18F-前列腺特异性膜抗原-1007 PET/CT显像、11C-胆碱PET/CT显像及单光子发射计算机断层成像术骨显像对前列腺癌骨转移的诊断价值比较

目的探讨¹⁸F-前列腺特异性膜抗原(PSMA)-1007标记的正电子发射体层显像融合计算机体层显像技术(PET/CT)显像、11C-胆碱(11C-CHO)PET/CT显像及单光子发射计算机断层成像术(SPECT)骨显像在前列腺癌骨转移诊断上的差异。方法回顾性分析2018年9月至2020年7月北部战区总医院核医学科收治的43例男性前列腺癌患者的临床资料,年龄(77.47±11.87)岁,年龄范围为55~89岁。所有患者行¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT显像及SPECT骨显像检查。分别统计¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT及SPECT骨显像诊断骨转移的阳性例数和阴性例数,计算三种方法各自的灵敏度、特异度、准确性、阳性预测值、阴性预测值,绘制受试者工作特征(ROC)曲线,计算并比较各自曲线下面积(AUC),评价三种检查方法对前列腺癌骨转移的诊断效能。结果 43例前列腺癌患者中,27例患者出现骨转移。¹⁸F-PSMA-1007 PET/CT显像示26例患者发生骨转移,漏诊1例;11C-CHO PET/CT显像示24例患者发生骨转移,误诊1例,漏诊4例;SPECT骨显像示23例患者发生骨转移,误诊3例,漏诊7例,三者诊断前列腺癌骨转移的灵敏度、特异度、准确性分别为96.3%(26/27)、100%(16/16)、97.7%(42/43);85.2%(23/27)、93.8%(15/16)、88.4%(38/43);74.1%(20/27)、81.3%(13/16)、76.7%(33/43)。¹⁸F-PSMA-1007 PET/CT显像、11C-CHO PET/CT和SPECT骨显像ROC曲线的AUC和95%CI分别为0.981(0.885~1.000)、0.913(0.763~0.967)、0.777(0.624~0.889)。三种检查的AUC曲线下面积进行两两比较,差异均有统计学意义(P<0.05)。采用Wilcoxon秩和检验对27例患者三种方法检出的骨转移灶的数量进行两两比较发现,¹⁸F-PSMA-1007 PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.484,P=0.013),¹⁸F-PSMA-1007 PET/CT显像与11C-CHO PET/CT显像比较,差异无统计学意义(Z=-0.160,P=0.873);11C-CHO PET/CT显像与SPECT骨显像比较,差异有统计学意义(Z=-2.085,P=0.037)。结论 PET/CT显像较SPECT骨显像能发现更多的骨转移灶。¹⁸F-PSMA-1007 PET/CT显像对前列腺癌骨转移诊断的灵敏度、特异度及准确性高于其他两种检查方式。在低前列腺特异性抗原(PSA)的情况下,能够精确地对前列腺癌骨转移做出诊断。

Comparison of 18F-prostate-specific membrane antigen-1007 positron emission tomography and computed tomography imaging 11C-choline positron emission tomography and computed tomography imaging and single-photon emission computed tomography bone imaging in the diagnosis of bone metastasis of prostate cancer

Objective To investigate the differences of ¹⁸F-prostate specific membrane antigen(PSMA)-1007 positron emission tomography and computed tomography(PET/CT)imaging,¹¹C-choline(¹¹C-CHO)PET/CT imaging and single-photon emission computed tomography(SPECT)bone imaging in the diagnosis of bone metastasis of prostate cancer.Methods A retrospective study was performed on 43 male patients with prostate cancer who were admitted to the Nuclear Medicine of General Hospital of Northern Theater Command from September 2018 to July 2020,aged(77.47±11.87)years old,ranging 55 to 89 years old.Patients underwent SPECT bone imaging,¹¹C-CHO PET/CT imaging and ¹⁸F-PSMA-1007 PET/CT imaging.¹⁸F-PSMA-1007 PET/CT imaging and ¹¹C-CHO PET/CT were statistically analyzed,the sensitivity,specificity,accuracy,positive predictive value and negative predictive value of the three methods were calculated,and the receiver operating characteristic(ROC)curve was drawn.The area under the curve(AUC)was calculated and compared to evaluate the diagnostic efficacy of the three methods for bone metastasis of prostate cancer.Results Among the 43 patients with prostate cancer,27 had bone metastases.¹⁸F-PSMA-1007 PET/CT imaging showed bone metastases in 26 patients,misdiagnosis in 1 case;¹¹C-CHO PET/CT imaging showed bone metastases in 24 cases,misdiagnosis in 1 case,missed in 4 cases;SPECT bone imaging showed bone metastases in 23 patients,misdiagnosis in 3 cases,missed in 7 cases.The sensitivity,specificity,and accuracy of the three diagnosis of prostate cancer bone metastasis were 96.3%(26/27),100%(16/16)and 97.7%(42/43);85.2%(23/27),93.8%(15/16)and 88.4%(38/43);74.1%(20/27),81.3%(13/16)and 76.7%(33/43).The AUC and 95%CI of ROC curves of ¹⁸F-PSMA-1007 PET/CT imaging,¹¹C-CHO PET/CT and SPECT bone imaging were 0.981(0.885 to 1.000),0.913(0.763 to 0.967)and 0.777(0.624 to 0.889).The areas under the AUC curve of the three tests were compared in pairs,and the differences were statistically significant(P<0.05).The Wilcoxon rank sum test was used to compare the number of bone metastases detected by the three methods in 27 patients.It showed that the ¹⁸F-PSMA-1007 PET/CT imaging versus SPECT bone imaging was statistically significant(Z=-2.484,P=0.013),¹⁸F-PSMA-1007 PET/CT imaging versus ¹¹C-CHO PET/CT imaging,the difference was not statistically significant(Z=-0.160,P=0.873);¹¹C-CHO PET/CT Imaging versus SPECT bone imaging,the difference was statistically significant(Z=-2.085,P=0.037).Conclusion PET/CT imaging showed more bone metastases than SPECT bone imaging.The sensitivity,specificity and accuracy of ¹⁸F-PSMA-1007 PET/CT imaging in the diagnosis of bone metastasis of prostate cancer are higher than the other two methods.In the case of low PSA,the diagnosis of bone metastasis of prostate cancer can be accurately made.