¹⁸F-PSMA PET/CT显像对前列腺癌骨转移探测价值初步研究

Objective: To compare the detection efficiency of ^99mTc-MDP SPECT and PSMA PET/CT in detecting bone metastases in patients with prostate cancer. Methods: We retrospectively collected data of 83 patients diagnosed with prostate cancer in The First Affiliated Hospital of Xi'an Jiaotong University from March 2019 to July 2020, concurrent with ^99mTc-MDP SPECT and ¹⁸F-PSMA PET/CT whole body imaging in the same period. Two nuclear medicine physicians attending a double-blind interpretation compared whether the patients with bone metastases detected by two imaging methods under different PSA levels and different Gleason scores, and further analyzed the location and number of inconsistent bone metastases as well as the ability of PET/CT to detect metastatic lesions other than bone. Results: Compared with ^99mTc-MDP SPECT, ¹⁸F-PSMA PET/CT could detect more prostate cancer patients with bone metastases (P<0.001). When TPSA<10 ng/mL or >20 ng/mL, the detection rate of PET/CT for bone metastasis was higher than that of whole body bone scan (P<0.05). When Gleason score>8, PET/CT was more effective in detecting bone metastasis. The detection rate was higher than that of whole body bone scan (P<0.05). The lesions with positive PET/CT but not diagnosed by bone scan were mainly located in the chest bone, spine bone, and pelvic bone; the lesions with positive bone scan but missed by PET/CT were also more common in chest bone, with low nuclide uptake. The average SUVmax was 2.62±0.47 (1.60-3.30), and adjacent to the liver, spleen or salivary glands with higher metabolism. There were 21/51 (41.18%) cases of lymph node metastasis found outside of bone, 5/51 (9.80%) cases of lung metastasis, and 1/51 (1.96%) cases of liver metastasis. Conclusion: ¹⁸F-PSMA PET/CT imaging is significantly superior to ^99mTc-MDP whole-body bone imaging in diagnosing bone metastasis of prostate cancer, and it can detect metastases other than bone.