68Ga-PSMA-617 PET/CT与多参数MRI对初诊前列腺癌诊断价值的比较

Comparison of diagnostic performance of 6SGa-PSMA-617PET/CT and multiparametric MRI in newly diagnosed prostate cancer

目的比较68Ga-PSMA-617PET/CT与多参数MRI检查对初诊前列腺癌原发灶的诊断效能,分析68Ga-PSMA-617PET/CT检查前列腺癌最大标准镊取值(SUVmax)与临床参数的相关性。方法回顾性分析2017年6月至2018年4月我院104例同期接受68Ga-PSMA-617PET/CT和多参数MR/检查的初诊疑似前列腺癌患者的临床资料。年龄(70.4±8.9)岁(42~89)岁。血清总PSA值为4.10~5228.00ng/ml,中位值为18.44(8.71,48.01)ng/ml。患者均接受经直肠前列腺穿刺活检术,根据病理结果分析68Ga-PSMA-617PET/CT和多参数MR/诊断前列腺癌的敏感性、特异性,以SUVmax值绘制ROC曲线,分析前列腺癌SUVmax值与PSA值、Gleason评分等临床参数的关系。结果104例中病理诊断前列腺癌68例,良性前列腺增生36例。68Ga-PSMA-617PET/CT检查诊断前列腺癌的敏感性为95.59%(65/68),特异性为88.89%(32/36);多参数MRI检查的敏感性为91.18%(62/68),特异性为63.89%(23/36)。两种检查的特异性差异有统计学意义(P=0.012)。绘制68Ga-PSMA-617PET/CT检查的ROC曲线,曲线下面积为0.954。104例中,36例良性前列腺增生组织SUVmax中位值为3.20(2.83,3.70),68例前列腺癌组织SUVmax中位值为12.21(7.48,17.46),二者差异有统计学意义(P<0.01)。68例前列腺癌中,不同Gleason评分(P<0.01)、国际泌尿病理协会(ISUP)分级分组(P<0.01)及危险因素等级(P=0.021)的前列腺癌组织SUVmax值的差异均有统计学意义,且SUVmax值与Gleason评分、ISUP分级分组呈正相关性(r1=0.742,P<0.01;r2=0.754,P<0.01)。结论68Ga-PSMA-617PET/CT检查较多参数MRI对于前列腺癌有更高的诊断效能,SUVmax值越高,提示肿瘤的分级及危险因素等级越高.68Ga-PSMA-617PET/CT检查对肿瘤的定位诊断、恶性程度分析以及预后判断均有重要的参考价值。

Objective To compare the diagnostic efficacy of 68Ga-PSMA-617 PET/CT and multiparameter MRI in the diagnosis of primary tumors of newly diagnosed prostate cancer,and analyze the correlation between SUVmax and clinical parameters of prostate cancer.Methods A retrospective analysis of the clinical data of 104 patients with newly diagnosed prostate cancer who underwent 68Ga-PSMA-617 PET/CT and multi-parametric MRI from June 2017to April 2018.The final pathological results were used as the gold standard for diagnosis.The age ranged from 42 to 89 years,with an average of (70.4±8.9)years. The median total serum PSA was 18.44(8.71,48.01)ng/ml.The pathological results were positive in 68 cases and negative in 36 cases.The sensitivity,specificity was calculated,the ROC curve was drawn and AUC value was calculated.The relationship between SUVmax value of prostate cancer and clinical parameters was analyzed.Results The sensitivity of 68Ga-PSMA-617 PET/CT was 95.59%(65/68)and the specificity was 88.89%(32/36);the sensitivity of MRI examination was 91.18%(62/68)and the specificity was 63.89%(23/36).There were statistical differences between the specificity of the two examination (P =0.012).The ROC curve of 68Ga-PSMA-617PET/CT was plotted and the AUC value was 0.954.Among the 104suspected prostate cancer patients,the median SUVmax of benign prostatic tissue was 3.20(2.83,3.70),and the median SUVmax of prostate cancer tissue was 12.21(7.48,17.46). Among 68 patients with prostate cancer,there were statistical differences between SUVmax values of prostate cancer tissues with different Gleason scores (P <0.01),ISUP group (P <0.01),risk grades (P = 0.021),and SUVmax values.There was a positive correlation with Gleason score and ISUP group (r1 = 0.7420,P<0.01;r2=0.754,P<0.01).Conclusions The 68Ga-PSMA-617 PET/CT examination had higher diagnostic efficacy than the multiparametric MRI for prostate cancer.The higher the SUVmax value predict the higher grade and higher risk.