为了调查基线18F-氟化钠（NaF）和18F-胆碱PET活性是否与转移性去势抵抗性前列腺癌（mCRPC）全身和个体骨转移的DWI MR影像对镭-223治疗的反应相关。共有三个中心的36名仅限骨转移的mCRPC患者被纳入前瞻性研究。在治疗基线和8周间隔进行全身(WB)-MRI与DWI和18F-NaF和18F-胆碱PET/CT检查。在每个患者中，计算基线和随访期间骨病局部(g)ADC的中位数变化。此外，对于每个患者，最多勾画出五个骨靶病灶，并记录个体的中位数ADC变化。患者和病灶ADC的增加>30%定义为反应的基准和个体标准。对于相同的目标，记录基线18F-NaF和18F-胆碱PET SUVmax。患者目标的SUVmax平均值与gADC的变化相关，病灶SUVmax与病灶ADC的变化相关。这项研究分析了36名患者的133个病灶（14例反应者）。回应者的18F-氟化钠PET患者平均SUVmax显著高于非回应者（中位数为56.0对比非回应者的38.7；p = 0.008），SUVmax与gADC增加呈正相关（rho = 0.42；p = 0.015）。48.7的SUVmax阈值识别出77％的敏感性和75％的特异性的反应者。反应性转移性骨灶的基线18F-NaF PET病灶SUVmax较高（中位数为51.6 vs 非反应性转移灶31.8；p = 0.001），基线病灶SUVmax与ADC增加呈正相关（rho = 0.39；p < 0.001）。36.8的SUVmax阈值提供了72％的敏感性和63％的特异性。基线18F-胆碱PET SUVmax与患者的ADC反应（p = 0.164）或病灶基础的ADC反应（p = 0.921）之间没有显著关联。18F-氟化钠PET基线SUVmax与对ADC变化定义的镭-223治疗的反应具有显著关联。骨转移的18F-氟化钠PET/CT基线最大SUV可用作镭-223治疗反应的预测性生物标志物。•转移性去势抵抗性前列腺癌骨转移的18F-氟化钠PET基线SUVmax与镭-223治疗的反应显示显著关联。•基线18F-氟化钠PET可以提高镭-223治疗的患者选择效果。•整体-DWI参数的变化可用于与转移性去势抵抗性前列腺癌骨转移的18F-氟化钠PET SUVmax基准的反应相关联。© 2023. 作者。

To investigate whether baseline 18F-sodium fluoride (NaF) and 18F-choline PET activity is associated with metastatic castration-resistant prostate cancer (mCRPC) global and individual bone metastases' DWI MR imaging response to radium-223 treatment.Thirty-six bone-only mCRPC patients were prospectively recruited from three centers. Whole-body (WB)-MRI with DWI and 18F-NaF and 18F-choline PET/CT were performed at therapy baseline and 8-week intervals. In each patient, bone disease median global (g)ADC change between baseline and follow-up was calculated. Additionally, up to five bone target lesions per patient were delineated and individual median ADC change recorded. An ADC increase > 30% defined response per-patient and per-lesion. For the same targets, baseline 18F-NaF and 18F-choline PET SUVmax were recorded. Mean SUVmax across patient targets was correlated with gADC change and lesion SUVmax with per-lesion ADC change.A total of 133 lesions in 36 patients (14 responders) were analyzed. 18F-NaF PET per-patient mean SUVmax was significantly higher in responders (median = 56.0 versus 38.7 in non-responders; p = 0.008), with positive correlation between SUVmax and gADC increase (rho = 0.42; p = 0.015). A 48.7 SUVmax threshold identified responders with 77% sensitivity and 75% specificity. Baseline 18F-NaF PET per-lesion SUVmax was higher in responding metastases (median = 51.6 versus 31.8 in non-responding metastases; p = 0.001), with positive correlation between baseline lesion SUVmax and ADC increase (rho = 0.39; p < 0.001). A 36.8 SUVmax threshold yielded 72% sensitivity and 63% specificity. No significant association was found between baseline 18F-choline PET SUVmax and ADC response on a per-patient (p = 0.164) or per-lesion basis (p = 0.921).18F-NaF PET baseline SUVmax of target mCRPC bone disease showed significant association with response to radium-223 defined by ADC change.18F-sodium fluoride PET/CT baseline maximum SUV of castration-resistant prostate cancer bone metastases could be used as a predictive biomarker for response to radium-223 therapy.• 18F-sodium fluoride PET baseline SUVmax of castration-resistant prostate cancer bone metastases showed significant association with response to radium-223. • Baseline 18F-sodium fluoride PET can improve patient selection for radium-223 therapy. • Change in whole-body DWI parameters can be used for response correlation with baseline 18F-sodium fluoride PET SUVmax in castration-resistant prostate cancer bone metastases.© 2023. The Author(s).