不同示蹤劑PET-CT在前列腺癌診斷中應用

不同示蹤劑PET/CT在前列腺癌診斷中的應用2放射性核素示蹤技術

是核醫(yī)學的基本技術！前列腺癌MRIT1骨顯像18F-FDG患者男性，72歲。尿頻、尿急2年。近來全身酸痛，直腸指診未觸及結節(jié)，PSA6ng/ml骨顯像首先發(fā)現(xiàn)全身成骨轉移符合線路SPECTPositronEmittingIsotopes18F T?

110minutes11C

T?

20minutes13N T?

10minutes15O T?

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

Thepositronemittingisotopecanbeincorporatedintoavarietyoftracers.Whattracerisused,dependsonthephysiologicalprocessbeingstudied.ThePETscannerconsistsofringsofpaireddetectorsthatdetectthesegammaraysCholineFDGPMSAAcetateFDHTNaFPCaRadiotracersusedinPCa

99mTc-MDP、PSA單抗、?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術后，內分泌治療后，肝轉移PSA4.5前列腺癌術后復發(fā)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檢出：前列腺癌原發(fā)灶及精囊轉移精囊轉移精囊轉移前列腺癌原發(fā)病灶核醫(yī)學未來—PET及核素診治SNMMIimageoftheyear--theranosticdrugunitesimagingandtherapyforprostatecancerPETimageshowsprostatecancerpatient'ssuccessfulresponsetoPSMA-617endoradiotherap