Evaluating extraprostatic extension of prostate cancer: pragmatic integration of MRI and PSMA-PET/CT.

IF 2.3 3区医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

Abdominal Radiology Pub Date : 2025-04-19 DOI:10.1007/s00261-025-04948-2

Sungmin Woo, Daniel Freedman, Anton S Becker, Doris Leithner, Charlotte Charbel, Marius E Mayerhoefer, Kent P Friedman, Angela Tong, David R Wise, Samir S Taneja, Michael J Zelefsky, Hebert Alberto Vargas

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引用次数: 0

Abstract

Purpose: To explore pragmatic approaches integrating MRI and PSMA-PET/CT for evaluating extraprostatic extension (EPE) of prostate cancer (PCa).

Methods: Consecutive patients with newly-diagnosed PCa that underwent multiparametric MRI and PSMA-PET/CT, followed by radical prostatectomy in 2021-2024 were included. Imaging parameters assessed on both modalities were: size, length of capsular contact (LCC), Likert scales (MRI EPE grade/PSMA Likert scale), PI-RADS/PRIMARY scores, and SUV_max. Three pragmatic integrated approaches were tested: (1) Integration of Likert scales (positive if either or both MRI and PSMA-PET/CT were positive); (2) P score (framework combining PI-RADS + PRIMARY); and (3) combining MRI morphological information with PSMA-PET/CT functional information (upgrading suspicion of lesions with LCC below cutoff if SUV_max>12). Diagnostic performance was tested with receiver operating characteristic (ROC) curves and compared using DeLong and McNemar tests.

Results: 67 men (median age, 66 years) with EPE in 76.1% (51/67) were included. Area under ROC curves (AUC) were 0.61-0.82; MRI-based LCC yielded the highest AUC 0.82 (0.71-0.92) with cutoff of ≥ 1.7 cm. Integrated Likert scale (MRI EPE grade/PSMA Likert scale) showed sensitivity of 80.4% (41/51) and specificity of 31.3% (5/16). P score (PI-RADS/PRIMARY) demonstrated sensitivity of 31.3% (16/51) and specificity of 87.5% (14/16). Combining morphological MRI information with functional PSMA-PET/CT yielded sensitivity and specificity of 80.4% (41/51) and 81.2% (13/16), respectively, which demonstrated significantly higher sensitivity but non-significantly different specificity compared with MRI-based LCC alone (66.7% [34/51, p = 0.02] and 87.5% [14/16, p > 0.99]). This approach upgraded suspicion in 8 patients with LCC < 1.7 cm due to SUV_max>12 among which 87.5% (7/8) were corrected upgraded and had pathological EPE.

Conclusion: Several pragmatic approaches were explored for integrating MRI and PSMA-PET/CT to assess EPE in PCa. Combining morphological information from MRI and PSMA expression on PET/CT demonstrated good diagnostic performance and may be a simple pragmatic integrated method that can be used.

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评估前列腺癌的前列腺外延伸：MRI和PSMA-PET/CT的实用整合。

目的：探讨MRI与PSMA-PET/CT结合评价前列腺癌前列腺外展（EPE）的实用方法。方法：纳入2021-2024年间连续接受多参数MRI和PSMA-PET/CT检查并行根治性前列腺切除术的新诊断前列腺癌患者。两种方式评估的成像参数为：大小、囊膜接触长度（LCC）、李克特量表（MRI EPE分级/PSMA李克特量表）、PI-RADS/PRIMARY评分和SUVmax。测试了三种实用的综合方法：(1)李克特量表的整合（如果MRI和PSMA-PET/CT中的一个或两个都是阳性，则为阳性）；(2) P评分（PI-RADS + PRIMARY结合框架）；(3)将MRI形态学信息与PSMA-PET/CT功能信息相结合（SUVmax>12时提高对LCC低于截断值的怀疑）。采用受试者工作特征（ROC）曲线检验诊断效果，并采用DeLong和McNemar检验进行比较。结果：纳入67例EPE患者，中位年龄66岁，占76.1%（51/67）。ROC曲线下面积（AUC）为0.61 ~ 0.82；基于mri的LCC的AUC最高，为0.82(0.71 ~ 0.92)，截止值≥1.7 cm。综合李克特评分（MRI EPE分级/PSMA李克特评分）的敏感性为80.4%(41/51)，特异性为31.3%（5/16）。P评分（PI-RADS/PRIMARY）的敏感性为31.3%(16/51)，特异性为87.5%（14/16）。形态学MRI信息与功能性PSMA-PET/CT信息相结合的敏感性和特异性分别为80.4%（41/51）和81.2%(13/16)，与单纯基于MRI的LCC （66.7% [34/51, p = 0.02]和87.5% [14/16,p > 0.99]）相比，敏感性显著提高，特异性无显著差异。该方法对8例LCC患者进行了升级怀疑，其中87.5%（7/8）的患者被纠正升级，并有病理性EPE。结论：探索了几种实用的方法来结合MRI和PSMA-PET/CT来评估前列腺癌的EPE。MRI形态学信息与PET/CT PSMA表达相结合具有较好的诊断效果，可能是一种简单实用的综合方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Abdominal Radiology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

5.20

自引率

8.30%

发文量

334

期刊介绍： Abdominal Radiology seeks to meet the professional needs of the abdominal radiologist by publishing clinically pertinent original, review and practice related articles on the gastrointestinal and genitourinary tracts and abdominal interventional and radiologic procedures. Case reports are generally not accepted unless they are the first report of a new disease or condition, or part of a special solicited section. Reasons to Publish Your Article in Abdominal Radiology: · Official journal of the Society of Abdominal Radiology (SAR) · Published in Cooperation with: European Society of Gastrointestinal and Abdominal Radiology (ESGAR) European Society of Urogenital Radiology (ESUR) Asian Society of Abdominal Radiology (ASAR) · Efficient handling and Expeditious review · Author feedback is provided in a mentoring style · Global readership · Readers can earn CME credits