18F-氟乙基胆碱对前列腺癌PET/CT诊断的价值及其非前列腺癌相关摄取的研究

目的 探讨18F-氟乙基胆碱(FECH) PET/CT在前列腺癌诊断中的价值,并分析前列腺癌患者的18F-FECH生理性摄取和其他非前列腺癌相关的摄取.方法 回顾性分析2009年10月至2011年12月共30例行18F-FECH和18F-FDG PET/CT的前列腺癌患者年龄56～83(平均61)岁],比较两者对前列腺癌原发灶诊断的灵敏度及准确性.测量并分析器官18F-FECH生理性摄取及非前列腺癌病灶摄取的SUVmax.对数据行x2检验和t检验.结果 30例患者中PET/CT共发现41个前列腺异常摄取灶.18F-FECH和18F-FDG显像对前列腺癌原发灶诊断灵敏度分别为87.9％(29/33)和36.4％(12/33;x2=8.1,P＜0.05),准确性分别为82.9％(34/41)和36.6％(15/41;x2=11.1,P＜0.05).肝脏、胰腺、脾脏、唾液腺可见18F-FECH生理性摄取,其中肝脏、胰腺生理性摄取最高,SUVmax分别为10.1±1.6和6.1±1.1.18F-FECH主要经肾脏排泄,泌尿系统可见放射性分布.18F-FECH PET/CT显像前列腺癌与前列腺良性病灶的SUVmax分别为6.0±2.2和2.6±1.3,差异有统计学意义(t=2.9,P＜0.05).30例患者中,发现10例有前列腺以外组织器官的非前列腺癌相关的PET异常表现,占33.3％,其中6例为炎性反应,1例为淋巴瘤,1例为结核,1例为肺癌,1例为松果体生殖细胞瘤.结论 18F-FECH显像在前列腺癌的诊断中有较高价值.准确分析患者生理性摄取及非前列腺癌相关病灶的摄取对前列腺癌的诊断至关重要,造成18F-FECH假阳性的良性病变主要是炎性反应.

The clinical value and pitfalls of ^18F-fluoroethylcholine PET/CT imaging in the diagnosis of prostate cancer

Objective To evaluate the clinical value of ^18F-fluoroethylcholine （FECH） PET/CT imaging in the diagnosis of prostate cancer and to investigate its physiological or non-cancerous uptake. Methods The subjects consisted of 30 patients（ age ranged from 56 to 83 years, mean age 61 years）with pathologically confirmed prostate cancer, in whom is F-FECH and is F-FDG PET/CT scans were undertaken from October 2009 to December 2011. The sensitivity and accuracy of the two tracers in detecting prostate cancer were compared. SUVmax was obtained for quantitative analysis. X2 test and t test were used for statis- tic analysis. Results Of the 30 patients, 41 lesions presented high uptake in prostate region. The sensitiv- ity and accuracy for diagnosing prostate cancer with ^18F-FECH PET/CT were 87.9% （29/33） and 82.9% （34/41）, respectively, while the sensitivity and accuracy with ^18 F-FDG PET/CT were 36.4% （ 12/33 ） and 36.6% （ 15/41 ）, respectively. There were significant differences in sensitivity and accuracy between the two methods X2 = 8.1 and 11.1, both P 〈 0.05）. Physiological uptake appeared in the liver, pancreas, spleen, salivary gland, and also, owing to renal excretion, in the urinary tract. The SUVmax in liver and pancreas were 10.1 ± 1.6 and 6.1 ± 1.1, respectively. The SUVmax was 6.0 ±2.2 in prostate cancer, while it was 2.6 ± 1.3 in benign lesions （ t = 2.9, P 〈 0.05 ）. Other abnormalities that were not related to prostate cancer were detected in 10 patients. Of these 10 patients, there were 6 with inflammation, 1 with lymphoma, 1 with tuberculosis, 1 with lung cancer and 1 with germinoma in pineal body. Conclusions ^18F-FECH PET/CT is promising for diagnosis of prostate cancer. Understanding the biodistribution and pitfalls of ^18F-FECH is very important for image interpretation.