经直肠前列腺超声造影参数成像的临床应用研究

The clinical practice of contrast-enhanced transrectal ultrasound with parametric imaging for differential diagnosis of prostatic nodules

目的评价经直肠前列腺超声造影参数成像在鉴别诊断前列腺结节性质的临床应用价值。方法临床疑诊为前列腺癌的59例患者根据前列腺穿刺活检病理结果分为良性前列腺增生组(BPH)和前列腺癌组(PCa),于超声造影前,在二维灰阶模式下记录前列腺结节大小,并采用彩色多普勒血流成像(CDFI)记录结节内血流情况。然后在前列腺结节最大切面下行超声造影检查,采集病灶的10个造影参数,即曲线下面积(AUC)、平均渡越时间(mTT)、灌注指数(PI)、达峰时间(TTP)、峰值强度(IMAX)、停留时间(ResT)、上升时间(RT)、曲线上升支斜率(WiR)、曲线下降支斜率(WoR)及两斜率乘积(WiR×WoR),相应每个彩色编码的参数图像可自动获得,采用参数成像软件SonoProstate进行分析。结果对59例患者63个前列腺结节的超声造影参数统计分析发现,除AUC外其余9个参数两组间差异有统计学意义(P<0.01);前列腺癌组mTT、TTP、ResT及RT较良性前列腺增生组低,而PI、IMAX、WiR、WoR与WiR×WoR较良性前列腺增生组高。10个参数间的两两组合共有44种,其中39种参数间组合的双变量相关分析有统计学意义(P≤0.01或P≤0.05)。24种参数间两两组合为正相关关系,15种参数间两两组合为负相关关系。结论经直肠前列腺超声造影参数成像技术能够有效获得反映造影剂灌注特征的参数值,并有助于前列腺结节性质的鉴别诊断。

Objective To evaluate the clinical practice of contrast-enhanced transrectal ultrasound （CETRUS） in differential diagnosis of prostatic nodules. Methods A total of fifty-nine patients were enrolled in this study. All patients took CETRUS examination and lesion-targeted TRUS guided biopsy successively on the same day. The characteristics of parametric imaging were observed and 10 parameters were measured with SonoProstate software. The values of data were statistically analyzed by t＇ test, Kendall＇ s correlation and Spearman correlation test. Results The patients were classified into BPH （26 patients） and PCa （33 patients） groups according to pathological findings. The nine parameters were significant different between 2 groups （ P 〈 0.05 ）. The value of each parameter in PCa and BPH groups was shown respectively as follow： mTT（21.94 ± 8.89 vs 38.09 ± 22.31 ） ,PI（42.02 ± 23.17 vs 22.68 ± 13.29） ,TTP（ 10.72 ± 3.04vs 13.38 ± 4. 18） ,IMAX（41.45 ± 22.69 vs 22.85 ± 12.79） ,ResT（17.95 ± 10.39 vs 41.34 ± 36.25）,RT（8.72±2.87 vs11.22±3.91）,WiR（8.89±5.98 vs4.47±3.77）,WoR（1.75 ±1.17 vs 0.72± 0.53） ,WiR × WoR （21.12± 26.86 vs 4.33 ± 6.35 ）. There were 44 matches of parameters, in which 39 matches were significant different （ P 〈 0.05 ）. Twenty-four matches were positive correlation, while 15 matches were negative correlation. Conclusions The values of parameters which reflect characteristics of perfusion mode can be achieved by parametric imaging and can help for identifying prostatic nodules.