^(18)F-PSMA-1007 PET/CT显像与mp-MRI在初发前列腺癌诊断效能中的比较

Diagnostic efficacy comparison of^(18)F-PSMA-1007 PET/CT imaging and mp-MRI in the diagnosis of newly diagnosed prostate cancer

目的:评估18氟标记前列腺特异性膜抗原-1007(^(18)F-PSMA-1007)PET/CT显像与多参数磁共振成像(mp-MRI)对初诊原发性前列腺癌(PCa)的诊断效能。方法:采用前瞻性研究方法选择2020年1月—2021年10月怀疑PCa拟行穿刺活检或手术的连续患者,最终入选46例,中位年龄68(54~81)岁。以病理为金标准,分析^(18)F-PSMA-1007 PET/CT显像和mp-MRI诊断原发性前列腺良恶性病变的诊断效能。绘制受试者工作特征曲线(ROC)、计算曲线下面积(AUC),得出最大标准化摄取值(SUVmax)和前列腺成像报告和数据系统(PI-RADS)的最佳诊断阈值。用Spearman相关性方法分析PCa低危和中高危组总前列腺特异抗原(TPSA)、SUVmax、PI-RADS、表观扩散系数(ADC)与Gleason(GS)间的相关性。以P<0.05认为差异或相关性有统计学意义。结果:46例患者以病理为金标准,PCa 39例,良性病变7例,良恶性病变组TPSA、SUVmax、ADC、PI-RADS均具有统计学意义(P值均<0.05)。^(18)F-PSMA-1007 PET/CT和mp-MRI对前列腺良恶性病变诊断的灵敏度、特异性、准确性、阳性预测值、阴性预测值分别为89.74%(35/39)、71.43%(5/7)、86.96%(40/46)、94.59%(35/37)、55.56%(5/9)和84.62%(33/39)、71.43%(5/7)、82.61%(38/46)、94.29%(33/35)、45.45%(5/11)。以约登指数最大值为切点确定SUVmax≥6.30、PI-RADS≥4分为诊断前列腺良恶性病变的最佳诊断阈值,AUC分别为0.905和0.881,差异均具有统计学意义,P值均为0.001,此阈值下对应的灵敏度、特异性分别为79.50%、100.00%和66.70%、100.00%。在mp-MRI和^(18)F-PSMA-1007 PET/CT相同扫描视野内,mp-MRI和^(18)FPSMA-1007 PET/CT发现区域内淋巴结转移分别为35.89%(14/39)和51.28%(20/39),骨转移分别为20.51%(8/39)和53.85%(21/39)。此外^(18)F-PSMA-1007 PET/CT发现17.95%(7/39)患者发生区域外淋巴结转移,33.33%(13/39)发生骨盆外骨转移,10.3%(4/39)发生肺转移。^(18)F-PSMA-1007 PET/CT比mp-MRI上调了约25.64%(10/39)的N分期,38.46%(15/39)的M分期。结论:^(18)F-PSMA-1007 PET/CT是原发性PCa良好的诊断和分期工具,其诊断效能高于mp-MRI。

Objective: To evaluate the diagnostic efficacy of 18-fluoro-labeled prostate specific membrane antigen-1007(^(18)F-PSMA-1007) PET/CT imaging and multi-parameter nuclear magnetic resonance(mp-MRI) in primary newly diagnosed prostate cancer(PCa). Methods: A prospective study was conducted on 46 consecutive patients with suspected PCa to undergo biopsy or surgery from January 2020 to October 2021, aged from 54 to 81 years old. Taking pathology as the gold standard,the diagnostic efficacy of^(18)F-PSMA-1007 PET/CT imaging and mp-MRI in the diagnosis of primary benign and malignant prostatic lesions was analyzed. The subject working characteristic curve(ROC) was drawn. The area under the curve(AUC) and the best diagnostic threshold of SUVmax and PI-RADS was obtained. Spearman correlation method was used to analyze the correlation between total prostate specific antigen(TPSA), SUVmax, PI-RADS, apparent diffusion coefficient(ADC) and Gleason(GS) in low risk group and medium high risk group of PCa. The difference or correlation was considered to be statistically significant(P<0.05). Results: According to pathology, there were 39 cases of PCa and 7 cases of benign lesions. There were significant differences in TPSA, SUVmax, ADC and PI-RADS between benign and malignant lesions. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of^(18)F-PSMA-1007 PET/CT and mp-MRI in the diagnosis of benign and malignant prostate lesions were 89.74%(35/39), 71.43%(5/7), 86.96%(40/46), 94.59%(35/37), 55.56%(5/9) and84.62%(33/39), 71.43%(5/7), 82.61%(38/46), 94.29%(33/35), 45.45%(5/11), respectively. Taking the maximum value of Jordan index as the cut-off point to determine SUVmax≥6.30 and PI-RADS≥4 as the best diagnostic threshold for benign and malignant prostate lesions, the AUC was 0.905 and 0.881, respectively, with statistically significant differences(both P are 0.001).The sensitivity and specificity under this threshold were 79.50%, 100.00% and 66.70%, 100.00%, respectively. In the same scanning field of mp-MRI and^(18)F-PSMA-1007 PET/CT, mp-MRI and^(18)F-PSMA-1007 PET/CT found that the regional lymph nodes metastases were 35.89%(14/39) and 51.28%(20/39) respectively, while bone metastases 20.51%(8/39) and 53.85%(21/39)respectively. In addition,^(18)F-PSMA-1007 PET/CT found that 17.95% of the patients had extraregional lymph node metastasis,33.33% of the patients had extrapelvic bone metastasis, and 10.26% of the patients had lung metastasis. Compared with mpMRI,^(18)F-PSMA-1007 PET/CT increased the N stage by 25.64%(10/39) and the M stage by 38.46%(15/39). Conclusion:^(18)FPSMA-1007 PET/CT is a good diagnostic and staging tool for primary PCa, and its diagnostic efficacy is higher than that of mp-MRI.