Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer
Prospective Comparison of 99mTc-MDP Scintigraphy, Combined 18F-NaF and 18F-FDG PET/CT, and Whole-Body MRI in Patients with Breast and Prostate Cancer
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DOI：
10.2967/jnumed.115.162610
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发表时间：
2015-12-01
影响因子：
9.3
通讯作者：
Iagaru, Andrei
中科院分区：
文献类型：
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作者：
Minamimoto, Ryogo;Loening, Andreas;Iagaru, Andrei
我们前瞻性地评估了F-18-NaF/（18）FFDG PET/CT在乳腺癌和前列腺癌患者中的联合应用，并将结果与Tc-99 m-MDP骨显像和全身MRI的结果进行了比较。研究方法：本研究前瞻性入组了30例转诊接受标准治疗骨密度成像的患者（15例女性乳腺癌患者和15例男性前列腺癌患者）。骨显像后行F-18-NaF/F-18-FDG PET/CT和全身MRI检查。全身MRI方案包括非增强和对比增强序列。将每次测试检测到的病变制成表格，并对结果进行比较。结果如下：对于外层病灶，F-18-NaF/F-18-FDG PET/CT和全身MRI在敏感性（92.9% vs. 92.9%，P = 1.00）、阳性预测值（81.3% vs. 86.7%，P = 0.68）或准确性（76.5% vs. 82.4%，P = 0.56）方面无统计学显著差异。然而，F-18-NaF/F-18-FDG PET/CT的敏感性和准确性明显高于全身MRI骨显像对骨骼病变的检出率分别为96.2% vs. 81.4%，89.8% vs. 74.7%，P = 0.001;骨显像对骨骼病变的检出率分别为96.2% vs. 64.6%，P < 0.001，89.8% vs. 65.9%，P < 0.001。总体而言，F-18-NaF/F-18-FDG PET/CT显示出比全身MRI更高的灵敏度和准确性（95.7% vs. 83.3%，P < 0.002，87.6% vs. 76.0%，P < 0.02），但与全身MRI和骨显像联合检查相比，无统计学显著性差异（95.7%与91.6%，P 50.17，87.6%与83.0%，P = 0.53）。F-18-NaF/F-18-FDG PET/CT显示与F-18-NaF/F-18-FDG PET/CT和全身MRI的组合无显著差异。3项检查的阳性预测值无统计学显著差异。结论：F-18-NaF/F-18-FDG PET/CT在评估骨骼疾病程度方面上级全身MRI和Tc-99 m-MDP闪烁扫描。此外，F-18-NaF/F-18-FDG PET/CT和全身MRI检测到可能改变这些患者治疗的外骨骼疾病。在乳腺癌和前列腺癌患者中，F-18-NaF/F-18-FDG PET/CT提供的诊断能力与全身MRI和骨显像相结合的诊断能力相似。需要更大的队列来证实这些初步发现，理想情况下使用新引入的同步PET/MRI扫描仪。
We prospectively evaluated the use of combined F-18-NaF/(18)FFDG PET/CT in patients with breast and prostate cancer and compared the results with those for Tc-99m-MDP bone scintigraphy and whole-body MRI. Methods: Thirty patients (15 women with breast cancer and 15 men with prostate cancer) referred for standard-of-care bone scintigraphy were prospectively enrolled in this study. F-18-NaF/F-18-FDG PET/CT and whole-body MRI were performed after bone scintigraphy. The whole-body MRI protocol consisted of both unenhanced and contrast-enhanced sequences. Lesions detected with each test were tabulated, and the results were compared. Results: For extraskeletal lesions, F-18-NaF/F-18-FDG PET/CT and whole-body MRI had no statistically significant differences in sensitivity (92.9% vs. 92.9%, P = 1.00), positive predictive value (81.3% vs. 86.7%, P = 0.68), or accuracy (76.5% vs. 82.4%, P = 0.56). However, F-18-NaF/F-18-FDG PET/CT showed significantly higher sensitivity and accuracy than whole-body MRI (96.2% vs. 81.4%, P < 0.001, 89.8% vs. 74.7%, P = 0.01) and bone scintigraphy (96.2% vs. 64.6%, P < 0.001, 89.8% vs. 65.9%, P < 0.001) for the detection of skeletal lesions. Overall, F-18-NaF/F-18-FDG PET/CT showed higher sensitivity and accuracy than whole-body MRI (95.7% vs. 83.3%, P < 0.002, 87.6% vs. 76.0%, P < 0.02) but not statistically significantly so when compared with a combination of whole-body MRI and bone scintigraphy (95.7% vs. 91.6%, P 5 0.17, 87.6% vs. 83.0%, P = 0.53). F-18-NaF/F-18-FDG PET/CT showed no significant difference from a combination of F-18-NaF/F-18-FDG PET/CT and whole-body MRI. No statistically significant differences in positive predictive value were noted among the 3 examinations. Conclusion: F-18-NaF/F-18-FDG PET/CT is superior to whole-body MRI and Tc-99m-MDP scintigraphy for evaluation of skeletal disease extent. Further, F-18-NaF/F-18-FDG PET/CT and whole-body MRI detected extraskeletal disease that may change the management of these patients. F-18-NaF/F-18-FDG PET/CT provides diagnostic ability similar to that of a combination of whole-body MRI and bone scintigraphy in patients with breast and prostate cancer. Larger cohorts are needed to confirm these preliminary findings, ideally using the newly introduced simultaneous PET/MRI scanners.