99Tcm-PSMA137 SPECT/CT 显像在前列腺癌诊断中的应用

Application of 99Tcm-PSMA137 SPECT/CT imaging in the diagnosis of prostate cancer

    摘要
  • 摘要:
    目的  探讨99Tcm-前列腺特异性膜抗原（PSMA）137 SPECT/CT 显像在前列腺癌诊断中的应用。
    方法  收集2022年9月至2024年4月于西安交通大学第一附属医院行99Tcm-PSMA137 SPECT/CT显像和MRI成像的82例确诊为前列腺癌的患者的临床资料、影像资料及组织病理学检查结果并进行回顾性队列分析。患者中位年龄69岁，范围 52~84岁。显像结果采用人工智能辅助定量分析，测量病灶最大径，计算病灶的最大标准摄取值（SUVmax）。根据《前列腺癌规范化标本取材及病理诊断共识（2021版）》进行Gleason评分。采用Pearson相关性分析评估SUVmax与年龄、血清前列腺特异性抗原（PSA）水平、组织病理学检查结果的相关性；采用Kruskal-Wallis检验比较不同Gleason评分患者SUVmax的组间差异，采用Dunn检验对不同Gleason评分患者的SUVmax进行两两比较。采用卡方检验比较不同影像检查方法对原发灶的检出率。
    结果 82 例前列腺癌患者中，80例（97.6%）为前列腺腺癌，2 例（2.4%）为前列腺癌伴导管腺癌。99Tcm-PSMA137 SPECT/CT 显像检出76 例患者的原发灶（92.7%, 76/82），骨组织异常摄取12例（14.6%, 12/82），淋巴结异常摄取2 例（2.4%, 2/82），肾上腺异常摄取1例（1.2%, 1/82），精囊腺异常摄取1例（1.2%, 1/82），盆腔软组织异常摄取1例（1.2%, 1/82）。病灶的SUVmax与血清PSA水平存在显著的正相关（r=0.727，P<0.001），但病灶的SUVmax与年龄、病灶最大径之间的无明显相关性（r=−0.122、0.008，P=0.294、0.950）。Gleason评分为6~10分患者的SUVmax分别为4.039±0.153、4.435±0.275、6.024±1.199、14.401±2.011、6.690±2.550。不同Gleason评分患者的SUVmax的差异有统计学意义（H=10.140，P=0.038），Gleason评分为6分与9分、7分与9分患者SUVmax的差异均有统计学意义（Z=−2.881、−2.926，P=0.037、0.035）。99Tcm-PSMA137 SPECT/CT显像对前列腺癌原发灶的检出率优于MRI（92.7%, 76/82）对（81.8%, 54/66），χ2=4.041，P=0.044。
    结论  99Tcm-PSMA137 SPECT/CT显像在前列腺癌的诊断中具有重要的应用价值。

     

    Abstract:
    Objective To explore the application of 99Tcm-prostate specific membrane antigen (PSMA)137 SPECT/CT imaging in the diagnosis of prostate cancer.
    Methods A retrospective cohort analysis was conducted on the clinical data, imaging data, and histopathological findings of 82 patients diagnosed with prostate cancer who underwent 99Tcm-PSMA137 SPECT/CT imaging and MRI at the First Affiliated Hospital of Xi'an Jiaotong University from September 2022 to April 2024. The patients had a median age of 69 years, and an age range of 52–84 years. The imaging results were analyzed quantitatively with the assistance of artificial intelligence, measured the maximum diameter of the lesion and the maximum standardized uptake value (SUVmax) of lesions was calculated. Gleason scoring was performed in accordance with the Consensus on specimen handling and pathological diagnosis of prostatic carcinoma (2021 version). Pearson correlation analysis was employed to evaluate the correlations of SUVmax with age, serum prostate-specific antigen (PSA) levels, and histopathological results. The Kruskal-Wallis test was applied to compare differences in SUVmax among patients with different Gleason scores, and the Dunn test was used for pairwise comparisons. The chi-square test was used to compare the detection rates of primary lesions among different imaging examination methods.
    Results Among 82 prostate cancer patients, 80 (97.6%) had prostate adenocarcinoma and 2 (2.4%) had prostate cancer with ductal adenocarcinoma. 99Tcm-PSMA137 SPECT/CT imaging detected primary lesions in 76 patients (92.7%, 76/82), with abnormal uptake observed in bone tissue in 12 patients (14.6%, 12/82), lymph nodes in 2 patients (2.4%, 2/82), the adrenal gland in 1 patient (1.2%, 1/82), the seminal vesicle in 1 patient (1.2%, 1/82), and pelvic soft tissue in 1 patient (1.2%, 1/82). Lesion SUVmax showed a significant positive correlation with serum PSA level (r=0.727, P<0.001), but no significant correlations were observed with patient age or lesion maximum diameter (r=−0.122, 0.008; P=0.294, 0.950). The SUVmax for Gleason scores of 6 to 10 were 4.039±0.153, 4.435±0.275, 6.024±1.199, 14.401±2.011, and 6.690±2.550, respectively. A statistically significant difference in SUVmax was found among patients with different Gleason scores (H=10.140, P=0.038). Specifically, statistically significant differences in SUVmax were observed between patients with Gleason scores of 6 and 9, as well as between those with Gleason scores of 7 and 9 (Z=−2.881, −2.926; P=0.037, 0.035). The detection rate of primary lesions in prostate cancer using 99Tcm-PSMA137 SPECT/CT imaging was superior to that of MRI ((92.7%, 76/82) vs. (81.8%, 54/66)) (χ2=4.041, P=0.044).
    Conclusion 99Tcm-PSMA137 SPECT/CT imaging has important application value in the diagnosis of prostate cancer.

     

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