^(18)F-PSMA-1007与^(18)F-FDG PET/CT对前列腺癌诊断的初步对比研究

Preliminary comparative study of ^(18)F-PSMA-1007 and ^(18)F-FDG PET/CT for diagnosing prostate cancer

目的比较^(18)F-PSMA-1007与^(18)F-FDG PET/CT对初诊前列腺癌原发灶及转移灶的诊断效能。方法回顾性纳入2019年10月~2021年3月20例经组织病理学确诊且未行任何治疗的前列腺癌患者,均行^(18)F-PSMA-1007与^(18)FFDG PET/CT,对比分析两者的诊断效能,并采用ROC曲线分析比较两者各自的SUV_(max)诊断阈值和诊断效能的差异;将患者血清tPSA水平、Gleason评分与原发灶的SUV_(max)[前列腺特异性膜抗原(PSMA)]进行Pearson相关性分析。采用Weighted Kappa检验对两者诊断结果进行一致性分析。结果20例患者阳性病灶共51处,其中4例患者有18处骨转移,5例患者有13处淋巴结转移。^(18)F-PSMA-1007与^(18)F-FDG PET/CT显像SUV_(max)ROC曲线下面积分别为0.870、0.585;两者诊断前列腺癌的敏感度、特异度、阳性预测值、阴性预测值和准确度分别为90.2%、90%、97.9%、64.3%、90.2%及60.8%、70%、91.2%、25.9%、65.6%,两者在敏感度的差异有统计学意义(P<0.05);^(18)F-PSMA-1007 PET/CT对于前列腺癌病灶及淋巴结转移灶的检出率均高于^(18)F-FDG PET/CT,差异有统计学意义(P<0.05)。血清tPSA值、Gleason评分与原发灶的SUV_(max)(PSMA)均呈正相关(r=0.515、0.765,均P<0.05)。两名医师对^(18)F-PSMA-1007 PET/CT的诊断具有良好的一致性(Kappa系数=0.85,P<0.05)。结论^(18)F-PSMA-1007 PET/CT对初诊前列腺癌原发灶及淋巴结转移的诊断均明显优于^(18)F-FDG PET/CT。

Objective To compare the diagnostic efficacy of^(18)F-PSMA-1007 and^(18)F-FDG PET/CT in primary and metastatic lesions of newly diagnosed prostate cancer. Methods From October 2019 to March 2021, 20 patients with pathologically confirmed prostate cancer underwent^(18)F-PSMA-1007 and^(18)F-FDG PET/CT before treatment. Receiver operating characteristic(ROC) curve analysis was used to compare the diagnostic threshold and diagnostic efficacy of SUV;between the two imaging methods. Pearson correlation analysis was used to evaluate correlation between the patient’s serum tPSA level, Gleason score, and SUV;(prostate specific membrane antigen, PSMA) of the primary tumor. The weighted kappa test was used to analyze the consistency of the diagnostic results between the two groups. Results There were 51 lesions in 20 patients including 18 bone metastases in 4 patients and 13 lymph node metastases in5 patients. The area under the ROC curve(AUC) of SUV;on^(18)F-PSMA-1007 scan was 0.870 with 90.2% sensitivity, 90% specificity,97.9% positive predictive value, 64.3% negative predictive value, and 90.2% accuracy compared to that of^(18)F-FDG PET/CT(0.585,60.8%, 70%, 91.2%, 25.9%, 65.6%) for diagnosing prostate cancer. The difference in sensitivity between the two methods was statistically significant(P<0.05). The detection rates of^(18)F-PSMA-1007 PET/CT for prostate cancer lesions and lymph node metastases were significantly higher than that of^(18)F-FDG PET/CT(P<0.05). The serum tPSA value, Gleason score and the SUV;value(PSMA) of the primary lesions were all positively correlated(r=0.515, 0.765, both P<0.05). There was better agreement in the diagnosis of^(18)FPSMA-1007 PET/CT between two nuclear medicine physicians(Kappa value=0.85, P<0.05). Conclusion^(18)F-PSMA-1007 PET/CT is significantly better than^(18)F-FDG PET/CT in the diagnosis of primary prostate cancer lesions and lymph node metastasis.