前列腺癌影像学误诊分析

Analysis of the imaging misdiagnosis of prostate carcinoma

目的 研究前列腺癌影像学误诊的情况，探讨不同影像学检查在前列腺癌的确诊中的意义。方法 从天津市前列腺癌数据库中检索出1984-2006年有影像学检查结果的病例共1201例患者，对影像学诊断结果与最后所确诊的前列腺癌不符的病例进行回顾性分析。结果 585例经腹部超声检查结果中，误诊264例，误诊率45．1％；经直肠超声检查178例，误诊18例，误诊率10．1％；CT检查264例，误诊91例，误诊率34．5％；MRI检查174例，误诊13例，误诊率7．5％。经统计学分析，MRI误诊率最低，其次是经直肠超声，然后是CT，误诊率最高者为经腹部超声检查，MRI与经直肠超声检查的误诊率差异无统计学意义。结论 经腹部超声检查作为重要筛查手段应进一步提高确诊率，经直肠超声检查主要用于前列腺活检，与盆腔MRI相比没有优势。CT检查可用于前列腺癌转移病灶的发现，对早期前列腺癌误诊率较高。MR／检查由于具有无创、方便而且误诊率低的优点，应是确诊前列腺癌的首选影像学检查方法。

Objective To find out the significance of different radiological examinations in the diagnosis of the prostate carcinoma through studying their radiological misdiagnosis rate. Methods By searching for patients having radiological examination results in the database of prostate carcinoma in Tianjin, got the patients whose examination results were different from prostate carcinoma. Analyzed the misdiagnosis rate of each kind of imaging diagnosis using Х^2-test retrospectively. Results In all patients searched, the misdiagnosis rate of transabdominal ultrasonography, transrectal uhrasonography （TRUS）, CT, MRI was 45.1%, 10.1%, 34.5% and 7.5% respectively. Statistical analysis showed that the misdiagnosis rate of MRI was the lowest, then TRUS, and CT. Transabdominalultrasonography had the highest misdiagnosis rate. There was not significant difference between MRI and TRUS. Conclusions As an efficient and important screening method, transabdominal uhrasonography still need to get a higher definite diagnosis rate. TRUS don＇t have obvious advantages over pelvis MRI in the diagnosis of prostate carcinoma except its usefulness in the biopsy of prostate. Pelvis MRI is still the most important imaging diagnosis of prostate carcinoma and should be first choice because of its noninvasive intervention, convenience and lowest misdiagnosis rate.