目的:前列腺特异性膜抗原(PSMA)靶向正电子发射断层扫描(PET)彻底改变了前列腺癌(PCa)的诊断和治疗,提供优于传统方法的诊断准确性,并实现与热无关的应用。然而,识别非特异性骨摄取(UBU)已经出现了一个重要的诊断挑战,如果误解,可能会导致过度分期和不适当的治疗决定。本系统综述探讨了接受PSMA-PET成像的PCa患者中UBU的现象。
方法:评估患病率的研究,地形分布,根据系统评价和荟萃分析(PRISMA)方法的首选报告项目选择UBU的潜在临床意义,并使用诊断准确性研究质量评估(QUADAS-2)工具进行评估。
结果:在PSMA-PET扫描中使用UBU的PCa患者的百分比范围为0至71.7%,根据使用的放射性药物,[18F]PSMA-1007发病率最高。肋骨是所有PSMA靶向放射性药物中UBU的主要部位。脊柱是[68Ga]Ga-PSMA-11,[18F]DCFPyL的第二常见UBU位点,[18F]rhPSMA-7,而骨盆带代表[18F]PSMA-1007的第二常见部位。UBU的平均最大标准化摄取值(SUVmax)在3.4至7.7之间变化,通常低于骨转移。
结论:我们的发现强调需要提高对UBU的认识和精确解释,以避免潜在的过度分期和随后的不当治疗决定。考虑到使用的放射性药物,PET衍生的半定量参数,UBU的地形分布,根据临床和实验室参数准确评估预测试概率可能有助于核医学医师解释PSMA-PET的发现。
OBJECTIVE: Prostate-Specific Membrane Antigen (PSMA)-targeted Positron Emission Tomography (PET) has revolutionised prostate cancer (PCa) diagnosis and treatment, offering superior diagnostic accuracy over traditional methods and enabling theragnostic applications. However, a significant diagnostic challenge has emerged with identifying unspecific bone uptakes (UBUs), which could lead to over-staging and inappropriate treatment decisions if misinterpreted. This systematic review explores the phenomenon of UBUs in PCa patients undergoing PSMA-PET imaging.
METHODS: Studies assessing the prevalence, topographical distribution, and potential clinical implications of UBUs were selected according to the Preferred Reporting Items for a Systematic Review and Meta-Analysis (PRISMA) method and evaluated with the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.
RESULTS: The percentage of PCa patients with UBUs on PSMA-PET scans ranged from 0 to 71.7%, depending on the radiopharmaceutical used, with [18F]PSMA-1007 showing the highest incidence. The ribs are the primary site of UBUs across all PSMA-targeted radiopharmaceuticals. The spine is the second most frequent
UBU site for [68Ga]Ga-PSMA-11, [18F]DCFPyL, [18F]rhPSMA-7, while the pelvic girdle represents the second most frequent site for [18F]PSMA-1007. The average maximum Standardized Uptake Value (SUVmax) of UBUs varied from 3.4 to 7.7 and was generally lower than that of bone metastases.
CONCLUSIONS: Our findings underscore the need for heightened awareness and precise interpretation of UBUs to avoid potential over-staging and subsequent inappropriate treatment decisions. Considering the radiopharmaceutical used, PET-derived semiquantitative parameters, the topographical distribution of UBUs, and accurately evaluating the pre-test probability based on clinical and laboratory parameters may aid nuclear medicine physicians in interpreting PSMA-PET findings.