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中华医学超声杂志(电子版) ›› 2019, Vol. 16 ›› Issue (06) : 458 -464. doi: 10.3877/cma.j.issn.1672-6448.2019.06.009

所属专题: 文献

生殖泌尿超声影像学

MRI-TRUS融合引导经会阴前列腺靶向结合饱和穿刺活检的临床应用
王琦1, 蔡杰2,(), 欧彤文1, 崔昕1(), 吴江涛1, 陈晓松1   
  1. 1. 100053 北京,首都医科大学宣武医院泌尿外科
    2. 100053 北京,首都医科大学宣武医院普通外科
  • 收稿日期:2018-08-29 出版日期:2019-06-01
  • 通信作者: 蔡杰, 崔昕

Clinical application of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer

Qi Wang1, Jie Cai2(), Tongwen Ou1, Xin Cui1,(), Jiangtao Wu1, Xiaosong Chen1   

  1. 1. Department of Urology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
    2. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
  • Received:2018-08-29 Published:2019-06-01
  • Corresponding author: Jie Cai, Xin Cui
  • About author:
    Corresponding author: Cai Jie, Email:
引用本文:

王琦, 蔡杰, 欧彤文, 崔昕, 吴江涛, 陈晓松. MRI-TRUS融合引导经会阴前列腺靶向结合饱和穿刺活检的临床应用[J/OL]. 中华医学超声杂志(电子版), 2019, 16(06): 458-464.

Qi Wang, Jie Cai, Tongwen Ou, Xin Cui, Jiangtao Wu, Xiaosong Chen. Clinical application of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2019, 16(06): 458-464.

目的

探讨磁共振成像-经直肠超声(MRI-TRUS)融合引导经会阴前列腺靶向结合饱和穿刺活检的临床应用价值。

方法

选取2018年3月至2018年7月在首都医科大学宣武医院泌尿外科收治的可疑前列腺癌患者15例,所有患者均行前列腺MRI和经直肠前列腺超声(TRUS)检查,并进行MRI-TRUS融合引导下经会阴前列腺靶向结合饱和穿刺活检术。根据患者前列腺影像报告和数据系统(PI-RAIDS)评分及MRI-TRUS融合图像,以不同颜色标记出高度怀疑为前列腺癌结节区域及可疑结节区域,作为穿刺靶区及可疑靶区。每例患者于靶区、可疑靶区及非靶区共穿刺30~36针。分析患者的穿刺阳性率、病理结果及并发症。

结果

15例患者共标记20个靶区和5个可疑靶区,来自12例患者的17个靶区和3个可疑靶区穿刺结果为阳性,靶向穿刺总阳性率为80%(20/25),所有阳性病例的穿刺病理结果均为前列腺腺泡癌。其余3例患者的3个靶区和2个可疑靶区穿刺结果为阴性,病理结果回报为前列腺增生伴炎症改变。5例于非靶区同时发现前列腺癌细胞,于非靶区诊断前列腺癌阳性率为33.3%(5/15)。15例患者中仅1例术后出现血尿,于术后第2天缓解,2例出现会阴区疼痛不适,于术后第3天缓解,所有患者均未出现血便、发热、脓毒血症、急性尿潴留等并发症。

结论

MRI-TRUS融合引导前列腺靶向结合饱和穿刺活检阳性率高,术后并发症少且轻,安全可行,是临床理想的前列腺穿刺活检方法。

Objective

To assess the clinical value of MRI-TRUS fusion guided transperineal prostate targeting combined with saturation biopsy in patients with suspected prostate cancer.

Methods

From March 2018 to July 2018, 15 patients with suspected prostate cancer were treated at the Department of Urology, Xuanwu Hospital of Capital Medical University. All patients underwent prostate MRI and transrectal ultrasound (TRUS). MRI-TRUS fusion guided transperineal prostate targeting combined with saturated prostate biopsy was performed. According to the patient's PI-RAIDS score and MRI-TRUS fusion image, the highly suspected prostate cancer nodule area and suspicious nodule area were marked in different colors, which were used as puncture target and suspicious target areas. A total of 30 or 36 puncture needles were punctured in the target area, suspicious target area, and non-target area in each patient. The positive rate of puncture, pathological results, and complications were analyzed.

Results

A total of 20 targets and 5 suspicious targets were labeled in 15 patients. The puncture results from 17 targets and 3 suspicious targets in 12 patients were positive. The total positive rate of targeted puncture was 80% (20/25). The pathological results of puncture in all positive cases were prostate acinar carcinoma. The puncture results from 3 target areas and 2 suspicious target areas in the other 3 patients were negative, and the pathological results were reported as benign prostatic hyperplasia (BPH) with inflammatory changes. Prostate cancer cells were found in 5 cases at the same time in non-target area. The positive rate of prostate cancer diagnosed in non-target area was 33.3% (5/15). Of the 15 patients, only 1 developed hematuria after operation, which resolved on the 2nd day after operation, and 2 had perineal pain discomfort, which resolved on the 3rd day after operation. No patients had complications such as bloody stool, fever, sepsis, and acute urinary retention.

Conclusion

MRI-TRUS fusion guided transperineal prostate targeting combined with saturated biopsy has the advantages of high positive rate, few postoperative complications, and high safety and feasibility, representing an ideal method for prostate biopsy.

图1 前列腺轮廓及靶区的磁共振成像-经直肠超声(MRI-TRUS)融合图像。右上图为前列腺超声各横切面图像,依据MRI影像预先描画前列腺周围轮廓线并与实时超声图像融合,并标记病灶靶区,以不同颜色标记出前列腺癌靶区及可疑靶区;左上图为前列腺矢状面超声实时图像,可显示超声与MRI融合后的前列腺轮廓及靶区;左下图显示红线可跟随经直肠超声探头左右转动调节,指向图中代表模板的穿刺位点(绿色点),用以选取适合的穿刺位置
图2 磁共振成像-经直肠超声(MRI-TRUS)融合引导前列腺穿刺实时图像。左上图显示指示红线已旋至穿刺靶区(红色圈),指示进针的模板位点(小绿点为模板位点,大绿点为已穿刺标记);右图为前列腺矢状位超声实时图像,可显示该层面的穿刺针道,进针深度已到达穿刺靶区并描记(绿色横线);左下图为前列腺3D容积显示病灶相对位置
图3 磁共振成像-经直肠超声(MRI-TRUS)融合引导前列腺穿刺的可视化图像。前列腺3D容积图上直观显示各穿刺针的位置及深度,图中显示了两个靶区(黄色及红色)以及靶区和非靶区的饱和穿刺位置(绿色)。
表1 经会阴前列腺靶向结合饱和穿刺活检患者的穿刺情况分析
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