不同示踪剂PET-CT在前列腺癌诊断中应用

不同示踪剂PET/CT在前列腺癌诊断中的应用2放射性核素示踪技术

是核医学的基本技术！前列腺癌MRIT1骨显像18F-FDG患者男性，72岁。尿频、尿急2年。近来全身酸痛，直肠指诊未触及结节，PSA6ng/ml骨显像首先发现全身成骨转移符合线路SPECTPositronEmittingIsotopes18F T½

110minutes11C

T½

20minutes13N T½

10minutes15O T½

2minutesNoticehowshortthehalf-livesare–thatmeansthatmostofthesetracershavetobeproducedclosetothescanner.Atthemoment,only18FcompoundscanbetransportedPETRadiotracersMetabolismGlucoseAminoacidsNucleotidesFattyacidsAcetateBloodFlowBloodVolumeHypoxiaDrugkinetics/metabolismNeuroreceptorsDopamine(preandpostsynaptic)SerotonineOpiateBenzodiazepine

Thepositronemittingisotopecanbeincorporatedintoavarietyoftracers.Whattracerisused,dependsonthephysiologicalprocessbeingstudied.ThePETscannerconsistsofringsofpaireddetectorsthatdetectthesegammaraysCholineFDGPMSAAcetateFDHTNaFPCaRadiotracersusedinPCa

99mTc-MDP、PSA单抗、18F-FLT、18F-FMAU、anti-18F-FACBC、18F-FMISO

FDGPET/CTTheroleoffluorodeoxyglucose(FDG)-PETscanninginmenwithsuspectedrecurrentprostatecanceriscontroversial.SomeearlyreportsconcludedthatPETisoflimitedutilityoverall,particularlyformenwithalowserumPSAorPSAvelocity

Incontrast,otherssuggestthatPETisusefulinimaginglocalrecurrences,osseousmetastases,ornodalandsofttissuelesions.2015-6-15PSA4.622015-11-13PSA172015-02-152015-07-08PSA0.87PSA9.82015-7-21前列腺癌根治性切除术后，内分泌治疗后，肝转移PSA4.5前列腺癌术后复发PSA1.2CholinePET/CTaToolforIdentifyingEarlyRecurrenceInalargecohortofpatients,thefeasibilityof11C-cholinePET/CTfordetectingthesitesofmetastaticdiseaseinPCapatientswithBCRwasconfirmed.ThePSAlevelwasthemainpredictorofapositivescanwith1.16ng/mLastheoptimalcut-offvalue.Inthemajorityofpositivescansoligometastaticdisease,potentiallytreatablewithsalvagetherapies,wasobserved.18F-CholinePET/CT-responseassessmentAcetatePET/CTPSMAPET/CTaTechniqueforDetectingVeryEarlyRecurrence18F-FDHTPET/CT“Glycolysis/ARConcordant”phenotype“ARPredominant”phenotypeNaFPET/CTModifiedthefollowingbullet“Newertechnologyusing18F-NaF

asthetracerforaPETscanorhybridimagingbonescanscanbeusedasadiagnosticstagingstudy”.Thesetestsappeartohavegreatersensitivitythanbonescan.However,thereiscontroversyabouthowtheresultsof18F-NaFPETbonescanshouldbeacteduponsinceallphase3clinicaltrialstodatehaveusedprogressioncriteriaonbonescans.TheProstateCancerRadiographicAssessmentsforDetectionofAdvancedRecurrence(RADAR)WorkingGrouprecommendsusing

18F-NaF

PET/CT

forskeletalassessmentinbiochemicalrecurrenceasaninitialscanwithPSA>5

ng/mL

orfordoublingofPSAafterapriornegativescan.CrawfordED,StoneNN,YuEY,etal.Challengesandrecommendationsforearlyidentificationofmetastaticdiseaseinprostatecancer.Radioimmunoimaging,RIIFusionimagingof111In-PSAMoAbSPECTRIIwithMRI检出：前列腺癌原发灶及精囊转移精囊转移精囊转移前列腺癌原发病灶核医学未来—PET及核素诊治SNMMIimageoftheyear--theranosticdrugunitesimagingandtherapyforprostatecancerPETimageshowsprostatecancerpatient'ssuccessfulresponsetoPSMA-617endoradiotherap