18F-PSMA-1007 PET/CT显像可无创精准诊断前列腺癌并确定分期

18F-PSMA-1007 PET/CT examination can noninvasively diagnose and stage the vast majority of prostate cancer

目的 探讨基于18F-PSMA-1007的PET/CT显像技术在前列腺癌(PCa)无创精准诊断中的应用价值。方法 选择2020年11月~2022年4月梅州市人民医院收治的117例疑似PCa患者,在其穿刺活检前行18F-PSMA-1007 PET/CT检查,并通过勾画感兴趣区域的方法测量病灶和肝的标准摄取最大值,并以肝为背景计算肿瘤背景比(TBR),结合穿刺后的病理结果(PCa 64例,良性53例),比较良恶性疾病TBR组间差异,绘制ROC曲线评价其诊断效能,从而得到最佳截断值。结果 PCa患者的TBR水平高于良性,两组间差异有统计学意义(P<0.001)。以TBR诊断PCa绘制ROC曲线,测得ROC曲线下面积为0.881(P<0.001),截断值取0.955时,敏感度和特异性分别为78.1%和94.3%。TBR低于截断值的14例PCa患者中,7例已出现淋巴结和/或骨转移,可间接诊断为PCa。结论18F-PSMA-1007 PET/CT TBR对鉴别前列腺的良恶性具有较高的应用价值,以TBR=0.955作为截断值可获得很好的诊断效能,即使TBR低于截断值,转移灶的发现可作为PCa的补充诊断,进一步提高诊断准确率。行18F-PSMA-1007 PET/CT检查可无创诊断绝大多数的PCa并确定分期。

Objective To investigate the application value of PET/CT imaging technology based on 18F-PSMA-1007 in the non invasive and accurate diagnosis of prostate cancer(PCa).Methods A total of 117 patients with suspected PCa admitted to Meizhou People's Hospital from November 2020 to April 2022 were examined by 18F-PSMA-1007 PET/CT before biopsy.The maximum standardized uptake value of the lesion and liver was measured by delineating the region of interest,and the tumor background ratio(TBR)was calculated with the liver as the background.Combined with the pathological results after biopsy(64 cases of PCa and 53 cases of benign),the TBR differences between benign and malignant diseases were compared,and the ROC curve was drawn to evaluate their diagnostic efficacy,so as to obtain the best cutoff value.Results The TBR level of PCa patients was higher than that of benign patients,and there was significant difference between the two groups(P<0.001).The ROC curve was plotted by TBR to diagnose PCa,and the area under the ROC curve was 0.881(P<0.001),and the sensitivity and specificity were 78.1%and 94.3%,respectively,when the cutoff value was taken as 0.955.Moreover,among the 14 PCa patients with TBR below the cutoff value,7 had developed lymph nodes and/or bone metastases,which could be indirectly diagnosed as PCa.Conclusion 18F-PSMA-1007 PET/CT TBR has a high application value in distinguishing benign and malignant prostate lesions.Using TBR=0.955 as the cut-off value can achieve good diagnostic efficiency.Even if the TBR is lower than the cutoff value,the detection of metastases can be used as a supplementary diagnosis of PCa and further improve the diagnostic accuracy.18F-PSMA-1007 PET/CT examination can noninvasively diagnose and stage the vast majority of PCa.