68Ga-PSMA-11 PET, 18F-PSMA-1007 PET, and MRI for Gross Tumor Volume Delineation in Primary Prostate Cancer: Intermodality and Intertracer Variability,Practical Radiation Oncology

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68Ga-PSMA-11 PET, 18F-PSMA-1007 PET, and MRI for Gross Tumor Volume Delineation in Primary Prostate Cancer: Intermodality and Intertracer Variability
Practical Radiation Oncology ( IF 3.3 ) Pub Date : 2021-04-30 , DOI: 10.1016/j.prro.2020.11.006
Cédric Draulans ₁ , Floris Pos ₂ , Robert J Smeenk ₃ , Linda Kerkmeijer ₄ , Wouter V Vogel ₅ , James Nagarajah ₆ , Marcel Janssen ₆ , Cindy Mai ₇ , Stijn Heijmink ₈ , Marloes van der Leest ₆ , Patrik Zámecnik ₆ , Raymond Oyen ₇ , Sofie Isebaert ₁ , Frederik Maes ₉ , Steven Joniau ₁₀ , Martina Kunze-Busch ₃ , Robin De Roover ₁ , Gilles Defraene ₁ , Uulke A van der Heide ₂ , Karolien Goffin ₁₁ , Karin Haustermans ₁

Affiliation

Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium; Department of Oncology, KU Leuven, Leuven, Belgium.
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands.
Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands.
Department of Radiology, University Hospitals Leuven, Leuven, Belgium.
Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium; Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium.
Department of Urology, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium.

Purpose

To assess the intermodality and intertracer variability of gallium-68 (⁶⁸Ga)- or fluorine-18 (¹⁸F)-labeled prostate-specific membrane antigen (PSMA) positron emission tomography (PET) and biparametric magnetic resonance imaging (bpMRI)-based gross tumor volume (GTV) delineation for focal boosting in primary prostate cancer.

Methods

Nineteen prospectively enrolled patients with prostate cancer underwent a PSMA PET/MRI scan, divided into a 1:1 ratio between ⁶⁸Ga-PSMA-11 and ¹⁸F-PSMA-1007, before radical prostatectomy (IWT140193). Four delineation teams performed manual contouring of the GTV based on bpMRI and PSMA PET imaging, separately. Index lesion coverage (overlap%) and interobserver variability were assessed. Furthermore, the distribution of the voxelwise normalized standardized uptake values (SUV%) was determined for the majority-voted (>50%) GTV (GTV^majority) and whole prostate gland to investigate intertracer variability. The median patientwise SUV% contrast ratio (SUV%-CR, calculated as median GTV^majority SUV% / median prostate gland without GTV^majority SUV%) was calculated according to the tracer used.

Results

A significant difference in overlap% favoring PSMA PET compared with bpMRI was found in the ¹⁸F subgroup (median, 63.0% vs 53.1%; P = .004) but was not present in the ⁶⁸Ga subgroup (32.5% vs 50.6%; P = .100). Regarding interobserver variability, measured Sørensen-Dice coefficients (0.58 vs 0.72) and calculated mean distances to agreement (2.44 mm vs 1.22 mm) were statistically significantly lower and higher, respectively, for the ¹⁸F cohort compared with the ⁶⁸Ga cohort. For the bpMRI-based delineations, the median Sørensen-Dice coefficient and mean distance to agreement were 0.63 and 1.76 mm, respectively. Median patientwise SUV%-CRs of 1.8 (interquartile range [IQR], 1.6-2.7) for ¹⁸F-PSMA and 3.3 (IQR, 2.7-5.9) for ⁶⁸Ga-PSMA PET images were found.

Conclusions

Both MRI and PSMA PET provided consistent intraprostatic GTV lesion detection. However, the PSMA tracer seems to have a major influence on the contour characteristics, owing to an apparent difference in SUV% distribution in the prostate gland.

中文翻译：

68Ga-PSMA-11 PET、18F-PSMA-1007 PET 和 MRI 用于描绘原发性前列腺癌的大体肿瘤体积：多模态和示踪剂间变异性

目的

评估基于镓 68 ( ⁶⁸ Ga) 或氟 18 ( ¹⁸ F) 标记的前列腺特异性膜抗原 (PSMA) 正电子发射断层扫描 (PET) 和双参数磁共振成像 (bpMRI) 的多态性和示踪剂间变异性用于原发性前列腺癌局灶性增强的总肿瘤体积 (GTV) 描绘。

方法

19 名前瞻性登记的前列腺癌患者在根治性前列腺切除术 (IWT140193) 之前接受了 PSMA PET/MRI 扫描，按照⁶⁸ Ga-PSMA-11 和¹⁸ F-PSMA-1007 的比例分为 1:1 。四个描绘团队分别基于 bpMRI 和 PSMA PET 成像对 GTV 进行了手动轮廓绘制。评估了指标病变覆盖率（重叠％）和观察者间的变异性。此外，确定了多数投票（> 50％）GTV（GTV^多数）和整个前列腺的体素标准化标准化摄取值（SUV％）的分布，以研究示踪剂间的变异性。中位患者 SUV% 对比度（SUV%-CR，计算为中位 GTV^多数SUV% / 中位前列腺无 GTV^大多数SUV%) 是根据使用的示踪剂计算的。

结果

在¹⁸ F 亚组（中位数，63.0% 对 53.1%；P = .004）中发现有利于 PSMA PET 的重叠百分比有显着差异，但在⁶⁸ Ga 亚组中不存在（32.5% 对 50.6%；P = .100）。关于观察者间的变异性，与⁶⁸ Ga 队列相比，¹⁸ F 队列的测量 Sørensen-Dice 系数（0.58 对 0.72）和计算的平均一致性距离（2.44 毫米对 1.22 毫米）在统计学上分别显着较低和较高。对于基于 bpMRI 的描绘，中值 Sørensen-Dice 系数和平均一致性距离分别为 0.63 和 1.76 毫米。中位患者 SUV%-CR 为 1.8（四分位距 [IQR]，1.6-2.7）发现了^{68 个}Ga-PSMA PET 图像的¹⁸ F-PSMA 和 3.3（IQR，2.7-5.9）。