经直肠多普勒超声及超声造影在鉴别前列腺良恶性结节中的应用价值

Transrectal Doppler and contrast-enhanced ultrasonography to siscriminate benign and xancerous nodules in prostate

目的 探讨经直肠多普勒超声及超声造影检查鉴别前列腺良恶性结节的临床价值.方法 应用彩色和能量多普勒超声（PDUS）及血流分析软件,记录52例患者共67个前列腺结节的峰值血流指数（PVI）,比较不同超声条件下前列腺良恶性结节组问PVI的差异.经直肠超声造影检查观察结节及其周围腺体组织造影增强模式,并对外腺低回声病灶行穿刺病理检查. 结果52例患者超声检出前列腺恶性结节32个,良性结节35个,恶性结节PVI为0.38±0.16、良性结节0.24±0.10（P=0.0023）;PDUS检测PVI分别为0.55±0.18、0.32±0.21（P〈0.01）,ROC曲线下面积0.817,95%,可信区间0.704～0.901.超声造影检查30个良性结节表现为与周围实质同步灌注,增强强度低于或接近周围实质;32个恶性结节表现为灌注早于周围实质,增强强度高于周围内外腺实质.结论 PDUS检测定量参数PVI是鉴别前列腺良恶性结节的有效指标,经直肠超声造影检查有助于前列腺外腺良恶性结节的鉴别诊断.

Objective To investigate the value of transrectal Doppler and contrast-enhanced ultrasonography（CETRUS）to discriminate benign and cancerous nodules in prostate. Methods Fifty-five patients with hypoechoic lesions（35 biopsy-proven benign nodules and 32 prostate cancer nodules）in the prostate underwent Color and power Doppler uhrasonography（PDUS）,and the parameter of peak vascularization index（PVI）in each prostate nodule was recorded and the differences of PVI in the benign and cancerous nodules were analyzed.CETRUS was then performed on all cases.The enhancement patterns of the lesions and their surrounding peripheral zone tissues were observed.After CETRUS,lesion-specific TRUS-guided biopsy and the routine sextant biopsy were performed subsequently. Results PVI of 32 prostate cancerous nodules and 35 prostate benign nodules were （0.38±0.16）,（0.24±0.19）,respectively,measured by color Doppler ultrasonography.And the former was significantly higher than the latter（P=0.0023）.PVI of the cancerous nodules and the benign nodules were（0.55±0.18）,（0.32±0.21）（P〈0.01）.Malignant lesions showed significant increased peak intensity and earlier arrival time compared with their surrounding outer gland tissue,while benign lesions showed nearly equal peak intensity and time to enhancement compared with their surrounding gland tissue by CETRUS. Conclusions PVI measured by PDUS was more effective than that measured by color Doppler to discriminate benign and cancerous nodules in prostate.CETRUS could be helpful in discriminatory performance of benign and cancerous nodules in prostate.