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目的:比较 68Ga-前列腺特异性膜抗原(PSMA)11 PET/ CT与多参数核磁共振(mpMRI)检查对初诊时是否接受新辅助内分泌治疗的前列腺癌患者盆腔淋巴结转移的诊断效能。 方法:回顾性分析2023年2—10月西京医院收治的52例中高危前列腺癌患者的病例资料，年龄(65.8±6.6)岁，术前前列腺特异性抗原(PSA)26.67(13.09，84.89)ng/ml。术前cT 2期28例，cT 3期16例，cT 4期8例；cN 0期22例，cN 1期30例。所有患者同时接受 68Ga-PSMA-11 PET/CT和mpMRI检查，诊断淋巴结阳性分别为28例和21例。危险度分层高危45例，中危7例。根据术前接受内分泌治疗情况分为初诊未治疗组(24例)和内分泌治疗组(28例)，年龄分别为(65.0±7.1)岁和(66.8±6.1)岁；术前PSA分别为26.17(16.73，61.18)ng/ml和27.32(11.94，130.18)ng/ml；Gleason评分≤7分分别为10例(41.7%)和6例(21.4%)，>7分分别为14例(58.3%)和22例(78.6%)；cT 1～2期分别为15例(62.5%)和13例(46.4%)，cT 3～4期分别为9例(37.5%)和15例(53.6%)；N 0期分别为16例(66.7%)和6例(21.4%)，N 1期分别为8例(33.3%)和22例(78.6%)；M 0期分别为22例(91.7%)和20例(71.4%)，M 1期分别为2例(8.3%)和8例(28.6%)；PET/CT检查诊断淋巴结阳性分别为9例(37.5%)和19例(67.9%)，mpMRI检查诊断淋巴结阳性分别为5例(20.8%)和16例(57.1%)；PET/CT检查诊断淋巴结阳性个数分别为13枚(72.2%)和47枚(90.1%)，mpMRI检查诊断淋巴结阳性个数分别为8枚(44.4%)和32枚(61.5%)；上述指标差异均无统计学意义( P>0.05)。所有患者均行根治性前列腺切除术＋扩大盆腔淋巴结清扫术，根据术后淋巴结病理检查结果，比较两种影像学检查诊断淋巴结转移的敏感性、特异性、阳性预测值、阴性预测值。采用受试者工作特征(ROC)曲线分别比较两种影像学检查对初诊未治疗组和内分泌治疗组盆腔淋巴结转移的诊断准确性。 结果:本研究52例，病理检查淋巴结阳性26例(50.0%)。本研究52例共清扫681枚淋巴结，病理检查阳性淋巴结70枚(10.28%)；26例淋巴结阳性病例清扫389枚淋巴结，阳性率为17.99%(70/389)。26例淋巴结阳性患者的PET/CT和mpMRI检出率分别为92.3%(24/26)和57.7%(15/26)。初诊未治疗组和内分泌治疗组淋巴结阳性患者分别为9例(37.5%)和17例(60.7%)，清扫淋巴结分别为320枚和361枚，阳性淋巴结分别为18枚(5.6%)和52枚(14.4%)。初诊未治疗组和内分泌治疗组的PET/CT检出率分别为88.89%(8/9)和94.12%(16/17)，mpMRI检出率分别为44.44%(4/9)和64.71%(11/17)。初诊未治疗组中，PET/CT和mpMRI检查诊断淋巴结阳性的ROC曲线的曲线下面积(AUC)分别为0.911和0.689( P＝0.027)，敏感性分别为88.9%和44.4%，特异性分别为93.3%和93.3%，阳性预测值分别为88.9%和80.0%，阴性预测值分别为93.3%和73.7%。内分泌治疗组中，PET/CT和mpMRI检查诊断淋巴结阳性的ROC曲线的AUC分别为0.834和0.596( P＝0.011)，敏感性分别为94.1%和64.7%，特异性分别为72.7%和54.5%，阳性预测值分别为84.2%和68.8%，阴性预测值分别为88.9%和和50.0%。 结论:对于前列腺癌患者，无论是否接受新辅助内分泌治疗， 68Ga-PSMA-11 PET/CT检查均能对盆腔淋巴结转移进行较精准的分期，诊断效能均明显优于mpMRI。

Objective:To compare the diagnostic efficacy of 68Ga-PSMA-11 PET/ CT and multi-parameter magnetic resonance imaging (mpMRI) for pelvic lymph node metastases in prostate cancer patients who received neoadjuvant endocrinology or not after initial diagnosis. Methods:Data of 52 patients with moderate and high-risk prostate cancer admitted to Xijing Hospital from February to October 2023, aged (65.8±6.6) years, preoperative prostate-specific antigen (PSA) 26.67 (13.09, 84.89) ng/ml, were retrospectively analyzed. Before operation, there were 28 cases of cT 2stage, 16 cases of cT 3 stage and 8 cases of cT 4 stage. There were 22 cases of cN 0 and 30 cases of cN 1. All patients underwent 68Ga-PSMA-11 PET/CT and mpMRI at the same time, and were diagnosed positive lymph nodes in 28 and 21 cases, respectively. Risk stratification were high risk in 45 cases, and medium risk in 7 cases. According to the preoperative endocrine treatment, they were divided into the newly diagnosed group without treatment (24 cases) and the endocrine treated group (28 cases), whose ages were (65.0±7.1) years and (66.8±6.1) years, respectively. Preoperative PSA was 26.17 (16.73, 61.18) ng/ml and 27.32 (11.94, 130.18) ng/ml, respectively. Gleason scores ≤7 were in 10 cases (41.7%) and 6 cases (21.4%), and Gleason scores >7 were in 14 cases (58.3%) and 22 cases (78.6%), respectively. There were 15 (62.5%) and 13 (46.4%) cases of cT 1-2 stage, and 9 (37.5%) and 15 (53.6%) cases of cT 3-4 stage, respectively. There were 16 (66.7%) and 6 (21.4%) cases of stage N 0, 8 (33.3%) and 22 (78.6%) cases of stage N 1, respectively. There were 22 (91.7%) and 20 (71.4%) cases of stage M 0, 2 (8.3%) and 8 (28.6%) cases of stage M 1, respectively. PET/CT diagnosis of lymph node positive was in 9 cases (37.5%) and 19 cases (67.9%), and mpMRI diagnosis of lymph node positive was in 5 cases (20.8%) and 16 cases (57.1%). The number of positive lymph nodes diagnosed by PET/CT was 13 (72.2%) and 47 (90.1%), and the number of positive lymph nodes diagnosed by mpMRI was 8 (44.4%) and 32 (61.5%). There was no significant difference ( P>0.05). All patients underwent radical prostatectomy as well as enlarged pelvic lymph node resection. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the two imaging examinations in the diagnosis of lymph node metastasis were compared according to the results of postoperative pathological examination of lymph nodes. Receiver operating characteristic (ROC) curve was used to compare the accuracy of the two imaging tests in the diagnosis of pelvic lymph node metastasis in the newly diagnosed untreated group and the endocrine treated group. Results:In this study, of 52 cases, 26 (50.0%) had positive lymph nodes by pathological examination. In this study, a total of 681 lymph nodes were dissected, with 70 lymph nodes (10.28%) being pathologically positive, and the positive rate of 26 patients was 17.99% (70/389). The PET/CT and mpMRI detection rates of 26 node-positive patients were 92.3% (24/26) and 57.7% (15/26), respectively. There were 9 (37.5%) and 17 (60.7%) lymph node positive patients in the untreated group and the endocrine therapy group, respectively. There were 320 and 361 lymph nodes were clear, with 18 (5.6%) and 52 (14.4%) positive lymph nodes, respectively. The detection rates of PET/CT and mpMRI were 88.89% (8/9) and 94.12% (16/17)in the untreated group, and 44.44% (4/9) and 64.71% (11/17)in the endocrine treated group, respectively. In the newly treated group, the area under the curve (AUC) of PET/CT and mpMRI for diagnosing positive lymph nodes were 0.911 and 0.689 ( P=0.027), the sensitivity were 88.9% and 44.4%, and the specificity were 93.3% and 93.3%, respectively. PPV were 88.9% and 80.0%, and NPV were 93.3% and 73.7%, respectively. In the endocrine therapy group, the AUC of PET/CT and mpMRI for lymph node positive diagnosis were 0.834 and 0.596 ( P=0.011), the sensitivity were 94.1% and 64.7%, the specificity were 72.7% and 54.5%, and the PPV were 84.2% and 68.8%, respectively. NPV were 88.9% and 50.0%, respectively. Conclusions:For prostate cancer patients, regardless of whether they receive neoadjuvant endocrine therapy, 68Ga-PSMA-11 PET/CT can accurately detect pelvic lymph node metastasis, and the diagnostic efficacy is significantly better than that of mpMRI.