PDF(Pubmed)
Abstract：
Background Multiparametric magnetic resonance imaging (mpMRI) is widely used for the evaluation of prostate cancer and is known to have better accuracy. Gallium-68 prostate-specific membrane antigen (Ga-68 PSMA) is a radiotracer that shows high localization in prostate cancer cells. Purpose The purpose of this study was to assess the sensitivity and utility of Ga-68 PSMA positron emission tomography/computed tomography (PET/CT) in comparison with mpMRI as a noninvasive imaging technique for the initial diagnosis and locoregional staging of prostate cancer using transrectal ultrasound (TRUS)-guided biopsy as gold standard. Materials and Methods This prospective observational study conducted from August 2017 to April 2020 evaluated 60 men ( n = 60) with biopsy-proven prostate carcinoma. They underwent mpMRI and Ga-68 PSMA PET/CT scans within 14 days with TRUS biopsy being gold standard. T staging of disease, N staging of lymph nodes within the pelvis, and M staging of lesions in pelvic bones (within the imaging field of mpMRI) were compared using PSPP version 1.0.1 statistical software. Results All 60 men with a mean age of 69.9 ± 9.35 years showed Ga-68 PSMA avid disease, whereas 55 were detected by mpMRI. The sensitivity in detection of prostate lesions (with 95% confidence interval) was 99.08% for Ga-68 PSMA PET/CT and 84.40% for mpMRI. Ga-68 PSMA PET/CT detected greater number of patients with regional lymph nodal involvement (19/60) as compared with mpMRI (12/60). Ga-68 PSMA PET/CT showed PSMA avid pelvic skeletal lesions in nine patients, whereas mpMRI detected pelvic lesions in six patients. In addition, four other patients showed extrapelvic skeletal lesions on Ga-68 PSMA PET/CT. Conclusion Ga-68 PSMA PET/CT has superior sensitivity in detection of primary prostate tumor, as compared with mpMRI. Both modalities correlate well in detection of seminal vesicle involvement. Ga-68 PSMA PET/CT outperformed mpMRI in detection of lymph nodal and skeletal metastases. Hence, Ga-68 PSMA PET/CT should be considered as first-line diagnostic modality for carcinoma prostate. Summary Statement : Ga-68 PSMA PET/CT shows superior diagnostic performance than mpMRI in the evaluation of prostate cancer.
摘要：
背景技术多参数磁共振成像(mpMRI)被广泛用于前列腺癌的评估,并且已知具有更好的准确性。镓-68前列腺特异性膜抗原(Ga-68PSMA)是在前列腺癌细胞中显示高度定位的放射性示踪剂。目的本研究的目的是评估Ga-68PSMA正电子发射断层扫描/计算机断层扫描（PET/CT）的敏感性和实用性，与mpMRI相比，作为一种非侵入性成像技术用于前列腺癌的初始诊断和局部分期使用直肠超声（TRUS）引导活检作为金标准。材料与方法这项前瞻性观察性研究于2017年8月至2020年4月进行，评估了60例（n=60）经活检证实为前列腺癌的男性。他们在14天内接受了mpMRI和Ga-68PSMAPET/CT扫描，TRUS活检是金标准。疾病的T分期，骨盆内淋巴结的N分期，使用PSPP1.0.1版统计软件比较了骨盆骨病变的M分期（在mpMRI的成像范围内）。结果60例平均年龄为69.9±9.35岁的男性均表现为Ga-68PSMA狂热病,而通过mpMRI检测到55。Ga-68PSMAPET/CT检测前列腺病变的灵敏度（95％置信区间）为99.08％，mpMRI为84.40％。与mpMRI（12/60）相比，Ga-68PSMAPET/CT检测到更多的区域淋巴结受累患者（19/60）。Ga-68PSMAPET/CT显示9例患者的PSMA狂热骨盆骨骼病变，而mpMRI检测到6例患者的盆腔病变。此外,另外4例患者在Ga-68PSMAPET/CT上显示肾盂外骨骼病变。结论Ga-68PSMAPET/CT对原发性前列腺肿瘤的检出具有较高的敏感性,与MPMRI相比。两种方式在检测精囊受累方面都有很好的相关性。Ga-68PSMAPET/CT在检测淋巴结和骨骼转移方面优于mpMRI。因此，Ga-68PSMAPET/CT应被视为前列腺癌的一线诊断方式。总结声明：Ga-68PSMAPET/CT在前列腺癌的评估中显示出比mpMRI更好的诊断性能。
