摘要
目的探讨^(18)F-前列腺特异性膜抗原(PSMA)PET/CTPRIMARY评分联合多参数磁共振(mpMRI)前列腺影像报告和数据系统(PI-RADS)评分对有临床意义前列腺癌(CsPCa)的诊断价值。方法回顾性分析2019年1月至2023年12月北京医院收治的63例行根治性前列腺切除术的前列腺癌患者的病例资料。中位年龄70(64,75)岁,前列腺特异性抗原(PSA)8.46(5.40,14.80)ng ml。所有患者术前均行^(18)F-PSMAPET/CT和mpMRI检查,术后前列腺标本制作病理大切片。2名影像科医生和1名病理科医生分别对前列腺病灶进行诊断和定位。根据病理大切片结果,Gleason评分≥3+4分诊断为CsPCa,Gleason评分=6分或阴性为非CsPCa。PSMAPET/CT图像采用PRIMARY评分(5分法):1分为无以下对应的模式,2分为移行带或中央带非局灶性高摄取,3分为移行带局灶性高摄取,4分为外周带局灶性高摄取,5分为SUV_(max)≥12.0。以前列腺病灶SUV_(max)/邻近SUV_(max)比值(LBR)半定量评价其对显像剂摄取的程度。mpMRI图像采用PI-RADS Version2.1进行评分。以患者作为研究对象比较CsPCa组和非CsPCa组的年龄、PSA、病灶数量的差异;以病灶作为研究对象比较CsPCa组和非CsPCa组的PRIMARY评分、LBR、PI-RADS评分、病灶分布构成的差异。采用多因素logistic回归分析CsPCa的独立预测因素。采用受试者工作特征(ROC)曲线确定各独立预测因素的最佳诊断阈值,分别构建PRIMARY评分、PI-RADS评分、二者联合应用的预测模型,比较各模型对CsPCa的诊断效能。结果本研究63例,CsPCa组54例(85.7%),非CsPCa组9例(14.3%),PSA分别为9.64(6.1,15.3)ng/ml和5.6(4.6,7.6)ng/ml,差异有统计学意义(P<0.05),年龄[71(64,75)岁与65(63,69)岁]、病灶数量[2(1,2)个与2(1,3)个]差异均无统计学意义(P>0.05)。CsPCa组81个病灶,Cleason评分3+4分49个、4+3分16个、8分14个、9~10分2个。非CsPCa组28个病灶,良性前列腺病变14个,Gleason评分3+3分14个。CsPCa组和非CsPCa组的PRIMARY�
Objective To explore the diagnostic value of ^(18)F-prostate specific membrane antigen(PSMA)PET/CT PRIMAY score combined with multiparameter MRI(mpMRI)PI-RADS score for clinically significant prostate cancer(CsPCa).Methods The data of 63 patients with prostate cancer who underwent radical prostatectomy at Beijing Hospital from January 2019 to December 2023 were retrospectively analyzed.The median age was 70(64,75)years old with prostate-specific antigen(PSA)level of 8.46(5.40,14.80)ng/ml.All patients underwent ^(18)F-PSMA PET/CT and mpMRI examination before surgery,and pathological large sections of prostate specimens were made after surgery.The prostate lesions were diagnosed and located by two radiologists and one pathologist respectively.Lesions with Gleason scores(GS)≥3+4 from the surgical pathology were diagnosed with CsPCa,and lesions with negative or CS=6 were diagnosed with non-CsPCa.The PSMA PET/CT images were evaluated using the PRIMARY study criteria(5-level PRIMARY score):no pattern(score of 1),diffuse transition zone or central zone(not focal)(score of 2),focal transition zone(score of 3),focal peripheral zone(score of 4),or an SUVmax of at least 12(score of 5).The degree of uptake of imaging agent in prostate lesions was semi-quantitatively evaluated using lesion-to-background ratios(LBR)of SUV_(max)-MpMRI was evaluated according to the Prostate Imaging Reporting and Data System(PI-RADS)version 2.1.The patients were divided into CsPCa group and non-CsPCa group based on patients and lesions.Mann-Whitney U test and chi-square test were used to compare the differences between groups.Multivariate logistic regression analysis was performed to determine the independent predictive factors of CsPCa.Receiver operator characteristic(ROC)curve was used to determine the optimal diagnostic threshold for each independent predictor.Predictive models were constructed for PRIMARY score,PI-RADS score,and their combined application,and the diagnostic performance of each model for CsPCa was compared.Results Of all 63
作者
朱辉
徐文睿
郭悦
刘龙腾
王森
侯惠民
李春媚
张伟
刘甫庚
刘明
Zhu Hui;Xu Wenrui;Guo Yue;Liu Longteng;Wang Miao;Hou Huimin;Li Chunmei;Zhang Wei;Liu Fugeng;Liu Ming(Department of Nuclear Medicine,Bejing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Bejing 100730,China;Department of Radiology,Bejing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Bejing 100730,China;Department of Pathology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Bejing 100730,China;Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,Chin)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2024年第6期439-444,共6页
Chinese Journal of Urology
基金
中央高水平医院临床科研业务费((2023-BJ-198)。
