PSMA-靶向(18)^F-DCFPyL PET/CT在肾透明细胞癌术后复发或转移病灶诊断中的作用分析

PSMA-targeted(18)^F-DCFPyL PET/CT in diagnosis of recurrence or metastasis of renal clear cell carcinoma after nephrectomy

目的评价(18)^F-DCFPyL正电子发射断层扫描/计算机体层摄影(positron emission tomography/computed tomography,PET/CT)在肾透明细胞癌(renal clear cell carcinoma,ccRCC)术后复发或转移病灶诊断中的作用。方法回顾性分析解放军总医院第一医学中心核医学科2018年12月-2019年10月12例术后通过临床及其他影像学检查怀疑复发或转移的ccRCC患者。应用(18)^F-DCFPyL对患者进行全身PET/CT检查,明确显像阳性病灶位置并测量病灶的大小及最大标准摄取值(maximum standardized uptake value,SUVmax),同时记录CT显示病灶的数量。通过病理和影像随访结果明确患者病灶性质,并评价(18)^F-DCFPyL PET/CT诊断能力。结果12例患者(男性11例,女性1例,平均年龄60.0岁)最终明确37个复发或转移病灶及1个术后改变病灶。在37个复发或转移病灶中,(18)^F-DCFPyL PET显像阳性病灶为35个,全部为复发或转移病灶,诊断敏感度为94.6%;CT发现了25个病灶,其中包括1个术后改变病灶,诊断敏感度为64.9%。所有37个转移或复发病灶SUVmax中位数为7.4(范围:0.8~21.7):其中骨骼和软组织病灶SUVmax中位数分别为6.9(范围:1.8~13.9)和4.5(范围:0.8~21.7);2个淋巴结病灶SUVmax分别为4.5和8.3。软组织复发及转移病灶大小与SUVmax存在正相关关系(r=0.544,P=0.024)。结论PSMA-靶向(18)^F-DCFPyL PET/CT对于ccRCC术后复发和转移病灶具有一定的诊断价值。

Objective To evaluate the performance of PSMA-targeted(18)^F-DCFPyL PET/CT in the diagnosis of recurrence or metastasis of renal clear cell carcinoma(ccRCC)after nephrectomy.Methods A retrospective study was performed in 12 patients with renal cell carcinoma after nephrectomy who were suspected of recurrence or metastasis by clinical and other imaging examinations from December 2018 to October 2019 in the department of nuclear medicine in the First Medical Center of Chinese PLA General Hospital.PSMA-targeted(18)^F-DCFPyL was used to perform an entire PET/CT examination on the patients to determine the location of the lesion.The size of the suspected lesion and the maximum standard uptake value(SUVmax)were measured,and the number of lesions displayed on the CT images were recorded.The definite diagnosis was used to evaluate the diagnostic ability of PSMA-targeted(18)^F-DCFPyL PET/CT.Results There were 37 recurrent or metastatic lesions and one postoperative change in the 12 patients.In the 37 recurrent or metastatic lesions,a total of 35 positive uptake lesions were found by PSMA-targeted(18)^F-DCFPyL PET/CT,all of which were relapsed or metastatic,indicating the sensitivity of 94.5%.CT found 25 lesions,including 1 lesion of postoperative change,with the diagnostic sensitivity of 64.9%.The median SUVmax of 37 lesions was 7.4(range,0.8-21.7);the median SUVmax of bone and soft tissue lesions were 6.9(range,1.8-13.9)and 4.5(range,0.8-21.7),respectively;the SUVmax of two lymph node lesions was 4.5 and 8.3,respectively.There was a positive correlation between the size and the SUVmax in soft tissue recurrent and metastatic lesions(r=0.544,P=0.024).Conclusion PSMA-targeted(18)^F-DCFPyL PET/CT has diagnostic value for recurrence or metastasis of renal clear cell carcinoma after nephrectomy.