超声造影微血管成像与常规超声靶向引导前列腺癌穿刺活检的比较研究

Detection of prostate cancer with contrast-enhanced ultrasonographic mieroflow imaging： comparison with conventional ultrasonography

目的比较超声造影微血管成像（MFI）与常规超声在靶向引导前列腺癌穿刺活检中的临床应用价值。方法对65例因血清前列腺特异抗原（PSA）升高（≥4．00μg／L）的患者行经直肠前列腺穿刺活检，活检前患者接受经直肠灰阶超声、能量多普勒（CDE）及MFI检查。在超声引导下对每位患者行底、中、尖三切面12点穿刺，如穿刺切面有可疑病灶，则直接对病灶进行活检。以病理结果为标准，比较三项超声技术检出的前列腺癌病例数及穿刺点数。结果65例患者共穿刺780针，穿刺病理诊断为前列腺癌36例（55．4％）共230针（29．5％）。MFI检出前列腺癌34例，比灰阶超声（26例）及CDE（28例）能检出更多的病例数（P=0．021，P=0．031），有6例（16．7％）患者被MFI单独检出。MFI穿刺点阳性检出的敏感性及准确性（80．0%、83．1％）高于灰阶超声（47．0％、76．8％）及CDE（37．4％、74．6％）（P〈0．001，P〈0．001；P=0．001，P〈0．001）；其穿刺点阳性检出的特异性（84．4％）则低于灰阶超声（89．3％）及CDE（90．2％）（P=0．009，P〈0．001）。结论超声造影MFI技术较常规超声能检出更多的前列腺癌病例数，提高穿刺点阳性检出的敏感性及准确性。

Objective To evaluate the value of contrast enhanced ultrasonography microflow imaging （MFI） in detecting prostate cancer. Methods Sixty-five patients with serum prostate-specific antigen levels higher than 4.00 μg/L were evaluated with transrectal gray scale,power Doppler,and MFI ultrasonography and then biopsy guided by ultrasonography. Biopsy was performed at twelve sites in the base,the mid gland and the apex in each patient. In these three transverse sections, when any of the three methods showed abnormality, the biopsy site was directed to the abnormal loci. Diagnostic efficiency of the three methods for prostate cancer detection was compared based on biopsy results according to patient and biopsy site. Results Overall prostate cancers were detected in 230 （29.5%） of 780 specimens in 36（55.4%） of 65 patients. MFI could detect more patients（34） than gray scale（26） and power Doppler（28） （ P = 0. 021, P = 0. 031）, 6（16.7%）of the 36 patients diagnosed with cancer were identified only by MFI. By biopsy site, MFI had higher sensitivity and overall accuracy （80.0% and 83.1%） than gray-scale （47.0% and 76.8%） and power Doppler （37.4% and 74.6%） ultrasonography（P〈0.001, P〈0.001; P =0.001, P 〈0.001）, while the specificity of MFI was 84.4%, lower than gray-scale（89.3%） and power Doppler（90.2%） ultrasonography（ P =0. 009, P 〈 0.001 ）. Conclusions MFI could detect more patients and improve sensitivity and overall accuracy by biopsy site than conventional ultrasonography.