^(18)F-PSMA-1007与^(18)F-FDG PET/CT在初诊肝细胞癌诊断中的应用比较

Comparison of ^(18)F-PSMA-1007 and ^(18)F-FDG PET/CT imaging in diagnosis of newly diagnosed hepatocellular carcinoma

目的比较^(18)F-前列腺特异膜抗原(PSMA)-1007和^(18)F-FDG PET/CT在初诊肝细胞癌(HCC)诊断中的应用价值。方法前瞻性纳入2022年4月至2022年7月期间在郑州大学第一附属医院行PET/CT显像的初诊HCC患者17例[男14例、女3例,年龄36~73(54.4±10.1)岁]。患者于3 d内完成^(18)F-FDG和^(18)F-PSMA-1007 PET/CT显像。对比2种显像对肝内病灶的检出情况。从正常肝组织(L)、腹主动脉(A)和右侧臀中肌(M)中选取ROI,获取SUV_(max),并与肝原发灶SUV_(max)(T)进行比较,即比较2组显像的T/L、T/A和T/M。采用Wilcoxon秩和检验、Kruskal-Wallis秩和检验分析数据。结果^(18)F-FDG、^(18)F-PSMA-1007 PET/CT及增强MRI检测每例患者肝内肿瘤病灶数目分别为1(0,2)、2(1,5)和2(1,4)个(H=7.10,P=0.029),^(18)F-PSMA-1007检测病灶数多于^(18)F-FDG检出数(P=0.024)。^(18)F-PSMA-1007肝内肿瘤SUV_(max)明显高于^(18)F-FDG[25.7(17.1,45.1)和6.3(2.9,12.4);z=3.39,P=0.001],但两者T/L差异无统计学意义[2.7(2.1,4.7)和1.6(1.0,4.5);z=0.52,P=0.602]。^(18)F-PSMA-1007的T/A、T/M高于^(18)F-FDG(z值:3.15和3.53,P=0.002和P<0.001)。有2例HCC^(18)F-PSMA-1007 PET/CT显像肝及肋骨见高摄取灶,而^(18)F-FDG显像未见显示,病理证实为HCC骨转移。结论与^(18)F-FDG相比,HCC对^(18)F-PSMA-1007具有更高的摄取。^(18)F-PSMA-1007 PET/CT可检测出更多的肝内肿瘤灶及远处骨转移灶。

Objective To compare the clinical utility of ^(18)F-prostate specific membrane antigen(PSMA)-1007 and ^(18)F-FDG PET/CT imaging in newly diagnosed hepatocellular carcinoma(HCC).Methods From April 2022 to July 2022,17 patients(14 males,3 females,age 36-73(54.4±10.1)years)with newly diagnosed HCC who underwent ^(18)F-FDG and ^(18)F-PSMA-1007 PET/CT imaging within 3 d in the First Affiliated Hospital of Zhengzhou University were prospectively enrolled.ROIs were drawn from normal liver tissue(L),abdominal aorta(A),right gluteus medius(M),and SUV_(max) of these regions were compared with the SUV_(max) of primary tumor(T).Wilcoxon rank sum test and Kruskal-Wallis rank sum test were used to analyze the data.Results ^(18)F-FDG PT/CT,^(18)F-PSMA-1007 PET/CT and enhanced MRI detected 1(0,2),2(1,5)and 2(1,4)tumor lesions of the liver in each patient respectively(H=7.10,P=0.029),and ^(18)F-PSMA-1007 detected more lesions than ^(18)F-FDG(P=0.024).Although SUV_(max) of ^(18)F-PSMA-1007 in HCC was significantly higher than that of ^(18)F-FDG(25.7(17.1,45.1)vs 6.3(2.9,12.4);z=3.39,P=0.001),there was no significant difference of T/L ratio between ^(18)F-PSMA-1007 and ^(18)F-FDG PET/CT imaging(2.7(2.1,4.7)vs 1.6(1.0,4.5);z=0.52,P=0.602).T/A and T/M ratios were significantly higher in ^(18)F-PSMA-1007 PET/CT imaging than those in ^(18)F-FDG PET/CT imaging(z values:3.15,3.53,P values:0.002,<0.001).^(18)F-PSMA-1007 PET/CT imaging found high uptake foci in the liver and ribs in 2 cases,which were pathologically confirmed as bone metastasis of HCC,while those lesions were not found by ^(18)F-FDG imaging.Conclusion Compared with ^(18)F-FDG,^(18)F-PSMA-1007 PET/CT demonstrates higher tumor uptake,more intrahepatic tumors foci and distant bone metastases.