT scores and pathological diagnosis results were evaluated by Phi coefficient analysis.Diagnostic efficacy was assessed by ROC curve analysis.Logistic regression was used to determine the impact of bleeding on image interpretation.Results ^(18)F-AlF-P16-093 PET/CT showed a moderate positive correlation with pathological diagnosis result(Phi=0.415,P<0.001),which was superior to mpMRI(Phi=0.338,P<0.001).The diagnostic efficacy of PET single-modality model was superior to mpMRI in all indicators.The combination of ^(18)F-AlF-P16-093 PET/CT with mpMRI significantly improved diagnostic specificity and positive predictive value,with the diagnostic specificity of the PET+T_(2) weighted imaging(WI)+diffusion WI(DWI)and PET+T_(2)WI+DWI+apparent diffusion coefficient(ADC)combinations exceeding 90%,and the positive predictive value exceeding 80%.Bleeding did not significantly affect the diagnosis of PCa by mpMRI and PET/CT(odds ratio(OR):0.463-0.785,all P>0.05).Conclusion ^(18)F-AlF-P16-093 PET/CT is superior to mpMRI in the detection and diagnostic efficacy of PCa lesions,and the combination of ^(18)F-AlF-P16-093 PET with mpMRI can further improve diagnostic specificity and positive predictive value,which is of guiding

关 键 词：前列腺肿瘤 前列腺特异膜抗原 正电子发射断层显像术 体层摄影术 X线计算机 多参数磁共振成像 活组织检查 针吸 

分 类 号：R737.25[医药卫生—肿瘤]