基于^(18)F-PSMA-1007 PET/CT的miPSMA评分与改良后miPSMA评分对前列腺良恶性病变的诊断价值  

Diagnostic value of miPSMA score based on ^(18)F-PSMA-1007 PET/CT and improved miPSMA score for benign and malignant prostate lesions

作　　者：保兰兰 赵铭 田蓉蓉[2] 贾媛[2] Bao Lanlan;Zhao Ming;Tian Rongrong;Jia Yuan(Statistics Teaching and Research Office,School of Public Health,Shanxi Medical University,Taiyuan 030013,China;PET/CT Center of Nuclear Medicine Department,Shanxi Province Cancer Hospital,Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences,Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)

机构地区：[1]山西医科大学公共卫生学院统计教研室,太原030013 [2]山西省肿瘤医院,中国医学科学院肿瘤医院山西医院,山西医科大学附属肿瘤医院核医学科PET/CT中心,太原030013

出　　处：《国际放射医学核医学杂志》2024年第12期782-788,共7页International Journal of Radiation Medicine and Nuclear Medicine

基　　金：国家肿瘤区域医疗中心科教培育基金(SD2023023);山西省重点研发计划项目(201903D321187)。

摘　　要：目的探讨基于^(18)F-前列腺特异性膜抗原(PSMA)-1007 PET/CT的分子成像PSMA(miPSMA)评分与改良后miPSMA评分对前列腺良恶性病变的诊断价值。方法采用横断面研究设计, 回顾性分析2018年7月至2023年4月于山西医科大学附属肿瘤医院行^(18)F-PSMA-1007 PET/CT显像的可疑前列腺癌(PCa)患者125例, 年龄(67.1±9.4)岁、范围39~87岁。建立改良后miPSMA评分:以组织病理学检查结果为"金标准", 绘制前列腺病灶最大标准化摄取值(SUVmax)诊断PCa的受试者工作特征(ROC)曲线, 取其最佳诊断临界值, 并计算最佳诊断临界值与脾脏平均标准化摄取值(SUV_(mean))的比值, 记为?%。以脾脏SUV_(mean)的△%为界将miPSMA评分中的1分(良性)细化为改良后miPSMA评分中的1a分(良性)和1b分(可疑恶性);并将改良后miPSMA评分≤1a分诊断为前列腺良性病变, 1b分诊断为前列腺可疑恶性病变, ≥2分诊断为PCa。计量资料的比较采用两独立样本t检验或Mann-WhitneyU检验, 计数资料的比较采用四格表卡方检验。采用Kappa检验分析2种评分方法诊断结果与组织病理学检查结果的一致性, 采用ROC曲线比较2种评分方法对前列腺良恶性病变的诊断效能。结果 125例患者的前列腺特异性抗原水平为24.50(10.60, 75.50)ng/ml。125例患者中, 81例经组织病理学检查结果证实为PCa, 44例经穿刺+随访半年以上结果证实为前列腺良性病变。PCa患者和前列腺良性病变患者的年龄、前列腺特异性抗原和SUVmax的差异均有统计学意义(t=1.20, Z=4.57、8.08, 均P<0.05)。与miPSMA评分相比, 改良后miPSMA评分的假阴性率明显降低[24.69%(20/81)对4.94%(4/81)], 差异有统计学意义(χ^(2)=26.17, P<0.001);灵敏度[75.31%(61/81)对95.06%(77/81)]、准确率[84.00%(105/125)对94.40%(118/125)]、阴性预测值[68.75%(44/64)对91.11%(41/45)]明显升高, 差异均有统计学意义(χ^(2)=28.02、18.25、32.11, 均P<0.05);特异度[100%(44/44)对93.18%(41/44)]和Objective To explore the diagnostic value of the molecular imaging prostate specific membrane antigen(miPSMA)score based on ^(18)F-PSMA-1007 PET/CT and improved miPSMA score for benign and malignant prostate lesions.Methods A cross-sectional study design was employed and a retrospective analysis was conducted on 125 patients with suspected prostate cancer(PCa)who underwent ^(18)F-PSMA-1007 PET/CT imaging at Cancer Hospital Affiliated to Shanxi Medical University from July 2018 to April 2023.The patients were aged(67.1±9.4)years,with an age range of 39–87 years.An improved miPSMA score was established as follows:histopathological examination results were adopted as the"gold standard",a receiver operating characteristic(ROC)curve was drawn to diagnose PCa on the basis of the maximum standardized uptake value(SUVmax)of prostate lesions,the optimal diagnostic threshold was determined,and the ratio of the optimal diagnostic threshold to the mean standardized uptake value(SUV_(mean))of the spleen(denoted asΔ%)was calculated.WithΔ%of spleen SUV_(mean) as the boundary,point 1(benign)in the miPSMA score was refined into 1a points(benign)and 1b points(suspected malignant)in the improved miPSMA score.Improved miPSMA scores≤1a,=1b,and≥2 were diagnosed as benign prostate disease,suspected malignant prostate disease,and PCa,respectively.Two independent sample t-tests or the Mann-Whitney U test was used to compare the quantitative data,while the four-grid chi square test was used to analyze the counting data.The Kappa test was employed to analyze the consistency between the diagnostic results of the two scoring methods and the histopathological examination results.ROC curves were utilized to compare the diagnostic efficacy of the two scoring methods for benign and malignant prostate lesions.Results The prostate-specific antigen levels of the 125 patients were 24.50(10.60,75.50)ng/ml.Among the 125 patients,81 were confirmed to have PCa via histopathological examination,and 44 were confirmed to have benign prostate lesio

关 键 词：前列腺肿瘤 前列腺特异性膜抗原 正电子发射断层显像术 体层摄影术 X线计算机 

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