99mTc-PSMA SPECT/CT探测前列腺癌病灶的临床应用价值  

Clinical value of ^(99m)Tc-PSMA SPECT/CT in detection of prostate cancer

作　　者：胡四龙[1,2,3,4,5] 许晓平[1,2,3,4,5] 朱耀 宿恒川[6,5] 何思敏[1,2,3,4,5] 叶定伟[6,5] 郭小毛[3,4,7,5] 章英剑[1,2,3,4,5] 

机构地区：[1]复旦大学附属肿瘤医院核医学科,上海200032 [2]复旦大学生物医学影像研究中心,上海200032 [3]上海分子影像探针工程技术研究中心(筹),上海200032 [4]复旦大学附属肿瘤医院质子重离子中心,上海201315 [5]复旦大学上海医学院肿瘤学系,上海200032 [6]复旦大学附属肿瘤医院泌尿外科,上海200032 [7]复旦大学附属肿瘤医院放疗科,上海200032

出　　处：《肿瘤影像学》2016年第3期272-278,共7页Oncoradiology

基　　金：上海市科委项目(No:14DZ2251400);上海市卫生和计划生育委员会项目(No:20124189)

摘　　要：目的:探讨^(^(99m))Tc标记前列腺特异性膜抗原(prostate specific membrane antigen,PSMA)小分子抑制剂(HYNIC-Glu-Urea-A,简称^(99m)Tc-PSMA)SPECT/CT显像探测前列腺癌原发灶和转移灶的临床价值。方法:回顾性分析69例(初诊12例、经治57例)前列腺癌患者^(99m)Tc-PSMA SPECT/CT结果,评价全身平面显像结合断层显像检测前列腺癌原发和(或)转移灶的价值,分析^(99m)Tc-PSMA阳性率与前列腺特异性抗原(prostate specific antigen,PSA)水平和Gleason评分的关系。结果:所有69例患者中,6例根治术后PSA<0.2 ng/m L患者为治愈状态,以患者为单位,^(99m)Tc-PSMA阳性率77.8%(49/63)。^(99m)Tc-PSMA阳性患者PSA水平(中位数25.52 ng/m L,范围0.85~3 239 ng/m L)明显高于^(99m)Tc-PSMA阴性患者PSA水平(中位数0.35 ng/m L,范围0.003~9.28 ng/m L)(P<0.001);在初诊和PSA>1.0 ng/m L的复发患者中,阳性率高达97.4%(37/38)。^(99m)Tc-PSMA阳性组患者Gleason评分高于阴性组患者(P<0.001)。结论:对于前列腺癌初诊患者和PSA>1.0 ng/m L的复发患者,^(99m)Tc-PSMA SPECT/CT对原发灶和复发转移灶的探测有较高应用价值,可为临床提供重要的治疗决策依据。Objective: To evaluate the clinical value of technetium-99 m labelled small molecule against prostate specific membrane antigen（PSMA）(HYNIC-Glu-Urea-A, 99mTc-PSMA) in the detection of primary and metastatic prostate cancers.Methods: A total of 69 consecutive prostate cancer patients who received 99mTc-PSMA SPECT/CT were retrospectively analyzed. The sensitivity of 99mTc-PSMA for the detection of the primary and metastatic lesions was evaluated. The relationships between positive 99mTc-PSMA and prostate specific antigen（PSA） level and Gleason score were analyzed. Results: Of all patients, 6 cases with PSA<0.2 ng/m L after radical prostatectomy remained biochemically disease-free. Based on per patient, in 77.8%（49/63） of thepatients at least one lesion indicative of prostate cancer was detected by 99mTc-PSMA SPECT/CT. The level of PSA in the patients with positive 99mTc-PSMA imaging was significantly higher than that in the patients with negative 99mTc-PSMA imaging（PSA median 25.52 ng/m L, range: 0.85-3 239 ng/m L） vs.（PSA median 0.35 ng/m L, range: 0.003-9.28 ng/m L）（P<0.001）. Among newly diagnosed patients and recurrent patients with PSA>1.0 ng/m L, 99mTc-PSMA imaging was able to detect lesions with improved sensitivity of 97.4%（37/38）; furthermore, among recurrent patients with PSA>10.0 ng/m L, the number and extent of lesions detected by 99 mTcPSMA SPECT/CT increased significantly. Gleason score in the patients with positive 99mTc-PSMA imaging was significantly higher than that in the patients with negative 99mTc-PSMA imaging（P<0.001）. Conclusion: Among newly diagnosed prostate cancer patients and recurrent patients with PSA>1.0 ng/m L, 99mTc-PSMA SPECT/CT can detect prostate cancer and metastases in a high number of patients and can provide important information for clinical treatment decision.

关 键 词：前列腺癌 前列腺特异性膜抗原 前列腺特异性抗原 GLEASON评分 99mTc-PSMA 单光子发射计算机断层扫描 

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