^(11)C-胆碱PET/CT显像在前列腺癌诊断中对^(18)F-FDG的补充价值

Added value of ^(11)C-choline PET/CT imaging to ^(18)F-FDG PET/CT in primary prostate cancer

目的:探讨^(11)C-胆碱PET/CT显像在前列腺癌诊断中对^(18)F-FDG的补充价值。方法:前瞻性对2011年10月—2016年1月我院核医学科进行PET/CT检查的前列腺疾病患者分别进行^(18)F-FDG和^(11)C-胆碱显像,共有63例男性患者纳入研究,以病理或≥6月的随访为标准确诊,其中前列腺癌患者38例,平均年龄71.0(48~91)岁,良性前列腺增生患者25例,平均年龄66.5(47~81)岁。比较^(18)F-FDG和^(11)C-胆碱PET/CT的诊断效能,分析^(11)C-胆碱PET/CT显像在前列腺癌诊断中对^(18)F-FDG的补充价值。结果:^(11)C-胆碱PET/CT显像前列腺癌组SUVmax(3.91±3.29)高于前列腺增生组(1.01±1.10),差异有统计学意义(t=4.252,P<0.05);^(18)F-FDG PET/CT显像前列腺癌组SUVmax(3.98±4.17)与良性前列腺增生组(2.17±3.33)无明显差异(t=1.824,P>0.05)。^(11)C-胆碱、^(18)F-FDG PET/CT诊断前列腺癌的灵敏度分别为89.5%、81.6%,特异性分别为88.0%、60.0%,准确性分别为88.9%、73.0%;阳性预测值分别为91.9%、75.6%,阴性预测值分别为84.6%、68.2%;两者联合应用的灵敏度89.5%、特异性96.0%、准确性92.1%、阳性预测值97.1%、阴性预测值85.7%。PET/CT发现有17例骨转移,8例淋巴结转移,1例肺转移。^(11)C-胆碱PET/CT检出骨转移病灶(584个)较^(18)F-FDG PET/CT(497个)多,差异有统计学意义(t=2.151,P<0.05)。^(11)C-胆碱PET/CT显像对淋巴结转移病灶的标准摄取值及转移个数与^(18)F-FDG PET/CT显像比较无统计学差异(P>0.05)。结论 :^(11)C-胆碱可弥补^(18)FFDG的不足,^(18)F-FDG联合^(11)C-胆碱PET/CT显像可提高PET/CT对前列腺癌的诊断效能。

Objective： To analyse the added value of 11C-choline PET/CT imaging to 18F-FDG PET/CT in primary prostate cancer. Methods： A prospective study of 18F-FDG PET/CT and 11C-choline PET/CT imaging in prostate patients encountered in our hospital from Oct 2011 to Jan 2016, a total of 63 male patients were included in the study. Including 38 cases of prostate cancer（mean age： 71 years old）, 25 cases of benign prostatic hyperplasia（mean age： 66.5 years old）, all cases were diagnosed by histopathology or follow-up or more for the standard diagnosis. Comparing 11C-choline with 18F-FDG PET/CT imaging for further analysis of the added value of 11C-choline PET/CT imaging to a 18F-FDG PET/CT in primary prostate cancer patients. Results： The 11C-choline PET/CT imaging showed that the SUVmax of the prostate cancer group（3.91±3.29） higher than the benign prostatic hyperplasia（1.01±1.10）. The SUVmax of 18F-FDG was no stastistical difference with the prostate cancer（3.98±4.17） and the benign prostatic hyperplasia（2.17±3.33）. The sensitivity, the specificity, the accuracy, the positive predictive value and the negative predictive value of 11C-choline PET/CT and 18F-FDG PET/CT are 89.5%, 81.6%, 88.0%, 60.0%, 88.9%, 73.0%, 91.9%, 75.6%, 84.6%, 68.2%, respectively. The sensitivity, the specificity, the accuracy, the positive predictive value and the negative predictive value of combined two radioactive tracers scan is 89.5%, 96%, 92.1%, 97.1%, 85.7%, respectively. Seventeen cases of bone metastases, 8 cases of lymph node metastasis, 1 case of pulmonary metastasis were recognized by PET/CT. The SUVmax of bone metastasis of 11C-choline PET/CT has no obviously variance compared with 18F-FDG PET/CT. 11C-choline PET/CT imaging showed that bone metastases lesions（584） were more than 18F-FDG PET/CT（497）, that difference was statistically significant（t=2.151, P〈0.05）. The SUVmax of lymph node metastasis and total number is no statistical difference between 11C-choline PET/CT imaging and 18F-FDG PET/CT（P〉0.05）. Conclusions： 11C-choline PET/CT imaging combined with 18F-FDG PET/CT imaging has better diagnostic value in the prostate cancer. 11C-choline PET/CT can make up for the inadequacy of 18F-FDG PET/CT.