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前列腺癌(prostate cancer,PCa)是男性泌尿生殖系统的常见恶性肿瘤,最新的统计数据显示,在北美男性新发癌症患者中,PCa的发病率已经跃居到第1位[1]。尽管PCa在我国男性癌症患者中的发病率仅居第6位,但是多数患者在首诊时已处于中晚期,失去了手术根治的机会。随着前列腺特异性抗原(prostate-specific antigen,PSA)筛查的积极开展以及人口老龄化的加剧,我国PCa的发病率呈逐步上升趋势[2]。早期诊断和正确评估疾病分期对临床治疗方案的选择和患者的远期预后具有重要的临床意义。
PSA筛查、MRI、CT、经直肠超声等均是检测和诊断PCa的重要手段。尽管有研究结果显示,单纯依靠PSA筛查会造成过度诊疗,影响患者整体生活质量,且缺少总体生存率的获益[3],但PSA筛查的确提高了PCa的检出率,尤其是对局限性、侵袭性较低的肿瘤类型。多参数磁共振成像(multiparametric magnetic resonance imaging,mpMRI)的T2加权像上致密的肿瘤组织的典型表现为低信号,在弥散加权成像上为高信号,表观弥散系数下降。CT作为针对组织密度不同进行成像的设备,在PCa的成像对比度及病灶的检出方面表现较差。对于淋巴结的评估,CT及MRI主要通过其长径和形态间接评估淋巴结侵犯及分期,在检测盆腔区域的阳性结节时灵敏度较低[4]。经直肠超声也常用于PCa的初步筛查,但其常与急慢性炎症的低回声区难以鉴别。PCa的最终确诊仍然取决于组织病理学检查结果,即经前列腺影像报告和数据系统第2.1版(PI-RADS v2.1)系统评估后,在超声或mpMRI引导下行穿刺活检术。
前列腺特异性膜抗原(prostate-specific membrane antigen,PSMA)作为一种新型的分子靶点,在超过90%的PCa的原发和转移性病灶中高度表达。随着PET的广泛应用,PSMA PET显像在临床上的应用越来越多,其对PCa的检出率可达到95%,并随着肿瘤分期和分级的提高以及PSA水平的升高而升高[5]。一体化 PSMA PET/MR新技术的应用,将PET高灵敏度的功能信息与MRI优良的软组织分辨率相结合,理论上具有优于PET/CT的潜在应用价值。本文就PSMA PET/MR在PCa诊断中的研究进展作一综述。
前列腺特异性膜抗原PET/MR 在前列腺癌诊断中的研究进展
Research progress of prostate-specific membrane antigen PET/MR in the diagnosis of prostate cancer
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摘要: 作为男性高发病率的恶性肿瘤,前列腺癌(PCa)的早期诊断和精准分期对临床治疗方案的选择和患者的远期预后具有重要的临床意义。基于分子靶点前列腺特异性膜抗原(PSMA)的新型PET分子探针在PCa的诊断中显示出较高的临床效能,其在临床上的开发和应用越来越广泛。一体化PET/MR将PET的高灵敏度功能信息与MRI的优良软组织分辨率相结合,其在临床中的初步应用已显示出重要的临床价值。PSMA PET/MR在PCa的诊断中具有潜在的优势,现就其研究进展作一综述。
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关键词:
- 前列腺肿瘤 /
- 前列腺特异性膜抗原 /
- 正电子发射断层显像术 /
- 磁共振成像 /
- 放射性示踪剂
Abstract: As a malignant tumor with high incidence in men, early diagnosis and accurate staging of prostate cancer (PCa) have important clinical significance in the selection of clinical treatment plans and long-term prognosis of patients. Novel PET molecular probes based on molecularly targeted prostate-specific membrane antigen (PSMA) have shown high clinical efficacy in the diagnosis of PCa, and their development and application in the clinical setting is becoming increasingly widespread. The initial clinical application of integrated PET/MR, which combines the highly sensitive functional information of PET with the excellent soft tissue resolution of MRI, has shown its important clinical value. PSMA PET/MR has potential advantages in the diagnosis of PCa, and its research progress is reviewed here. -
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