Background: While prostate-specific membrane antigen (PSMA)-targeted imaging has revolutionized metastatic detection, unspecific bone uptake (UBU)—particularly in the ribs—is a common but diagnostically challenging finding in prostate cancer (PCa) patients. This review aims to synthesize current evidence on PSMA-avid rib lesions in PCa and to propose a structured approach for differentiating true metastases from benign mimics. Methods: A comprehensive literature search across PubMed, EMBASE, Scopus, and Web of Science identified relevant studies on PSMA imaging interpretation, tracer-specific patterns, rib lesion morphology, and clinical correlates. Data on uptake intensity, CT features, lesion number, location, tracer type, patient-specific risk factors, and follow-up behavior were extracted and analyzed. Results: Most solitary rib lesions are benign, particularly in low-risk patients or when located in the anterior/lateral arcs. Metastatic lesions are more likely to present as multiple foci, show cortical destruction on CT, exhibit high uptake intensity, and occur in patients with elevated PSA, high Gleason score, or ongoing androgen deprivation.18F-PSMA-1007 is especially prone to UBU in the ribs compared to68Ga-PSMA-11. Based on these variables, we propose a clinical decision tree to guide interpretation of PSMA-avid rib lesions. Conclusions: Accurate interpretation of rib lesions on PSMA PET/CT requires a multimodal, context-sensitive approach. Our diagnostic decision tree guides precise differentiation of benign versus metastatic rib lesions, enhancing staging accuracy and clinical decision-making. Biomarker-guided therapies offer potential for personalized treatment, though rib-specific validation remains a critical need.
背景：尽管前列腺特异性膜抗原（PSMA）靶向成像已彻底改变了转移灶的检测方式，但非特异性骨摄取（UBU）——尤其在肋骨部位——是前列腺癌（PCa）患者中常见但诊断上具有挑战性的发现。本综述旨在整合当前关于PCa中PSMA高摄取肋骨病灶的证据，并提出一种结构化方法以区分真性转移灶与良性类似病变。 方法：通过系统检索PubMed、EMBASE、Scopus和Web of Science数据库，筛选出关于PSMA成像判读、示踪剂特异性模式、肋骨病灶形态学特征及临床关联性的相关研究。提取并分析摄取强度、CT特征、病灶数量与位置、示踪剂类型、患者特异性危险因素及随访演变等数据。 结果：大多数孤立性肋骨病灶为良性，尤其见于低危患者或病灶位于前/外侧肋弓时。转移性病灶更倾向于表现为多发病灶、CT显示骨皮质破坏、呈现高摄取强度，且多发生于PSA升高、Gleason评分较高或正在接受雄激素剥夺治疗的患者中。与⁶⁸Ga-PSMA-11相比，¹⁸F-PSMA-1007更易在肋骨部位出现UBU。基于这些变量，我们提出临床决策树以指导PSMA高摄取肋骨病灶的判读。 结论：准确解读PSMA PET/CT中的肋骨病灶需采用多模态、结合临床背景的综合分析方法。我们提出的诊断决策树有助于精确区分良性与转移性肋骨病灶，从而提升分期准确性与临床决策质量。生物标志物指导的治疗策略为个体化治疗提供了可能，但针对肋骨病灶的验证仍是亟待解决的关键问题。
Fifty Shades of PSMA-Avid Rib Lesions: A Comprehensive Review
肿瘤(癌症)患者之家