68Ga-PSMA-11 PET-CT与全身磁共振成像诊断前列腺癌远处转移的效能比较

目的 对比分析以68镓(68Ga)标记的靶向前列腺特异性膜抗原(PSMA)分子探针PSMA-11为示踪剂的PET-CT(68Ga-PSMA-11 PET-CT)与全身磁共振成像(WB-MRI)诊断前列腺癌远处转移的效能.方法 回顾性分析2019年1月至12月我院收治的行68Ga-PSMA-11 PET-CT及WB-MRI的52例前列腺癌患者的临床资料.由核医学科及影像医学科主治医师各2名分别对患者的68Ga-PSMA-11 PET-CT和WB-MRI检查结果进行盲法分析,并以最佳比较标准(BVC)为金标准对患者进行分组.根据结果绘制ROC曲线并计算AUC,对2种检查方法的灵敏度、特异度等进行统计分析.结果 入组的52例前列腺癌患者中20例无远处转移、32例发生远处转移.WB-MRI检测远处转移的 AUC 为0.844(95％CI0.719～0.968),灵敏度为93.75％(30/32)、特异度为75.00％(15/20);68Ga-PSMA-11 PET-CT 检测远处转移的AUC为0.959(95％CI0.893～1.000),灵敏度为96.88％(31/32)、特异度为95.00％(19/20),2种方法的灵敏度及特异度差异均无统计学意义(P均＞0.05).远处转移患者中有25例发生骨转移、29例发生淋巴结转移.68Ga-PSMA-11 PET-CT检测前列腺癌骨转移灶的灵敏度为92.00％(23/25)、特异度为100.00％(27/27),WB-MRI检测灵敏度为60.00％(15/25)、特异度为88.89％(24/27),2种方法灵敏度差异有统计学意义(P=0.04);2种方法对淋巴结转移检测的灵敏度[89.66％(26/29)vs 86.21％(25/29)]及特异度[95.65％(22/23)vs 91.30％(21/23)]差异均无统计学意义(P均＞0.05).结论 68Ga-PSMA-11 PET-CT与WB-MRI检测前列腺癌远处转移均具有较高的诊断效能.在骨转移的诊断方面,68Ga-PSMA-11 PET-CT的诊断效能优于WB-MRI.

68Ga-PSMA-11 PET-CT in comparison with whole-body magnetic resonance imaging for dignosis of distant metastasis in prostate cancer patients

Objective To compare the diagnostic value of 68Ga-PSMA PET/CT and whole-body MRI (WB-MRI) for the detection of distant metastasis in patients with prostate cancer. Methods The clinical data of 52 patients with prostate cancer who underwent 68Ga-PSMA PET/CT and WB-MRI from January 2019 to December 2019 were retrospectively analyzed. For the 52 patients, the age at diagnosis was 65.60 ± 5.49 (55 - 85), the median total PSA was 39.24 (14.76, 95.45) ng/mL. The metastatic diagnosis depended on the best valuable comparator (BVC). The receiver operator characteristic (ROC) was drawn and the area under the curve (AUC) was calculated. The sensitivity and specificity of 68Ga-PSMA PET/CT and WB-MRI were also calculated. Results Of the 52 patients, 20 were diagnosed without distant metastasis, 32 were diagnosed with distant metastasis. For WB-MRI, the sensitivity and specificity were 93.75% (30/32) and 75.00% (15/20), respectively. For 68Ga-PSMA PET/CT, the sensitivity and specificity were 96.88% (31/32) and 95.00% (19/20), respectively. There was no significant difference in the sensitivity (P =1.00) and specificity (P =0.25) of the two imaging methods for the detection of distant metastasis. Of the 32 patients with distant metastasis, 25 were diagnosed with bone metastasis, 29 were diagnosed with lymph nodes metastasis. The sensitivity of 68Ga-PSMA PET/CT and WB-MRI for the detection of bone metastasis were 92.00% (23/25) and 60.00% (15/25) (P =0.04), respectively. The specificity of 68Ga-PSMA PET/CT and WB-MRI for the detection of bone metastasis were 100.00% (27/27) and 88.89% (24/27) (P >0.05), respectively. For the detection of lymph nodes metastasis, there was no significant difference in the sensitivity (P =1.00) and specificity (P =1.00) of the two imaging methods. Conclusions Both 68Ga-PSMA PET/CT and WB-MRI performed great value for patients with prostate cancer, and were equally effective in the detection of distant metastasis. In the diagnosis of bone metastases, 68Ga-PSMA PET/CT was superior to WB-MRI.