Utility of Multiparametric Prostate MRI to Predict Regional or Distant Metastatic Disease Against Conventional Staging Using CT and Bone Scintigraphy or 68Ga-PSMA PET in Intermediate-to-High-Risk Prostate Cancer.
Multiparametric magnetic resonance imaging (mpMRI) is now the standard of care to guide prostate biopsies during workups and assessment of men with suspected prostate cancer (PCa). In addition to intraprostatic lesion detection, MRI usually covers the bony pelvis and pelvic lymph nodes, two of the commonest sites for metastatic disease. Subsequent staging has traditionally been based on further scanning using a combination of computed tomography (CT) and bone scintigraphy (BS), and more recently, positron emission tomography (PET) scanning with prostate-specific membrane antigen (PSMA) ligand. However, the value of additional staging investigations for men who are negative for metastatic disease on pelvic MRI is unclear. This study aims to evaluate the concordance of MRI findings with other imaging performed during staging.
Patients with a Gleason score (GS) of ≥ 7 who had received both a pre-biopsy mpMRI and subsequent staging investigations from a single institution between 2019 to 2022 were identified. Imaging reports for PET, CT, and BS were used as the reference standard to evaluate MRI accuracy. PSMA-PET was considered the definitive outcome if multiple scans were performed. MRI findings were then classified as positive, negative, or equivocal. The accuracy was calculated using interpretations where equivocal cases were considered positive or negative for spread, representing a 'pessimistic' or 'optimistic' reading, respectively. A subgroup assessment of results considering only the use of CT + BS and PET was also done.
This study identified 214 patients for inclusion. The median age was 70 (IQR: 65-75) years, prostate-specific antigen (PSA) was 9.65 (IQR: 6.9-14.3) (ng/ml), and PSA density was 0.26 (ng/ml/cc) (IQR: 0.15-0.46). Complete conventional staging was performed for 130 patients, and PSMA-PET was performed for 102 patients. The results for the optimistic against pessimistic interpretations were the following: overall accuracy (90% vs 89%), sensitivity (0.48 vs 0.52), specificity (0.97 vs 0.95), negative predictive value (NPV) (0.84 vs 0.93), and positive predictive value (PPV) (0.71 vs 0.63). When comparing subgroup results considering only conventional imaging against only PSMA-PET, there were markedly more discordant findings in the PET group.
The impression of nodal and metastatic status through mpMRI poorly correlates with results from conventional staging and PSMA-PET. PSMA-PET more often produces discordant results to mpMRI, signifying an additive diagnostic value. MRI should not be used alone in the workup of prostate cancer in patients with a GS ≥ 7, where metastasis is a concern.
Nguyenhuy M
，Chan XQ
，Homewood D
，Ogluszko C
，Dundee P
，Corcoran N
... -
《Cureus》
A single-center retrospective review of metastatic prostate cancer on PSMA position emission tomography/computed tomography: Beyond lymph nodes and bones.
Prostate-specific membrane antigen (PSMA) Positron emission tomography/computed tomography (PET/CT) has become a crucial imaging modality for the staging of patients with prostate cancer. The purpose of this study is to retrospectively determine the frequency, anatomical distribution, and clinical-pathologic correlates of extra-nodal and extra-osseous metastatic prostate cancer detected on PSMA PET/CT.
All available 650 PSMA PET/CT performed in patients with biopsy-proved prostate cancer in our institution between September 2021 and December 2023 were reviewed for the presence of extra-nodal and extra-osseous metastatic disease (M1C disease). Thirty-four patients with M1C disease were identified.
The most frequent sites of visceral/soft tissue metastases were the lungs (58.8%), liver (23.5%) and adrenal glands (20.6%). 75% of patients with lung metastases detected on PSMA PET/CT had concurrent intrathoracic lymph node involvement. A higher frequency of patients with M1C disease (55.9%) had a high Gleason score. The median prostate-specific antigen (PSA) level at the time of the PSMA scan was 20.16 ng/mL. There was a statistically significant association between PSA level and osseous disease (p = 0.004), as well as PSA level and nodal disease (p = 0.008). While a large number of patients had concurrent osseous and nodal disease (82.4% and 79.4%, respectively), no visceral/soft tissue sites demonstrated a significant association with the presence of osseous or nodal involvement.
Given the increasing utilization of PSMA PET/CT, increased knowledge of the location and pattern of distribution of visceral/soft tissue metastatic sites is crucial not only for staging but also to better understand patterns of therapeutic response. We identified the lungs, liver and adrenal glands as the most common visceral/soft tissue metastatic sites from prostate cancer. We found that higher PSA levels at the time of PSMA PET/CT imaging were positively associated with concurrent osseous and nodal involvement.
De Jesus GNC
，Pereira V
，Karak P
，Shearier E
... -
《-》
Diagnosing Bone Metastases in Breast Cancer: A Systematic Review and Network Meta-Analysis on Diagnostic Test Accuracy Studies of 2-[(18)F]FDG-PET/CT, (18)F-NaF-PET/CT, MRI, Contrast-Enhanced CT, and Bone Scintigraphy.
This systematic review and network meta-analysis aimed to compare the diagnostic accuracy of 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in patients with breast cancer. Following PRISMA-DTA guidelines, we reviewed studies assessing 2-[18F]FDG-PET/CT, 18F-NaF-PET/CT, MRI, contrast-enhanced CT, and bone scintigraphy for diagnosing bone metastases in high-stage primary breast cancer (stage III or IV) or known primary breast cancer with suspicion of recurrence (staging or re-staging). A comprehensive search of MEDLINE/PubMed, Scopus, and Embase was conducted until February 2024. Inclusion criteria were original studies using these imaging methods, excluding those focused on AI/machine learning, primary breast cancer without metastases, mixed cancer types, preclinical studies, and lesion-based accuracy. Preference was given to studies using biopsy or follow-up as the reference standard. Risk of bias was assessed using QUADAS-2. Screening, bias assessment, and data extraction were independently performed by two researchers, with discrepancies resolved by a third. We applied bivariate random-effects models in meta-analysis and network meta-analyzed differences in sensitivity and specificity between the modalities. Forty studies were included, with 29 contributing to the meta-analyses. Of these, 13 studies investigated one single modality only. Both 2-[18F]FDG-PET/CT (sensitivity: 0.94, 95% CI: 0.89-0.97; specificity: 0.98, 95% CI: 0.96-0.99), MRI (0.94, 0.82-0.98; 0.93, 0.87-0.96), and 18F-NaF-PET/CT (0.95, 0.85-0.98; 1, 0.93-1) outperformed the less sensitive modalities CE-CT (0.70, 0.62-0.77; 0.98, 0.97-0.99) and bone scintigraphy (0.83, 0.75-0.88; 0.96, 0.87-0.99). The network meta-analysis of multi-modality studies supports the comparable performance of 2-[18F]FDG-PET/CT and MRI in diagnosing bone metastases (estimated differences in sensitivity and specificity, respectively: 0.01, -0.16 - 0.18; -0.02, -0.15 - 0.12). The results from bivariate random effects modelling and network meta-analysis were consistent for all modalities apart from 18F-NaF-PET/CT. We concluded that 2-[18F]FDG-PET/CT and MRI have high and comparable accuracy for diagnosing bone metastases in breast cancer patients. Both outperformed CE-CT and bone scintigraphy regarding sensitivity. Future multimodality studies based on consented thresholds are warranted for further exploration, especially in terms of the potential role of 18F-NaF-PET/CT in bone metastasis diagnosis in breast cancer.
Gerke O
，Naghavi-Behzad M
，Nygaard ST
，Sigaroudi VR
，Vogsen M
，Vach W
，Hildebrandt MG
... -
《-》
ResearchGate
(全网免费下载)
钛学术
(全网免费下载)
