ojrdrtОнкологический журнал: лучевая диагностика, лучевая терапияJournal of oncology: diagnostic radiology and radiotherapy2587-75932713-167XНЕКОММЕРЧЕСКОЕ ПАРТНЕРСТВО «ОБЩЕСТВО ИНТЕРВЕНЦИОННЫХ ОНКОРАДИОЛОГОВ»10.37174/2587-7593-2024-7-3-41-47ojrdrt-376Research ArticleЯДЕРНАЯ МЕДИЦИНАNUCLEAR MEDICINEПЭТ/КТ с 18F-PSMA-1007 в диагностике метастазов светлоклеточного почечно-клеточного рака в сравнении с 18F-ФДГ: проспективное исследованиеPET/CT with 18F-PSMA-1007 in Diagnostics of Metastatic Lesions of Clear-Cell Renal Cell Carcinoma in Comparison with 18F-FDG: Prospective Studyhttps://orcid.org/0000-0002-5375-2498ИльяковВ. С.IlyakovV. S.

Ильяков Вадим Сергеевич — врач-радиолог отделения радионуклидной диагностики №2 отдела радионуклидной диагностики и терапии НИИ КиЭР, аспирант

115478 Москва, Каширское шоссе, 24

Vadim S. Ilyakov

4 Kashirskoe Shosse, Moscow,115478

vadimilakov075@gmail.comhttps://orcid.org/0000-0003-1632-351XПронинА. И.ProninA. I.

Пронин Артем Игоревич — к.м.н., врач-радиолог, заведующий отделом радионуклидной диагностики и терапии, заведующий отделением радионуклидной диагностики №2

115478 Москва, Каширское шоссе, 24

Artem I. Pronin

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0002-2963-4176ПарнасА. В.ParnasA. V.

Парнас Александр Вадимович — врач-радиолог отделения радионуклидной диагностики №2 отдела радионуклидной диагностики и терапии, аспирант

115478 Москва, Каширское шоссе, 24

Alexander V. Parnas

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0002-4648-2362СубботинА. С.SubbotinA. S.

Субботин Алексей Сергеевич — м.н.с., врач-рентгенолог, отделения радионуклидной диагностики №2

115478 Москва, Каширское шоссе, 24

Alexey S. Subbotin

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0002-8476-7879КрыловА. С.KrylovA. S.

Крылов Александр Сергеевич — к.м.н., доцент, заведующий отделением радионуклидной диагностики №1

115478 Москва, Каширское шоссе, 24

Alexander S. Krylov

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0003-4122-9285ГелиашвилиТ. М.GeliashviliT. M.

Гелиашвили Тамара Мамуковна — к.м.н., заведующая отделением радионуклидной терапии, врач-радиолог, врач-онколог

115478 Москва, Каширское шоссе, 24

Tamara M. Geliashvili

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0002-3975-1130БезумоваЕ. В.BezumovaE. V.

Безумова Елизавета Витальевна — инженер и медицинский физик отделения радионуклидной диагностики №2

115478 Москва, Каширское шоссе, 24

Elizaveta V. Bezumova

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0002-8260-3520МехедоваО. В.MehedovaO. V.

Мехедова Ольга — руководитель блока, инженер-радиохимик циклотронно-радиохимического блока отделения радионуклидной диагностики №2

115478 Москва, Каширское шоссе, 24

Olga V. Mehedova

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0003-2312-6020НестероваН. И.NesterovaN. I.

Нестерова Наталия Игоревна — инженер-радиохимик группы научно-технических разработок отдела радионуклидной диагностики и терапии

115478 Москва, Каширское шоссе, 24

Natalia I. Nesterova

4 Kashirskoe Shosse, Moscow, 115478

https://orcid.org/0000-0001-7748-9527МатвеевВ. Б.MatveevV. B.

Матвеев Всеволод Борисович — заместитель директора по научной и инновационной работе, заведующий отделением онкоурологии, д.м.н., профессор, член-корреспондент РАН

115478 Москва, Каширское шоссе, 24

Vsevolod B. Matveev

4 Kashirskoe Shosse, Moscow, 115478

Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина Минздрава РоссииРоссияN.N. Blokhin National Medical Research Center of OncologyRussian Federation202419092024734147Copyright © Ильяков В.С., Пронин А.И., Парнас А.В., Субботин А.С., Крылов А.С., Гелиашвили Т.М., Безумова Е.В., Мехедова О.В., Нестерова Н.И., Матвеев В.Б., 20242024Ильяков В.С., Пронин А.И., Парнас А.В., Субботин А.С., Крылов А.С., Гелиашвили Т.М., Безумова Е.В., Мехедова О.В., Нестерова Н.И., Матвеев В.Б.Ilyakov V.S., Pronin A.I., Parnas A.V., Subbotin A.S., Krylov A.S., Geliashvili T.M., Bezumova E.V., Mehedova O.V., Nesterova N.I., Matveev V.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.oncoradjournal.ru/jour/article/view/376Цель

Цель: Проведение проспективного исследования, показывающее возможности ПЭТ/КТ с 18F-PSMA-1007 в сравнении с 18F-ФДГ в диагностике метастатического светлоклеточного почечно-клеточного рака (сПКР).

Материал и методы

Материал и методы: В исследование включено 97 пациентов c метастатическим сПКР. У всех пациентов доступны результаты биопсии первичной опухоли. Метастатические очаги подтверждалась данными биопсии, контролем в динамике и другими диагностическими методами. Всем пациентам проведено ПЭТ/КТ с 18F-PSMA-1007 и 18F-ФДГ.

Результаты

Результаты: У 97 пациентов было выявлено 1247 метастазов: 1002 — ПСМА-позитивных, 245 — ПСМА-негативных, 694 — ФДГ-позитивных, 553 — ФДГ-негативных. Наибольшее количество очагов было выявлено в легких (601 у 43 пациентов), костях (220 у 46 пациентов) и лимфоузлах (166 у 34 пациентов).

У 62 пациентов ПСМА-позитивных очагов оказалось больше в сравнении с 18F-ФДГ, у 32 — равное количество очагов, у 3 — больше очагов по данным ПЭТ/КТ с 18F-ФДГ.

Чувствительность и специфичность 18F-PSMA-1007 в диагностике метастазов сПКР составили 80 % и 72 %, положительная и отрицательная прогностическая ценность — 87 % и 61 % соответственно.

Чувствительность и специфичность 18F-ФДГ в диагностике метастазов сПКР составили 55 % и 54 %, положительная и отрицательная прогностическая ценность — 69 % и 41 % соответственно.

Средняя разница SUVmax между 18F-PSMA-1007 и 18F-ФДГ составила 5,32, TBR (tumor background ratio) — 5,66. Очаги в легких демонстрировали значительно более низкий уровень SUVmax и TBR (для обоих РФЛП в сравнении с прочими метастазами.

Обсуждение и выводы

Обсуждение и выводы: Анализ полученных данных демонстрирует более высокую эффективность 18F-PSMA-1007 в сравнении с 18F-ФДГ в диагностике метастатического сПКР. ПЭТ/КТ с 18F-PSMA-1007 позволила выявить большее количество мета стазов, SUVmax и TBR при исследованиях с 18F-PSMA-1007 в среднем значительно выше таковых при ПЭТ/КТ с 18F-ФДГ.

Наименьшую эффективность ПЭТ/КТ с 18F-PSMA-1007 демонстрирует в диагностике очагов в легких до 1 см. Целесообразно проведение отдельного анализа легочных очагов и прочих метастазов для исключения влияния большого количества низкоактивных и ложноотрицательных очагов на статистические показатели.

ПЭТ/КТ с 18F-PSMA-1007 может быть рекомендована к применению у пациентов с подозрением на метастатический сПКР как альтернатива рутинным методам диагностики и ПЭТ/КТ с 18F-ФДГ. Дальнейшего изучения требуют возможности 18F-PSMA-1007 в оценке эффективности системной терапии.

Purpose

Purpose: To demonstrate the capabilities of PET/CT with 18F-PSMA-1007 in comparison with 18F-FDG in the diagnostics of metastatic ccRCC.

Material and methods

Material and methods: Ninety-seven patients with metastatic ccRCC were included in the study. Biopsy results of the primary tumor were available in all patients. Metastatic foci were confirmed by biopsy, follow-up and other diagnostic methods. All patients under went PET/CT with 18F-PSMA-1007 and 18F FDG.

Results

Results: A total of 1247 metastases were identified in 97 patients: 1002 — PSMA-positive, 245 — PSMA-negative, 694 — FDG-positive, and 553 — FDG-negative. The largest number of foci was found in the lungs (601 in 43 patients), bones (220 in 46 patients), and lymph nodes (166 in 34 patients).

Sixty-two patients had more PSMA-positive foci compared with 18FDG, 32 had an equal number of foci, and 3 had more foci according to PET/CT with 18FDG.

The sensitivity and specificity of 18F-PSMA-1007 in the diagnostics of ccRCC metastases were 80 % and 72 %, positive and negative predictive value were 87 % and 61 %, respectively.

The sensitivity and specificity of 18F-FDG in the diagnostics of ccRCC metastases were 55 % and 54 %, positive and negative predictive value were 69 % and 41 %, respectively.

The mean SUVmax difference between 18F-PSMA-1007 and 18FDG was 5.32, and the mean TBR difference was 5.66. Lung foci demonstrated significantly lower SUVmax and TBR for both RPs compared to other metastases.

Discussion and conclusions. Data analysis demonstrates higher efficiency of 18F-PSMA-1007 compared to 18F-FDG in the diagnostics of ccRCC metastases. PET/CT with 18F-PSMA-1007 revealed a higher number of metastases, SUVmax and TBR in studies with 18F-PSMA-1007 are on average significantly higher than those with 18F FDG.

PET/CT with 18F-PSMA-1007 demonstrates the lowest efficiency in the diagnosis of foci in the lungs up to 1 cm. It is feasible to analyze pulmonary foci and other metastases separately to exclude the influence of a large number of low-active and false-negative foci on statistical parameters.

PET/CT with 18F-PSMA-1007 can be recommended for use in patients with suspected metastatic ccRCC as an alternative to routine diagnostic methods and PET/CT with 18F-FDG. The potential of 18F-PSMA-1007 in assessing the efficacy of systemic therapy requires further investigation.

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The authors declare that there are no conflicts of interest present.