^(68)Ga-PSMA-11PET/CT对未经治疗前列腺癌的临床决策的影响

Role of ^(68)Ga-PSMA-11 PET/CT in the clinical management of nave prostate carcinoma

目的:评价镓68(^(68 )Ga)标记Glu-CO-Lys(Ahx)-HBED-CC(PSMA-11)对未经治疗前列腺癌(PCa)的早期诊断及对临床决策影响的临床价值。方法:回顾性分析2017年5月~2017年10月在我院接受^(68 )GaPSMA-11PET/CT检查并经病理证实的20例PCa和13例前列腺增生(BPH)患者的临床资料,年龄52~89岁,血清前列腺特异性抗原(PSA)值为5.52~1 251ng/ml。由3位经验丰富的核医学医师对PET/CT图像进行双盲诊断。以感兴趣区方法,半定量计算肿瘤放射性摄取,以最大标准化摄取值(SUV_(max))表示。评价^(68 )Ga-PSMA-11PET/CT在术前诊断PCa的效能,对治疗方案的影响,并比较PCa组织放射性摄取与格里森评分(GS)和PSA的相关性。结果:^(68 )Ga-PSMA-11准确诊断了19例(19/20)PCa,敏感性、特异性、阳性预测值、阴性预测值、准确性分别为95.0%、69.2%、82.6%、90.0%和84.9%。发现7例(7/20)患者淋巴结转移,5例(5/20)患者骨转移。PCa患者肿瘤组织常呈局灶性放射性摄取,前列腺良性病变常为弥散性摄取,或轻度摄取。PCa患者肿瘤组织SUV_(max)明显高于BPH患者的前列腺SUV_(max)[(21.24±15.57)vs.(5.82±2.82),P<0.001]。受试者工作特征曲线(ROC曲线)分析出SUV_(max)的最佳临界值(cut-off值)为7.945[曲线下面积(AUC)为0.9096,P<0.0001],敏感性和特异性分别为85%和84.62%。PCa患者的SUV_(max)与GS和PSA值有显著相关(P<0.001;P<0.001)。结论:^(68 )Ga-PSMA-11PET/CT对PCa原发灶及转移灶均有很好的诊断价值,尤其是在高危PCa有非常高的诊断效能,显著影响临床决策。

Objective：To assess the role of ^（68 ）Ga-PSMA-11PET/CT in early diagnosis of prostate carcinoma（PCa）and clinical management.Method：From May 2017to October 2017,twenty patients with PCa and 13patients with BPH were consecutively enrolled in this study.All patients underwent ^（68 ）Ga-PSMA-11PET/CT,and their final diagnoses were confirmed by histopathology.The age and PSA of the patients were 52-89years old and5.52-1 251ng/ml,respectively.Three professional nuclear medicine physicians read the image in a double-blind manner.ROI analysis was used,tumor uptake was presented by standard uptake value（SUV_（max））.Diagnostic efficacy of ^（68 ）Ga-PSMA-11PET/CT was evaluated,and the correlation between tumor uptake and GS,PSA was further evaluated.Result：^（68 ）Ga-PSMA-11accurately detected 19（19/20）PCa patients with the sensitivity,specificity,positive predictive value,negative predictive value,accuracy were 95.0%,69.2%,82.6%,90.0%,84.9%,respectively.Seven PCa patients had ^（68 ）Ga-PSMA-11-avid lesions in the lymph node metastasis and 5PCa patients had positive finding in the bone metastasis.The PCa patients had higher SUV_（max）than BPH patients[（21.24±15.57）vs.（5.82±2.82）,P〈0.001].ROC revealed an optional SUV_（max）cut-off of 7.945（AUC=0.9096,P〈0.0001）,which achieved a 85%sensitivity and a 84.62%specificity.SUV_（max）of the PCa patients have significant relations with GS and PSA（P〈0.001;P〈0.001）.Conclusion：^（68 ）Ga-PSMA-11PET/CT have high sensitivity for the detection of the primary and metastatic lesions in PCa,higher GS or PSA associated with higher SUV_（max）,which will further improve the diagnostic efficacy.