Prospective evaluation of 18F-NaF and 18F-FDG PET/CT in detection of occult metastatic disease in biochemical recurrence of prostate cancer.
Prospective evaluation of 18F-NaF and 18F-FDG PET/CT in detection of occult metastatic disease in biochemical recurrence of prostate cancer.
复制标题
DOI：
10.1097/rlu.0b013e318252d829
复制
发表时间：
2012-07
影响因子：
10.6
通讯作者：
Quinn DI
中科院分区：
文献类型：
--
作者：
Jadvar H;Desai B;Ji L;Conti PS;Dorff TB;Groshen SG;Gross ME;Pinski JK;Quinn DI
本研究旨在前瞻性评价18F-NaF和18F-FDG PET/CT在检测前列腺癌和生化复发男性中的隐匿性转移性疾病中的作用。37例前列腺特异性抗原（PSA）复发（中位数，3.2 ng/mL;范围，0.5-40.2 ng/mL）的男性患者接受了局限性前列腺癌的确定性治疗[26例根治性前列腺切除术（RP），11例外部放射治疗]，常规成像阴性，在同一周内的2天接受了18F-FDG和18F-NaF PET/CT。由2名经验丰富的放射科医生对研究进行解释，一致认为异常摄取疑似转移性疾病。参考标准是成像和临床随访的组合。使用针对主要治疗调整的方差分析，比较阳性和阴性PET/CT的PSA值等级。采用Wilcoxon秩和检验评价RP患者PSA和扫描阳性之间的相关性。2例患者的18F-FDG PET/CT扫描结果为淋巴结疾病阳性。18F-NaF PET/CT对隐匿性骨转移的真阳性检出率为16.2%。阳性与阴性PET/CT扫描的中位PSA水平分别为4.4和2.9 ng/mL，在前列腺切除术男性中差异轻微（P = 0.072）。RP和外照射放射治疗中18F-NaF或18F-FDG阳性PET/CT患者的PSA ≤ 2 ng/mL的比例分别为10%（n = 10）和未确定（n = 0），PSA大于2 ng/mL但≤ 4 ng/mL的比例分别为29%（n = 7）和50%（n = 2），PSA> 4 ng/mL但≤ 10 ng/mL的患者分别为60%（n = 5）和40%（n = 5），PSA> 10 ng/mL的患者分别为25%（n = 4）和25%（n = 4）。在前列腺癌的生化复发中，18F-NaF PET/CT可用于检测隐匿性骨转移，而18F-FDG PET/CT的产率相对有限。18F-NaF PET/CT阳性倾向于与前列腺切除术男性的PSA水平升高相关，并且可能发生在比传统认识更低的PSA范围内。
This study aimed to perform a prospective evaluation of 18F-NaF and 18F-FDG PET/CT in the detection of occult metastatic disease in men with prostate cancer and biochemical relapse. Thirty-seven men with prostate-specific antigen (PSA) relapse (median, 3.2 ng/mL; range, 0.5–40.2 ng/mL) after definitive therapy for localized prostate cancer [26 radical prostatectomy (RP), 11 external beam radiation therapy] and negative conventional imaging underwent 18F-FDG and 18F-NaF PET/CT on 2 separate days within the same week. Studies were interpreted by 2 experienced radiologists in consensus for abnormal uptake suspicious for metastatic disease. The reference standard was a combination of imaging and clinical follow-up. Rank of PSA values for positive and negative PET/CT was compared using analysis of variance adjusting for primary therapy. Association between PSA and scan positivity in patients with RP was evaluated using Wilcoxon rank sum test. Result of the 18F-FDG PET/CT scan was positive for nodal disease in 2 patients. True-positive detection rate for occult osseous metastases by 18F-NaF PET/CT was 16.2%. Median PSA levels for positive versus negative PET/CT scans were 4.4 and 2.9 ng/mL, respectively, with the difference marginally significant in prostatectomized men (P = 0.072). Percentages of patients with either 18F-NaF– or 18F-FDG–positive PET/CT in RP and external beam radiation therapy were 10% (n = 10) and undefined (n = 0) for a PSA of 2 ng/mL or less, 29% (n = 7) and 50% (n = 2) for PSA greater than 2 ng/mL but 4 ng/mL or less,60% (n = 5) and 40%(n = 5) for PSA greater than 4 ng/mL but 10 ng/mL or less, and 25% (n = 4) and 25% (n = 4) for PSA greater than 10 ng/mL, respectively. In biochemical relapse of prostate cancer, 18F-NaF PET/CT is useful in the detection of occult osseous metastases, whereas the yield of 18F-FDG PET/CT is relatively limited. 18F-NaF PET/CT positivity tends to associate with increasing PSA level in prostatectomized men and may occur in lower PSA ranges than conventionally recognized.