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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (01) : 66 -71. doi: 10.3877/cma.j.issn.1672-6448.2019.01.015

所属专题: 文献

生殖泌尿超声影像学

经直肠多模态超声影像评分系统诊断前列腺癌的临床研究
张明博1, 罗渝昆1,, 张艳1, 王一茹1, 吴猛1, 唐杰1, 费翔1   
  1. 1. 100853 北京,解放军总医院超声诊断科
  • 收稿日期:2018-07-04 出版日期:2019-01-01
  • 通信作者: 罗渝昆
  • 基金资助:
    国家自然科学基金(81501498)

The clinical study of multi-mode trans-rectal ultrasonic imaging scoring system in the diagnosis of prostate cancer

Mingbo Zhang1, Yukun Luo1,, Yan Zhang1, Yiru Wang1, Meng Wu1, Jie Tang1, Xiang Fei1   

  1. 1. Department of Ultrasound, Chinese People's Liberation Army General Hospital, Beijing 100853, China
  • Received:2018-07-04 Published:2019-01-01
  • Corresponding author: Yukun Luo
引用本文:

张明博, 罗渝昆, 张艳, 王一茹, 吴猛, 唐杰, 费翔. 经直肠多模态超声影像评分系统诊断前列腺癌的临床研究[J/OL]. 中华医学超声杂志(电子版), 2019, 16(01): 66-71.

Mingbo Zhang, Yukun Luo, Yan Zhang, Yiru Wang, Meng Wu, Jie Tang, Xiang Fei. The clinical study of multi-mode trans-rectal ultrasonic imaging scoring system in the diagnosis of prostate cancer[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(01): 66-71.

目的

建立前列腺癌多模态超声影像评分系统,并评价该评分系统对前列腺癌的诊断价值。

方法

选取2016年5月至2017年12月在解放军总医院行超声引导下穿刺活检和(或)手术切除的86例可疑前列腺癌患者,术前对前列腺行经直肠常规超声、剪切波弹性成像、超声造影检查,分析三种模态超声影像特征,并与手术或穿刺病理进行对照。总结前列腺癌经直肠多模态超声影像特征,建立评分系统,并评价该系统对前列腺癌的诊断价值。

结果

前列腺癌常规超声表现为低回声、边界不清、形态不规则、内外腺分界不清、包膜侵犯、血流信号丰富且为中心血流;剪切波弹性成像表现为非对称分布,前列腺癌病灶平均弹性模量高于良性病灶[(94.7±44.2)kPa vs(60.8±26.0)kPa],差异有统计学意义(t=-3.578,P=0.001);超声造影表现为快速高增强,分布不均匀(低增强区伴点状血管结构,点状、片状或结节状高增强),内外腺分界不清,包膜或直肠壁侵犯。常规超声、超声造影、弹性成像有1项阳性即诊断为前列腺癌,其敏感度、阴性预测值和准确性分别为98.0%、96.7%和89.5%;三者均为阳性诊断为前列腺癌,其特异度和阳性预测值分别为97.3%和97.1%。

结论

经直肠多模态超声影像评分系统可提高超声对前列腺癌的诊断价值。

Objective

To establish a multi-modal trans-rectal ultrasonic imaging scoring system for prostate cancer and to evaluate its diagnostic value.

Methods

From May 2016 to December 2017, 86 patients with suspected prostate cancer who received ultrasound (US) guided biopsy and/or surgery were enrolled in the study. The characteristics of trans-rectal conventional US (TRUS), shear wave sonoelastography (SWE) and contrast enhanced ultrasound (CEUS) were analyzed for each prostate with comparison of pathological results. And multi-mode scoring system were established for the diagnosis of prostate cancer.

Results

For prostate cancer, TRUS showed low echo, unclear boundary, irregular shape, unclear internal and external gland boundary, capsule invasion, rich blood flow signal and center vascularization; SWE showed asymmetric distribution with higher average elastic modulus [(94.7±44.2) kPa] than that of benign lesions [(60.8±26.0) kPa], the difference was statistically significant (t=-3.578, P=0.001); CEUS showed rapid and high enhancement, heterogeneous distribution (low enhanced area with punctate vascular structure), punctate or nodular enhancement, unclear internal and external gland boundary, capsular or rectal wall invasion. If any of TRUS, SWE and CEUS findings was positive, the sensitivity, negative predictive value and accuracy of multi-mode trans-rectal US were 98.0%, 96.7% and 89.5% respectively. If all of TRUS, SWE and CEUS findings were positive, the specificity and positive predictive value of multi-mode trans-rectal US were 97.3% and 97.1% respectively.

Conclusion

Trans-rectal multimodal ultrasonic imaging scoring system can improve the diagnostic value of ultrasound on prostate cancer.

表1 前列腺癌及前列腺增生患者一般资料
表2 前列腺癌及前列腺增生患者常规超声特征
表3 前列腺患者剪切波超声弹性成像及超声造影特征
图1 良性前列腺增生患者多模态超声图像。图a为二维超声未见明显病灶;图b为彩色多普勒超声血流分布对称;图c为剪切波弹性成像呈对称性分布;图d为超声造影内腺均匀稍高增强,外腺均匀稍低增强;诊断为良性,与病理结果相符
图2 前列腺癌患者多模态超声图像。图a为二维超声左侧周围区内侧可见一低回声结节,边界清晰,形态规则;图b为彩色多普勒超声周边可见少许血流信号;图c、d为剪切波弹性成像不对称性分布;图e、f超声造影结节呈稍高增强,结节处包膜侵犯。诊断为恶性,手术病理:前列腺腺癌,Gleason分级4+3=7分。诊断与病理结果相符)
表4 常规超声、超声造影、弹性成像、多模态超声对前列腺癌的诊断价值
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