| Objective:1.To evaluate the diagnostic value of 68Ga-PSMA PET/CT for renal cell carcinoma primary tumor and metastatic lesions.2.To compare the diagnostic value of ccRCC between 68Ga-PSMA PET/CT and 18F-FDG PET/CT.3.To identify the efficacy evaluation value of 68Ga-PSMA PET/CT for the first-line targeted therapy in metastatic renal cell carcinoma.Methods:1.In the first part,38 patients with RCC diagnosed or treated in Nanjing Drum Tower Hospital from April 2017 to December 2017 were enrolled in the study.All the patients underwent 68Ga-PSMA PET/CT in Nanjing Clinical Nuclear Medicine Center.We evaluated the RCC primary tumor and metastatic lesions according to the imaging reports and analysis by 2 urologists.SUVmax of primary tumor and metastatic lesions were calculated through visual analysis and ROI semi-quantitative analysis to assess the uptake of radiotracer.We recorded the clinical,imaging and pathological information of the cases.We analyzed each SUVmax of RCC primary tumor and distinct metastatic lesions using statistical description,Student's t test and rank sum test.2.In the second part,12 patients with RCC were recruited in the study.All the patients underwent 68Ga-PSMA PET/CT one week before they underwent 18F-FDG PET/CT. Imaging analysis was the same as above.We calculated the SUVmax of primary tumor and metastatic lesions and analyzed the differences between 68Ga-PSMA PET/CT and 18F-FDG PET/CT.3.In the third part,8 patients with advanced RCC were enrolled in the study,of which 2 were treated with Sunitinib and 6 were treated with Pazopanib.All the patients underwent 68Ga-PSMA PET/CT before the targeted therapy and received 68Ga-PSMA PET/CT again 2 months later.SUVmax of the metastatic lesions of same location were calculated.Results:1.The First Part1.1 68Ga-PSMA PET/CT showed physiologic uptake in salivary glands,small intestine,liver and kidney in all patients.1.2 The SUVmax of primary tumor was 15.18±6.39.ccRCC showed higher 68Ga-PSMA-11 uptake than other subtypes of RCC,with mean SUVmax of 17.30±5.15,however the SUVmax of other subtypes were all below 10.1.3 In patients with metastatic lesions,38 lung metastatic lesions,38 lymph node metastatic lesions,32 bone metastatic lesions,1 adrenal gland metastatic lesions,2 local recurrences nd 20 metastatic lesions in other parts were found.The SUVmax of lung,lymph node,bone and other metastases were 3.51±2.75,14.27±12.41,20.59±10.82 and 10.98±7.60,espectively.Adrenal gland metastases and local recurrences were excluded because of the mall numbers.There were significant differences between bone,lymph node,other metastases and lung metastases of their SUVmax.2.The Second Part2.1 Primary tumors were found in 7 patients and metastatic lesions were found in 8 patients.2.2 The SUVmax of primary tumors were 13.95±6.28 and 10.85±6.23?p=0.456?in 68Ga-PSMA PET/CT and 18F-FDG PET/CT,respectively.There were no significant differences between these two methods in detecting primary tumors.2.3 The SUVmax of lung metastases were 4.00±2.89 and 17.47±9.19(p<0.001=in 68Ga-PSMA PET/CT and 18F-FDG PET/CT,respectively.There were significant differences between these two methods in detecting lung metastases.2.4 The SUVmax of lymph node metastases were 16.52±11.96 and 10.19±5.19?p=0.086?in 68Ga-PSMA PET/CT and 18F-FDG PET/CT,respectively.There were no significant differences between these two methods in detecting lymph node metastases.2.5 The SUVmax of bone metastases were 25.90±7.94 and 6.83±2.47(p<0.001=in 68Ga-PSMA PET/CT and 18F-FDG PET/CT,respectively.There were significant differences between these two methods in detecting bone metastases.3.The Third Part3.1 Lung metastases were found in 6 patients?18 lesions?,lymph node metastases were found in 5 patients?16 lesions?,bond metastases were found in 4 patients?14 lesions?.There were also some other metastases,including psoas major muscle,inferior vena cava thrombosis,uterus and axilla.3.2 The SUVmax of lung metastases,lymph node metastases,bone metastases,other metastases before the targeted therapy were 5.08±3.24,22.51±13.24,22.51±13.24, 8.12±3.94,respectively.The SUVmax of lung metastases,lymph node metastases,bone metastases,other metastases after 2-month targeted therapy were 1.42±0.77,4.79±2.55,8.01±3.77,2.38±1.04,2.48±0.83,respectively.There were significant differences of SUVmax before and after the targeted therapy,and p value were 0.017,0.003,<0.001,0.019,respectively.Conclusion:1.The First Part1.1 68Ga-PSMA PET/CT provided great diagnostic value for RCC.1.2 68Ga-PSMA PET/CT showed diagnostic value for ccRCC primary tumor,but there was not obvious uptake of radiotracer for other subtypes of RCC.1.3 68Ga-PSMA PET/CT was more sensitive in detecting lymph node,bone and other metastases than lung metastases.2.The Second Part2.1 There were no significant differences in detecting primary RCC and lymph node metastases between 68Ga-PSMA PET/CT and 18F-FDG PET/CT.2.2 68Ga-PSMA PET/CT was more sensitive in detecting bond metastases than 18F-FDG PET/CT,however 18F-FDG PET/CT performed better in detecting lung metastases.3.The Third Part 68Ga-PSMA PET/CT proved to be a promising method to evaluate the therapeutic effect of first-line targeted therapy in advanced RCC patients. |
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