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中华医学超声杂志(电子版) ›› 2017, Vol. 14 ›› Issue (09) : 706 -710. doi: 10.3877/cma.j.issn.1672-6448.2017.09.015

所属专题: 文献

介入超声影像学

经直肠实时组织弹性成像联合多参数磁共振成像引导前列腺靶向穿刺活检的价值
韩红生1, 陆海娟1,(), 张磊1, 钟惠琴1, 王省白2   
  1. 1. 314001 浙江中医药大学附属嘉兴中医院超声科
    2. 314001 浙江中医药大学附属嘉兴中医院放射科
  • 收稿日期:2016-12-01 出版日期:2017-09-01
  • 通信作者: 陆海娟
  • 基金资助:
    嘉兴市科技研究计划(2013AY21053-2)

The value of transrectal real-time tissue elastography combined with multi parameter magnetic resonance imaging in prostate biopsy

Hongsheng Han1, Haijuan Lu1,(), Lei Zhang1, Huiqin Zhong1, Shengbai Wang2   

  1. 1. Department of Ultrasonography, Jiaxing Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicine University, Jiaxing 314001, China
    2. Department of Radiology, Jiaxing Traditional Chinese Medicine Hospital, Zhejiang Chinese Medicine University, Jiaxing 314001, China
  • Received:2016-12-01 Published:2017-09-01
  • Corresponding author: Haijuan Lu
  • About author:
    Corresponding author, Lu Haijuan, Email:
引用本文:

韩红生, 陆海娟, 张磊, 钟惠琴, 王省白. 经直肠实时组织弹性成像联合多参数磁共振成像引导前列腺靶向穿刺活检的价值[J/OL]. 中华医学超声杂志(电子版), 2017, 14(09): 706-710.

Hongsheng Han, Haijuan Lu, Lei Zhang, Huiqin Zhong, Shengbai Wang. The value of transrectal real-time tissue elastography combined with multi parameter magnetic resonance imaging in prostate biopsy[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(09): 706-710.

目的

探讨经直肠实时组织弹性成像(TRTE)联合多参数磁共振成像(MRI)引导前列腺靶向穿刺活检的价值。

方法

2013年12月至2015年12月嘉兴市中医医院收治的疑诊前列腺癌患者105例。所有患者均经手术病理证实。105例患者分别行TRTE和MRI检查后,行经直肠超声引导下穿刺活检。穿刺采用常规6点穿刺活检和上述检查阳性征象部位针对性靶向活检。以手术病理结果作为金标准,计算TRTE、MRI、TRTE联合MRI引导穿刺活检诊断前列腺癌的敏感度、特异度、准确性、阳性预测值、阴性预测值。

结果

手术病理证实,本组105例患者中,前列腺良性结节44例,前列腺癌61例。前列腺癌56例。TRTE诊断为前列腺癌的52例中,手术病理证实45例。MRI诊断为前列腺癌的56例中,手术病理证实48例。TRTE、MRI及TRTE联合MRI引导穿刺活检诊断前列腺癌的敏感度、特异度、准确性、阳性预测值、阴性预测值分别为71.4%、84.0%、78.0%、0.865、0.698,78.6%、81.8%、80.0%、0.857、0.734,90.1%、88.6%、89.5%、0.916、0.866。TRTE联合MRI引导穿刺活检诊断前列腺癌的敏感度、特异度、准确性、阳性预测值、阴性预测值均高于TRTE及MRI。

结论

TRTE和MRI均有各自的优势。穿刺前的精准定位,有助于制定前列腺穿刺个性化方案,二者联合应用可提高前列腺癌的检出率。

Objective

To evaluate the value of transrectal real-time tissue elastography (TRTE) combined with multi parameter magnetic resonance imaging (MRI) in prostate biopsy.

Methods

One hundred and five patients of suspected prostate cancer patients were treated from December 2013 to December 2015 in Jiaxing Traditional Chinese Medicine Hospital. All the patients were confirmed by operation and pathology. Transrectal ultrasonography guided biopsy was performed in 105 patients after TRTE and MRI examinations, respectively, including routine 6 point needle biopsy and targeted biopsy of the positive area. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of TRTE, MRI and TRTE combined with MRI guided biopsy in the diagnosis of prostate cancer were evaluated with the results of operation and pathology as the gold standard.

Results

Surgical pathology confirmed that there were 44 benign prostatic nodules and 61 cases of prostate cancer in 105 cases. Fifty-two cases of prostate cancer was diagnosed by TRTE, and 45 cases were confirmed by operation and pathology. Fifty-six cases of prostate cancer was diagnosed by MRI, and 48 cases were confirmed by operation and pathology. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosing prostate cancer by TRTE, MRI and TRTE combined with MRI guided percutaneous biopsy were 71.4%, 84.0%, 78.0%, 0.865, 0.698, 78.6%, 81.8%, 80.0%, 0.857, 0.734, 90.1%, 88.6%, 89.5%,0. 916 and 0.866. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of diagnosing prostate cancer by TRTE combined with MRI guided biopsy were higher than those of TRTE and MRI.

Conclusions

Both TRTE and MRI have their respective advantages. The accurate localization before puncture is helpful to develop individualized program for prostate puncture, and the combining use of the two methods can improve the detection rate of prostate cancer.

图4~6 前列腺移行区结节弹性图(图4)及磁共振成像图(图5、6)。图4左图为二维灰阶超声声像图,二维经直肠超声检查示为前列腺移行区大小为23 mm×32 mm的等回声区(箭头所示),右图为超声弹性成像图,弹性成像表现为蓝绿相间,主要为绿色(绿色区域面积>50%)(箭头所示),弹性评分Ⅱ分,病理证实为前列腺癌;图5为磁共振成像DWI可见前列腺中央区小片状高信号影;图6示前列腺中央区结节磁共振成像ADC值0.000 719
表1 TRTE诊断前列腺良恶性结节与手术病理结果比较(例)
表2 MRI诊断前列腺良恶性结节与手术病理结果比较(例)
表3 TRTE联合MRI引导穿刺活检诊断前列腺良恶性结节与手术病理结果比较(例)
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