高b值磁共振弥散加权成像引导前列腺穿刺的研究

Study of high-b-value diffusion-weighted imaging-guided prostate biopsy

目的探讨高b值磁共振弥散加权成像(MRI-DWI)提高经直肠前列腺穿刺阳性率的可行性及价值。方法对77例临床疑似前列腺癌患者行MRI-DWI扫描,检查后1个月内完成前列腺穿刺,采用5区13针穿刺与MRI-DWI定位穿刺相结合的方法。根据穿刺病理结果,分别统计常规B超引导穿刺与MRI-DWI引导穿刺诊断癌灶的总检出率和多灶性病变检出率,以及中央腺病变和周围带病变的检出率。结果经病理共证实35例前列腺癌,MRI-DWI引导与超声引导穿刺的检出率分别为62.9%和80.0%(P=0.23);对多灶性病变的检出率分别为58.3%和33.3%(P<0.05)。MRI-DWI对中央腺前列腺癌的检出尤其对前列腺增大基础上的癌灶检出具有优势(76.5%vs.47.1%,P<0.05),B超引导穿刺对周围带前列腺癌的检出具有优势(89.3%vs.57.1%,P<0.05)。结论 MRI-DWI有助于发现可疑癌灶,尤其对位于中央腺常规穿刺易漏诊部位的可疑病灶。高b值MRI-DWI有助于提高前列腺穿刺活检的阳性率。

Objective To investigate the value of high-b-value diffusion-weighted imaging(DWI) combined with transrectal ultrasound-guided prostrate biopsy in detection of prostate cancer.Methods MRI-DWI was performed in 77 patients with suspected prostate cancer before 13-core prostate biopsy in combination of MRI-DWI.According to the results of pathology,the detection rates of prostate cancer located in central gland and peripheral zone and multiple lesions were analyzed.Results A total of 35 cases of prostate cancer were proved.The total detection rates of prostate cancer by MRI-DWI and 13-core biopsy were 62.9% and 80.0%(P=0.23).The detection rates of multiple lesions by MRI-DWI and 13-core biopsy were 58.3% and 33.3%(P<0.05).MRI-DWI was superior in detection of prostate cancer in central gland(76.5% vs.47.1%,P<0.05),while,13-core biopsy was superior in detection of prostate cancer in peripheral zone(89.3% vs.57.1%,P<0.05).Conclusion MRI-DWI can improve the detection rate of prostate cancer in central gland especially on the basis of benign prostatic hyperplasia.High-b-value MRI-DWI is useful for improving detection rate.