68Ga-PSMA-617 PET/CT与99Tcm-MDP骨扫描诊断前列腺癌骨转移的比较

Comparison of 68Ga-PSMA-617 PET/CT and 99Tcm-MDP bone scintigraphy for bone metastases in prostate cancer

目的比较68Ga-PSMA-617PET/CT与99Tcm-MDP骨扫描诊断前列腺癌患者骨转移的差异。 方法回顾性分析2017年6月至2018年2月我院73例接受68Ga-PSMA-617 PET/CT检查和99Tcm-MDP骨扫描检查的初诊前列腺癌患者的临床资料。年龄40～88岁，平均69.1岁；PSA值5.62～1 260.00 ng/ml，平均144.59 ng/ml；Gleason评分6～l0分，平均8分。根据检查结果将患者分为有骨转移和无骨转移两组，分别统计两种方法诊断的骨转移阳性例数和阴性例数，计算敏感性、特异性。绘制受试者工作特征曲线，并计算曲线下面积（AUC），比较两种方法的诊断效率。对骨转移患者采用配对样本Wilcoxon秩和检验比较68Ga-PSMA-617 PET/CT与99Tcm-MDP骨扫描检测转移灶数量的差异。 结果73例中临床诊断骨转移32例，无骨转移41例。68Ga-PSMA-617PET/CT检查发现骨转移32例，99Tcm-MDP骨扫描诊断骨转移31例。两者的敏感性分别为100.0%（32/32，95%CI 89.1%～100.0%）和90.6%（29/32，95%CI 75.0%～98.0%），特异性分别为100.0%（41/41，95%CI 91.4%～100.0%）和95.1%（39/41，95%CI 83.5%～99.4%），AUC值分别为1.000（95%CI 0.951～1.000）和0.929（95%CI 0.844～0.976），两者AUC值差异有统计学意义（P＝0.034）。68Ga-PSMA-617 PET/CT和99Tcm-MDP骨扫检出骨转移灶数量为1、2、3、4、5、〉5个的例数分别为5、2、4、3、1、17例和6、4、3、4、0、12例，差异有统计学意义（Z＝－2.949，P＝0.003）。 结论68Ga-PSMA-617 PET/CT较99Tcm-MDP骨扫描能更准确地发现更多的转移灶，是前列腺癌患者影像检查评估方法的重要补充，可在前列腺癌的分子显像和治疗中发挥重要的作用。

ObjectiveTo compare the diagnostic differences for the detection of bone metastases between 68Ga-PSMA-617 PET/CT and 99Tcm-MDP bone scintigraphy in preliminary diagnosed prostate cancer patients. MethodsSeventy-three patients who were diagnosed with prostate cancer by pathology were retrospectively analyzed from June 2017 to February 2018, and they all underwent both 68Ga-PSMA-617 PET/CT and 99Tcm-MDP bone scintigraphy without therapy beforehand. Mean age was 69.1 （range 40-88） years, the mean PSA level was 144.59 （range 5.62-1 260.00） ng/ml, and the Gleason score ranged 6-10. The patients were divided into two groups by whether or not had bone metastases according to the aforementioned two examinations. Both the sensitivity and specificity are calculated. The number of bone metastatic focus of the two examinations were also compared through the Wilcoxon rank testing. ResultsThirty-two of 73 patients were diagnosed with bone metastases. 68Ga-PSMA-617 PET/CT and 99Tcm-MDP detected 32 and 31 bone metastases, with the sensitivity of 100.0%（32/32, 95%CI 89.1%-100.0%）and 90.6%（29/32, 95%CI 75.0%-98.0%）, the specificity of 100.0%（41/41, 95%CI 91.4%-100.0%）and 95.12%（39/41, 95%CI 83.5%-99.4%）, and the AUC of 1.000（95%CI 0.951-1.000）and 0.929（95%CI 0.844-0.976）, respectively. There was significant difference in AUC between the two methods（P=0.034）. Two examinations exhibited significantly different number of metastatic sites（Z=-2.949, P=0.003）. Conclusions68Ga-PSMA-617 PET/CT outperform 99Tcm-MDP bone scintigraphy for the detection of bone involvement in prostate cancer patients. It will be an important imaging supplement for prostate cancer patients and play an important role in term of the accurate treatment based on the more accurate evaluation.