双参数MRI与^(18)F‐PSMA‐1007 PET/CT定量参数对高危前列腺癌预测价值的对比研究  

Comparison of the accuracy of two different scoring criteria for predicting high-risk prostate cancer based on biparametric MRI and ^(18)F-PSMA-1007 PET/CT

作　　者：常儒玺 罗量 谢宏俊 李运轩 沈聪 董伟璇 段小艺[1] Chang Ruxi;Luo Liang;Xie Hongjun;Li Yunxuan;Shen Cong;Dong Weixuan;Duan Xiaoyi(Department of PET/CT Center,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Urology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院PET/CT室,西安710061 [2]西安交通大学第一附属泌尿外科,西安710061

出　　处：《中华解剖与临床杂志》2024年第10期643-649,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的探讨双参数MRI和18F-前列腺特异性膜抗原(PSMA)-1007正电子发射体层摄影(PET)/CT的定量参数对高危前列腺癌的预测价值。方法回顾性队列研究。纳入2020年1月—2023年7月西安交通大学第一附属医院泌尿外科收治的前列腺癌患者163例, 年龄49~92(70.4±7.9)岁, 均行18F-PSMA-1007 PET/CT和双参数MRI检查。163例患者根据穿刺活检或术后病理检查Gleason评分分为中低危组(Gleason评分≤7分)73例和高危组(Gleason评分>7分)90例。观察项目:(1)比较2组患者年龄, 18F-PSMA-1007 PET/CT的定量参数PSMA阳性肿瘤体积(PSMA-TV)、最大标准摄取值(SUVmax)、病灶总摄取量(TLU)、分子成像PSMA(miPSMA)评分, 以及双参数MRI的前列腺影像报告和数据系统(PI-RADS)评分的差异;(2)绘制受试者操作特征(ROC)曲线, 比较双参数MRI、18F-PSMA-1007 PET/CT的定量参数对高危前列腺癌的预测效能;(3)采用单因素、多因素logistic回归分析高危前列腺癌的影像学独立预测因素。结果 (1)高危组与中低危组比较, 患者年龄、SUVmax、miPSMA评分差异均无统计学意义(P值均>0.05);高危组PSMA-TV、TLU、PI-RADS评分均高于中低危组, 差异均有统计学意义(Z=2.51、1.99、3.85, P值均<0.05)。(2)不同影像学参数预测高危前列腺癌的ROC曲线显示:双参数MRI的PI-RADS评分曲线下面积(AUC)最大(AUC=0.661, 95%CI:0.583~0.733);18F-PSMA-1007 PET/CT 的miPSMA评分特异度(89.04%)最高、但灵敏度(22.22%)最低, SUVmax、PSMA-TV、TLU的灵敏度、特异度均相近。(3)单因素、多因素logistic回归分析显示, PI-RADS评分>4分是高危前列腺癌的独立预测因素(OR=2.303, 95%CI:1.163~4.562, P=0.017)。结论相较于18F-PSMA-1007 PET/CT的定量参数, 双参数MRI的PI-RADS评分(>4分)对高危前列腺癌有较好的预测价值。Objective This study aimed to investigate the predictive value of quantitative parameters on the basis of biparametric MRI and ^(18)F-prostate specific membrane antigen(PSMA)-1007 positron emission tomography(PET)/CT for high-risk prostate cancer.Methods This retrospective cohort study included 163 patients with prostate cancer who were admitted to the Department of Urology at the First Affiliated Hospital of Xi'an Jiaotong University from January 2020 to July 2023,aged 49-92(70.4±7.9)years,and they underwent ^(18)F-PSMA-1007 PET/CT and biparametric MRI.The 163 patients were divided into intermediate-low-risk group(Gleason score≤7,n=73)and high-risk group(Gleason score>7,n=90)on the basis of biopsy or postoperative pathological Gleason score.(1)The differences in age,quantitative parameters of ^(18)F-PSMA-1007 PET/CT PSMA-positive tumor volume(PSMA-TV),maximum standardized uptake value(SUVmax),total lesion uptake(TLU),molecular imaging PSMA(miPSMA score),and biparametric MRI Prostate Imaging Reporting and Data System(PI-RADS)score between the two groups were compared.(2)Plot receiver operating characteristic(ROC)curves were used to compare the predictive efficiency of biparametric MRI and the quantitative parameters of ^(18)F-PSMA-1007 PET/CT for high-risk prostate cancer.(3)Univariate and multivariate logistic regressions were used to analyze the independent imaging predictors of high-risk prostate cancer.Results(1)No statistically significant differences were observed in age,SUVmax,and miPSMA scores between the high-risk and intermediate-low-risk groups(all P values>0.05).The high-risk group had significantly higher PSMA-TV,TLU,and PI-RADS scores than the intermediate-low-risk group(Z=2.51,1.99,3.85;all P values<0.05).(2)The ROC curves for predicting high-risk prostate cancer with different imaging parameters showed that the area under the curve(AUC)for the PI-RADS score from biparametric MRI was the largest(AUC=0.661,95%CI:0.583-0.733).The miPSMA score from ^(18)F-PSMA-1007 PET/CT had the highest specificit

关 键 词：前列腺肿瘤 正电子发射体层摄影 高危前列腺癌 双参数 磁共振成像 前列腺特异性膜抗原 预测因素 

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