18F-PSMA-1007 PET/CT examination can noninvasively diagnose and stage the vast majority of prostate cancer
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摘要:
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。 -
关键词:
- 18F-PSMA-1007 /
- PET/CT /
- 前列腺癌 /
- 无创性诊断
Abstract: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. -
Key words:
- 18F-PSMA-1007 /
- PET/CT /
- prostate cancer /
- noninvasive diagnosis
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图 1 PCa患者图像
Figure 1. Images of prostate cancer patients. A: CT images; B: 18F-PSMA-1007 PET images; C: 18F-PSMA-1007 PET/CT images shows prostate cancer; D: Distribution of 18F-PSMA-1007 in the body.
图 2 前列腺良性疾病患者图像
Figure 2. Images of patients with benign prostatic disease. A: CT images; B: 18F-PSMA-1007 PET images; C: 18F-PSMA-1007 PET/CT images shows non prostate cancer; D: Distribution of 18F-PSMA-1007 in the body.
图 4 TBR低于截断值的PCa患者
Figure 4. Prostate cancer patients with TBR below cutoff value. A: Radioactive uptake in the prostate is generally normal, TBR=0.48; B-C: Two radioactive abnormal high uptake lesions were seen next to the right iliac artery, which are considered as lymph node metastases of prostate cancer. It indirectly helps diagnose prostate cancer.
表 1 PCa组与良性组各参数比较
Table 1. Comparison of parameters between PCa group and benign group
Index PCa Benign t/Z P Age（year, Mean±SD） 72.66±7.812 67.13±7.429 3.893 < 0.001 tPSA[ng/mL, M(P25，P75)] 41.87（12.515, 95.512） 12.158±6.841 -5.328 < 0.001 fPSA[ng/mL, M(P25，P75)] 6.896（1.725, 14.128） 1.942（0.843, 3.806） -3.806 < 0.001 TBR[M(P25，P75)] 2.1（0.992, 3.485） 0.626±0.259 -7.072 < 0.001 tPSA: Total prostate specific antigen; fPSA: Free prostate specific antigen; TBR: Tumor background ratio. PCa: Prostate cancer. 
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表 2 两种显像对淋巴结转移灶的检出能力比较
Table 2. Comparison of the detection ability of two types of imaging for lymph node metastasis [n(%)]
MRI 18F-PSMA-1007 PET/CT Total + - + 20（31.3） 0（0） 20（31.3） - 8（12.5） 36（56.2） 44（68.7） Total 28（43.8） 36（56.2） 64（100.0）
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表 3 两种显像对骨转移灶的检出能力比较
Table 3. Comparison of the detection ability of two types of imaging for bone metastasis[n(%)]
MRI 18F-PSMA-1007 PET/CT Total + - + 15（23.4） 0（0） 15（23.4） - 9（14.1） 40（62.5） 49（76.6） Total 24（37.5） 40（62.5） 64（100.0）
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