AUTHOR=Zhang Yu , Shi Yuanying , Ye Liefu , Li Tao , Wei Yongbao , Lin Zhiyi , Chen Wenxin 

TITLE=Improving diagnostic efficacy of primary prostate cancer with combined 99mTc-PSMA SPECT/CT and multiparametric-MRI and quantitative parameters

JOURNAL=Frontiers in Oncology

VOLUME=13

YEAR=2023

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2023.1193370

DOI=10.3389/fonc.2023.1193370

ISSN=2234-943X

ABSTRACT=<sec><title>Purpose</title><p>This prospective study aimed to evaluate the difference between <sup>99m</sup>Tc-PSMA single-photon emission computed tomography (SPECT)/CT and multiparametric magnetic resonance imaging (mpMRI) in the detection of primary prostate cancer (PCa).</p></sec><sec><title>Materials and methods</title><p>Fifty-six men with suspected PCa between October 2019 and November 2022 were prospectively enrolled in this study. The median age of the patients was 70 years (range, 29-87 years). Patients were divided into high-(Gleason score&gt;7, n=31), medium- (Gleason score=7, n=6) and low-risk groups (Gleason score &lt; 7, n=6). All patients underwent <sup>99m</sup>Tc-PSMA SPECT/CT and mpMRI at an average interval of 3 days (range, 1-7 days). The maximum standardized uptake value (SUV<sub>max</sub>), the minimum apparent diffusion coefficient (ADC<sub>min</sub>), and their ratio (SUV<sub>max</sub>/ADC<sub>min</sub>) were used as imaging parameters to distinguish benign from malignant prostatic lesions.</p></sec><sec><title>Results</title><p>Of the 56 patients, 12 were pathologically diagnosed with a benign disease, and 44 were diagnosed with PCa. <sup>99m</sup>Tc-PSMA SPECT/CT and mpMRI showed no significant difference in the detection of primary PCa (kappa =0.401, <italic>P</italic>=0.002), with sensitivities of 97.7% (43/44) and 90.9% (40/44), specificities of 75.0% (9/12) and 75.0% (9/12), and AUC of 97.4% and 95.1%, respectively. The AUC of SUV<sub>max</sub>/ADC<sub>min</sub> was better than those of SUV<sub>max</sub> or ADC<sub>min</sub> alone. When SUV<sub>max</sub>/ADC<sub>min</sub> in the prostatic lesion was &gt;7.0×10<sup>3</sup>, the lesion was more likely to be malignant. When SUV<sub>max</sub>/ADC<sub>min</sub> in the prostatic lesion is &gt;27.0×10<sup>3</sup>, the PCa patient may have lymph node and bone metastases. SUV<sub>max</sub> was positively correlated with the Gleason score (<italic>r</italic>=0.61, P=0.008), whereas ADC<sub>min</sub> was negatively correlated with the Gleason score (<italic>r</italic>=-0.35, <italic>P</italic>=0.023). SUV<sub>max</sub>/ADC<sub>min</sub> was positively correlated with the Gleason score (<italic>r</italic>=0.59, <italic>P</italic>=0.023). SUV<sub>max</sub>/ADC<sub>min</sub> was the main predictor of the high-risk group, with an optimal cut-off value of 15.0×10<sup>3</sup>.</p></sec><sec><title>Conclusions</title><p>The combination of <sup>99m</sup>Tc-PSMA SPECT/CT and mpMRI can improve the diagnostic efficacy for PCa compared with either modality alone; SUV<sub>max</sub>/ADC<sub>min</sub> is a valuable differential diagnostic imaging parameter.</p></sec>