基于SUVmax判读疑诊前列腺癌患者18F-PSMA-1007 PET/MRI图像局限性的研究

Limitations of SUVmax-based interpretation of 18F-PSMA-1007 PET/MRI in patients with suspected prostate cancer

    摘要
  • 摘要:
    目的 评估18F-前列腺特异性膜抗原（PSMA）-1007 PET/MRI在疑诊前列腺癌（PCa）患者中的诊断效能，探索其在PCa诊断中的价值。
    方法 采用回顾性队列研究分析2022年3月至12月于浙江大学医学院附属第一医院行18F-PSMA-1007 PET/MRI检查及穿刺活检的113例疑诊PCa患者的临床资料和影像资料，患者年龄（65.4±7.7）岁。分别获得患者的临床指标、双参数磁共振成像（bpMRI）（以下简称MRI）影像指标、PSMA PET影像指标、联合影像指标及综合指标，并比较各指标诊断PCa的效能。采用受试者工作特征曲线的曲线下面积（AUC）分析各指标诊断PCa的诊断效能；采用二元Logistic回归模型的概率预测法分别将年龄、血清总前列腺特异性抗原（tPSA）水平和前列腺特异性抗原密度（PSAD）归类为临床指标，最小表观扩散系数（ADCmin）、平均表观扩散系数（ADCavg）、最大表观扩散系数（ADCmax）和前列腺影像报告和数据系统（PI-RADS）评分归类为MRI影像指标，最大标准摄取值（SUVmax）和分子显像前列腺特异性膜抗原（miPSMA）评分归类为PET影像指标，MRI影像指标和PET影像指标再归类为联合影像指标，临床指标、MRI影像指标和PET影像指标再归类为综合指标。采用DeLong检验对各指标的诊断效能进行两两比较。
    结果 113例疑诊PCa患者中，55例（48.7%）经穿刺活检确诊为PCa，58例（51.3%）经穿刺活检及随访确诊为前列腺良性病变。MRI影像指标对PCa的诊断效能（AUC=0.943）高于PET影像指标（AUC=0.742），且差异有统计学意义（Z=4.009，P<0.001）。MRI影像指标中，PI-RADS评分对PCa的诊断效能最高（AUC=0.911）。PET影像指标中，SUVmax对PCa的诊断效能（AUC=0.822）高于miPSMA评分（AUC=0.780），且差异有统计学意义（Z=1.972，P=0.049）。联合影像指标的诊断效能（AUC=0.946）高于PET影像指标（AUC=0.742），且差异有统计学意义（Z=4.192，P<0.001）。综合指标对PCa的诊断效能（AUC=0.948）高于联合影像指标（AUC=0.946），但差异无统计学意义（Z=0.477，P=0.633）。
    结论 在疑诊PCa患者18F-PSMA-1007 PET/MRI图像的判读中，单纯依靠PET显像SUVmax的诊断价值有限，联合影像指标能明显提高PCa的诊断效能。

     

    Abstract:
    Objective To evaluate the diagnostic efficacy of 18F-prostate specific membrane antigen (PSMA)-1007 PET/MRI in patients with suspected prostate cancer (PCa) and explore its value in the diagnosis of PCa.
    Methods A retrospective cohort analysis was conducted on clinical data and imaging data of 113 suspected PCa patients who underwent 18F-PSMA-1007 PET/MRI and puncture biopsy at the First Affiliated Hospital, Zhejiang University School of Medicine between March and December 2022. The patients' mean age was (65.4±7.7) years. Clinical indicators, biparametric magnetic resonance imaging (bpMRI) (hereafter referred to as MRI) imaging indicators, PSMA PET imaging indicators, combined imaging indicators, and comprehensive indicators of patients were obtained. Their diagnostic efficacies for PCa were compared and analyzed using area under the curve (AUC) of receiver operating characteristic curve. Binary Logistic regression model-based probability prediction was employed to classify age, serum total prostate specific antigen (tPSA), and prostate specific antigen density (PSAD) as clinical indicators; minimum apparent diffusion coefficient (ADCmin), mean apparent diffusion coefficient (ADCavg), maximum apparent diffusion coefficient (ADCmax), and prostate imaging reporting and data system (PI-RADS) score as MRI imaging indicators; and maximum standardized uptake value (SUVmax) and molecular imaging PSMA (miPSMA) score as PET imaging indicators. MRI and PET imaging indicators were further integrated into combined imaging indicators, whereas clinical, MRI, and PET indicators were integrated into comprehensive indicators. The DeLong test was used to compare pairwise differences between indicators.
    Results Among the 113 suspected PCa patients, 55(48.7%) were diagnosed with PCa by puncture biopsy, and 58(51.3%) were confirmed to have benign prostatic lesions through puncture biopsy and follow-up. The diagnostic efficacy of MRI indicators for PCa (AUC=0.943) was higher than that of PET imaging indicators (AUC=0.742) , with a statistically significant difference (Z=4.009, P<0.001), with the PI-RADS score being the most effective among MRI imaging indicators (AUC=0.911). Among PET imaging indicators, SUVmax had a higher diagnostic efficacy (AUC=0.822) than the miPSMA score (AUC=0.780), with a statistically significant difference (Z=1.972, P=0.049). The combined imaging indicators demonstrated higher diagnostic efficacy (AUC=0.946) than PET imaging indicators alone (AUC=0.742), with a statistically significant difference (Z=4.192, P<0.001). The comprehensive indicators showed higher diagnostic efficacy (AUC=0.948) than the combined imaging indicators (AUC=0.946), but the difference was not statistically significant (Z=0.477, P=0.633).
    Conclusions In the interpretation of PSMA PET/MRI images for patients suspected of PCa, relying solely on the SUVmax from PET has limited diagnostic value. Combined imaging indicators can significantly improve the diagnostic efficacy of PCa.

     

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