[68Ga]Ga-PSMA-11 PET/CT and [18F]Fluorocholine PET/CT in Assessment and Clinical Decision Making of Recurrent Prostate Cancer: A Prospective Crossover Trial.

IF 2.5 4区 医学 Q2 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
Mohsen Beheshti, Malihe Shahbazi-Akbari, Marcus Hacker, Wolfgang Loidl, Werner Langsteger
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引用次数: 0

Abstract

Purpose: There are few prospective studies addressed toward the role of 68Gallium-labelled prostate-specific membrane antigen-11 ([68Ga]Ga-PSMA-11) compared to [18F]Fluorocholine ([18F]FCH) PET/CT in clinical decision-making as prostate-specific PET-tracers. This study aims to evaluate the impact of PET/CT using [68Ga]Ga-PSMA-11 and [18F]FCH in clinical management of recurrent prostate cancer (PCa) and correlates imaging findings with clinical characteristics of PCa.

Procedures: Forty-six patients with PCa (mean age 68.3 ± 6.3 years) with biochemical recurrence were enrolled in this prospective crossover trial. All patients underwent both [68Ga]Ga-PSMA-11 and [18F]FCH PET/CT within a maximum interval of 12 days (median 7d). A standard randomization tool randomized the sequence of PET/CT imaging. Clinical decision-making occurred in an interdisciplinary meeting considering PET/CT findings. PET/CT-blinded readings were performed 3 months after imaging followed by a consensus meeting for final interpretation of detected lesions.

Results: Both imaging modalities detected 136 total malignant lesions. [68Ga]Ga-PSMA-11 and [18F]FCH PET/CT detected 125 and 60 lesions with a sensitivity of 96% and 48%, respectively. Tumor-to-background ratios and semi-quantitative PET parameters on [68Ga]Ga-PSMA-11 were significantly higher in 54 (41.2%) tracer-avid congruent lesions detected on both imaging modalities. [68Ga]Ga-PSMA-11 PET/CT exclusively detected 71 (52.2%) lesions, while 6 (4.4%) lesions were solely seen on [18F]FCH PET/CT. [68Ga]Ga-PSMA-11 and [18F]FCH PET/CT were positive in 35/46 (76%) and 26/46 (57%) patients, respectively. PET/CT imaging led to a major treatment change in 4 (8.7%) patients, of which [18F]FCH PET/CT had superior impact in one patient.

Conclusions: [68Ga]Ga-PSMA-11 PET/CT revealed superior diagnostic performance to [18F]FCH PET/CT in patients with recurrent PCa, specifically with very low PSA levels ≤ 1 ng/ml. Moreover, it led to more accurate staging and clinical management of the disease. [18F]FCH PET/CT may play a complementary role in rare, select high-risk cases with negative [68Ga]Ga-PSMA-11 PET/CT and ongoing ADT.

[68Ga]Ga-PSMA-11 PET/CT与[18F]氟胆碱PET/CT评估前列腺癌复发及临床决策:一项前瞻性交叉试验。
目的:目前关于68镓标记前列腺特异性膜抗原-11 ([68Ga]Ga-PSMA-11)与[18F]氟胆碱([18F]FCH) PET/CT作为前列腺特异性PET示踪剂在临床决策中的作用的前瞻性研究较少。本研究旨在评估使用[68Ga]Ga-PSMA-11和[18F]FCH的PET/CT在复发性前列腺癌(PCa)的临床治疗中的作用,并将影像学表现与PCa的临床特征联系起来。程序:46例生化复发的PCa患者(平均年龄68.3±6.3岁)入组这项前瞻性交叉试验。所有患者均在最长间隔12天(中位间隔7天)内接受了[68Ga]Ga-PSMA-11和[18F]FCH PET/CT检查。标准随机化工具随机化PET/CT成像顺序。临床决策发生在考虑PET/CT结果的跨学科会议上。成像后3个月进行PET/ ct盲法读数,随后召开共识会议,对检测到的病变进行最终解释。结果:两种成像方式共检出136个恶性病灶。[68Ga]Ga-PSMA-11和[18F]FCH PET/CT分别检出125个和60个病变,灵敏度分别为96%和48%。[68Ga]Ga-PSMA-11的肿瘤与背景比和半定量PET参数在两种成像方式下检测到的54个(41.2%)示踪剂一致病变中均显著高于[68Ga]Ga-PSMA-11。[68Ga]Ga-PSMA-11 PET/CT仅检出71个(52.2%)病灶,而[18F]FCH PET/CT仅检出6个(4.4%)病灶。[68Ga]Ga-PSMA-11和[18F]FCH PET/CT阳性分别为35/46(76%)和26/46(57%)。PET/CT成像导致4例(8.7%)患者的治疗发生重大改变,其中[18F]FCH PET/CT对1例患者的影响更大。结论:[68Ga]Ga-PSMA-11 PET/CT对复发性PCa患者的诊断优于[18F]FCH PET/CT,特别是PSA水平极低≤1 ng/ml的患者。此外,它还导致了更准确的疾病分期和临床管理。[18F]FCH PET/CT可能在罕见的、选择性高风险的[68Ga]Ga-PSMA-11 PET/CT阴性且持续ADT的病例中发挥补充作用。
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来源期刊
CiteScore
6.90
自引率
3.20%
发文量
95
审稿时长
3 months
期刊介绍: Molecular Imaging and Biology (MIB) invites original contributions (research articles, review articles, commentaries, etc.) on the utilization of molecular imaging (i.e., nuclear imaging, optical imaging, autoradiography and pathology, MRI, MPI, ultrasound imaging, radiomics/genomics etc.) to investigate questions related to biology and health. The objective of MIB is to provide a forum to the discovery of molecular mechanisms of disease through the use of imaging techniques. We aim to investigate the biological nature of disease in patients and establish new molecular imaging diagnostic and therapy procedures. Some areas that are covered are: Preclinical and clinical imaging of macromolecular targets (e.g., genes, receptors, enzymes) involved in significant biological processes. The design, characterization, and study of new molecular imaging probes and contrast agents for the functional interrogation of macromolecular targets. Development and evaluation of imaging systems including instrumentation, image reconstruction algorithms, image analysis, and display. Development of molecular assay approaches leading to quantification of the biological information obtained in molecular imaging. Study of in vivo animal models of disease for the development of new molecular diagnostics and therapeutics. Extension of in vitro and in vivo discoveries using disease models, into well designed clinical research investigations. Clinical molecular imaging involving clinical investigations, clinical trials and medical management or cost-effectiveness studies.
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