Assessment of Simplified Methods for Quantification of 18F-FDHT Uptake in Patients with Metastatic Castration-Resistant Prostate Cancer
Assessment of Simplified Methods for Quantification of 18F-FDHT Uptake in Patients with Metastatic Castration-Resistant Prostate Cancer
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DOI：
10.2967/jnumed.118.220111
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发表时间：
2019-09-01
影响因子：
9.3
通讯作者：
Lammertsma, Adriaan A.
中科院分区：
文献类型：
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作者：
Kramer, Gerbrand M.;Yaqub, Maqsood;Lammertsma, Adriaan A.
F-18-氟二氢睾酮(F-18-FDHT)PET/CT为评估转移性去势耐受前列腺癌(MCRPC)患者雄激素受体的表达提供了一种无创方法。本研究的目的是评估量化mCRPC患者F-18-FDHT摄取的简化方法，并评估肿瘤灌注对这些F-18-FDHT摄取指标的影响。方法：17例mCRPC患者纳入这项前瞻性观察的多中心研究。14例患者行静脉采血30min动态F-18-FDHTPET/CT扫描及复查。此外，对6名患者进行了动脉采血和动态O-15-H2O扫描。评估了几种简化的方法：Patlak曲线图；SUV归一化体重(SUVBW)、瘦体重(SUVLBM)、全血(SUVWB)、父母血浆活性浓度(SUVPP)、父母血浆曲线下面积(SUVAUC，PP)和全血输入曲线下面积(SUVAUC，WB)；以及经性激素结合球蛋白水平校正的SUVBW。结果与F-18-FDHT和O-15-H2O的全药代动力学参数相关联。最后，对各个定量摄取指标的重复性进行了评估。结果：87个F-18-FDHT-AVID病变被评估。F-18-FDHT摄取符合不可逆二组织室模型。将连续代谢校正的动脉血浆输入函数替换为图像导出的输入函数，结合静脉样本数据可以得到类似的K-I结果(R-2=0.98)。Patlak K-I与SUVAUC、PP呈良好的相关性(R-2>；0.9)。SUVBW与K-I呈中度相关(R-2=0.70，可能是由于快速的F-18-FDHT代谢所致)。在计算SUVSHBG时，与K-I的相关性提高(R-2=0.88)。全动力学模型参数的重复性不如简化方法(重复性系数)。36%对28%)。F-18-FDHT摄取表现出最小的血流依赖性。结论：mCRPC患者的F-18-FDHT动力学符合带血容量参数的不可逆二组织室模型。SUVAUC、PP与不可逆的二组织室模型分析显示出近乎完美的相关性，可用于全身PET/CT摄取F-18-FDHT的准确定量。此外，当需要不太复杂的扫描方案和准确性时，SUVSHBG可能被用作量化F-18-FDHT摄取的一种更简单的方法。
F-18-fluorodihydrotestosterone (F-18-FDHT) PET/CT potentially provides a noninvasive method for assessment of androgen receptor expression in patients with metastatic castration-resistant prostate cancer (mCRPC). The objective of this study was to assess simplified methods for quantifying F-18-FDHT uptake in mCRPC patients and to assess effects of tumor perfusion on these F-18-FDHT uptake metrics. Methods: Seventeen mCRPC patients were included in this prospective observational multicenter study. Test and retest 30-min dynamic F-18-FDHT PET/CT scans with venous blood sampling were performed in 14 patients. In addition, arterial blood sampling and dynamic O-15-H2O scans were obtained in a subset of 6 patients. Several simplified methods were assessed: Patlak plots; SUV normalized to body weight (SUVBW), lean body mass (SUVLBM), whole blood (SUVWB), parent plasma activity concentration (SUVPP), area under the parent plasma curve (SUVAUC,PP), and area under the whole-blood input curve (SUVAUC,WB); and SUVBW corrected for sex hormone-binding globulin levels (SUVSHBG). Results were correlated with parameters derived from full pharmacokinetic F-18-FDHT and O-15-H2O. Finally, the repeatability of individual quantitative uptake metrics was assessed. Results: Eighty-seven F-18-FDHT-avid lesions were evaluated. F-18-FDHT uptake was best described by an irreversible 2-tissue-compartment model. Replacing the continuous metabolite-corrected arterial plasma input function with an image-derived input function in combination with venous sample data provided similar K-i results (R-2 = 0.98). Patlak K-i and SUVAUC,PP showed an excellent correlation (R-2 > 0.9). SUVBW showed a moderate correlation to K-i (R-2 = 0.70, presumably due to fast F-18-FDHT metabolism. When calculating SUVSHBG, correlation to K-i improved (R-2 = 0.88). The repeatability of full kinetic modeling parameters was inferior to that of simplified methods (repeatability coefficients. 36% vs., 28%, respectively). F-18-FDHT uptake showed minimal blood flow dependency. Conclusion: F-18-FDHT kinetics in mCRPC patients are best described by an irreversible 2-tissue-compartment model with blood volume parameter. SUVAUC, PP showed a near-perfect correlation with the irreversible 2-tissue-compartment model analysis and can be used for accurate quantification of F-18-FDHT uptake in whole-body PET/CT scans. In addition, SUVSHBG could potentially be used as an even simpler method to quantify F-18-FDHT uptake when less complex scanning protocols and accuracy are required.