Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis
Combination of 68Ga-PSMA PET/CT and Multiparametric MRI Improves the Detection of Clinically Significant Prostate Cancer: A Lesion-by-Lesion Analysis
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Ga-68-PSMA PET/CT 和多参数 MRI 相结合可提高临床显着性前列腺癌的检测：逐个病灶分析
DOI：
10.2967/jnumed.118.221010
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发表时间：
2019-07-01
影响因子：
9.3
通讯作者：
Guo, Hongqian
中科院分区：
文献类型：
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作者：
Chen, Mengxia;Zhang, Qing;Guo, Hongqian
我们的目的是探讨Ga-68-PSMA PET/CT单独（PET/CT）或与多参数MRI （PET/MRI）联合使用是否可以提高临床显著性前列腺癌（PCa）的检出率。方法：我们回顾性地收集了54例在根治性前列腺切除术前接受MRI和PET/CT检查的患者。在MR图像、PET/CT图像和病理图像上标记感兴趣的区域。病变被定义为用三种模式中的任何一种获得的图像上标记的感兴趣区域。采用前列腺影像学报告和数据系统（PI-RADS）、分子影像学PSMA表达评分和病理结果对所有病变进行特征分析。采用接收机-工作特性分析对诊断性能进行分析。采用净重分类指数（NRI）分析不同PI-RADS评分病变的具体改善情况。结果：共分析54例患者的90个病变，其中66个病变具有临床显著性PCa。受试者操作特征分析显示，PET/MRI在检测临床显著性PCa方面优于MRI（曲线下面积变化0.06；95%可信区间0.01 ~ 0.12;P < 0.05）。根据计算的截止点，PET/MRI的表现明显优于MRI (NRI, 21.9%, P < 0.01)，在不牺牲特异性（96%对88%，P < 0.05）的情况下，敏感性（89%对76%，P < 0.01）得到改善。PI-RADS 3级病变对临床显著性PCa的诊断有所改善（NRI, 66.7%; P < 0.01）。结论：PET/MRI提高了PI-RADS 3病变中有临床意义PCa的检出率。
Our purpose was to explore whether Ga-68-PSMA PET/CT alone (PET/CT) or in combination with multiparametric MRI (PET/MRI) can improve the detection of clinically significant prostate cancer (PCa). Methods: We retrospectively enrolled 54 patients who underwent both MRI and PET/CT before radical prostatectomy. Regions of interest on MR images, PET/CT images, and pathologic images were marked. A lesion was defined as a region of interest marked on images obtained with any of the 3 modalities. All lesions were characterized using the prostate imaging reporting and data system (PI-RADS), the molecular imaging PSMA expression score, and the pathologic results and analyzed. Diagnostic performance was analyzed by receiver-operating-characteristic analysis. Specific improvement for lesions with different PI-RADS scores was analyzed using the net reclassification index (NRI). Results: In total, 90 lesions from 54 patients were analyzed, among which 66 lesions represented clinically significant PCa. Receiver-operating-characteristic analysis showed PET/MRI to perform better than MRI in detecting clinically significant PCa (change in area under the curve, 0.06; 95% confidence interval, 0.01-0.12; P < 0.05). With the calculated cutoff, PET/MRI performed significantly better than MRI (NRI, 21.9%; P < 0.01), with an improvement in sensitivity (89% vs. 76%, P < 0.01) at no sacrifice of specificity (96% vs. 88%, P > 0.05). Improvement in diagnosing clinically significant PCa occurred for lesions classified as PI-RADS 3 (NRI, 66.7%; P < 0.01). Conclusion: PET/MRI improves the detection of clinically significant PCa for PI-RADS 3 lesions.