| Objective To compare the diagnostic ability of 18F-PSMA-1007 PET/CT imaging and 99mTC-MDP whole body bone scan for bone metastasis of prostate cancer.To analyze the correlation between prostate specific antigen(PSA),alkaline phosphatase(ALP),Gleason score and bone metastasis of prostate cancer.Methods Patients who underwent radical prostatectomy in our Hospital from August 2020 to December 2021 and were clinically suspected of recurrence during follow-up were collected.Forty-two patients were enrolled with an average age of 68.3±9.2(45-83)years.All patients underwent 18F-PSMA-1007 PET/CT imaging and 99mTC-MDP whole body bone scan.The images obtained by the two imaging methods were interpreted from both patient and lesion levels by double-blind method,and the final diagnosis of the patients and lesions was made according to the best comparison standard method.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy of the two imaging methods were compared.The difference and consistency between the two imaging methods and the final diagnosis results were analyzed.The lesions detected by the two imaging methods were analyzed in detail.The distribution of false positive and false negative lesions was summarized.Total prostate-specific antigen(TPSA),free prostate-specific antigen(FPSA),free prostate-specific antigen ratio(FPSAR),ALP and Gleason score were collected from patients last tested before enrollment.The correlation between the above indicators and bone metastasis of prostate cancer was analyzed.Patients were divided into three groups according to TPSA level Gleason score(0.2≤TPSA<5ng/ml、5≤TPSA<20ng/ml and TPSA≥20ng/ml groups,Gleason≤6,6<Gleason≤8 and Gleason>8 groups).The differences in the incidence of bone metastases among subgroups were compared.The difference between the two imaging methods was analyzed by McNemar test.The degree of consistency between the diagnosis results and the final diagnosis results of the two imaging methods was analyzed by Kappa consistency test.Spearman correlation analysis and two independent sample nonparametric test were used to analyze the correlation between PSA,ALP,Gleason score and bone metastasis.The differences in the incidence of bone metastases between subgroups with different TPSA,Gleason scores were analyzed by Chi-square test and multiple post-mortem comparisons.Results Analysis by patients:22 patients with bone metastasis were diagnosed by the best comparison method.26 cases of bone metastasis were diagnosed by 18F-PSMA-1007 PET/CT imaging.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 100%,80%,84.6%and 100%,respectively.19 cases of bone metastasis were diagnosed by 99mTC-MDP whole body bone scan.The sensitivity was 63.6%,specificity was 75.0%,positive predictive value was 73.7%,negative predictive value was 65.3%,and diagnostic accuracy was 69.0%.The difference between the two imaging methods was statistically significant(P=0.021).18F-PSMA-1007 PET/CT imaging was more consistent with the final diagnosis than 99mTC-MDP whole body bone scan(K=0.883,0.453,respectively).Analysis by lesions:124 bone metastases were diagnosed by the best comparison method.131 bone metastases were diagnosed by 18F-PSMA-1007 PET/CT imaging.Its diagnostic accuracy was 94.7%.83 bone metastases were diagnosed by 99mTC-MDP whole-body bone scan.The diagnostic accuracy is 51.1%.The difference between the two imaging methods was statistically significant(P=0.001).Specific analysis showed that the 18F-PSMA-1007 PET/CT imaging results contained 7 false positive lesions,mainly located in the ribs.99mTC-MDP whole-body bone scan revealed 13 false positive lesions,mainly in the spine,and 54 false-negative lesions,mainly in the ribs and pelvis.The median TPS A was 10.92ng/mL,the median FPSA was 2.75ng/mL,the median FPSAR was 0.25 and the median ALP was 87U/L,the Gleason score ranges from 6 to 10.TPS A,FPSA,FPSAR,ALP Gleason score were significantly positively correlated with bone metastasis of prostate cancer(r>0,P<0.05).TPSA<5ng/mL group compared with TPS A>5ng/mL group,Gleason score<6 group compared with Gleason score≥8 group,the incidence of bone metastasis was statistically significant.Conclusion 18F-PSMA-1007 PET/CT imaging is superior to 99mTC-MDP whole body bone scan in the diagnosis of bone metastasis of prostate cancer.The false positive lesions in 18F-PSMA-1007 PET/CT imaging were mainly located in the ribs.In the 99mTC-MDP whole-body bone scan diagnosis,the false-positive lesions were mainly located in the spine,while the false-negative lesions were mainly located in the ribs and pelvis.TPSA,FPSA,FPSAR,ALP and Gleason scores were significantly positively correlated with bone metastasis of prostate cancer. |
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