体外线圈行前列腺磁共振波谱检查在高龄患者中的应用

Application of prostate MRS with external coil in advanced age patients

目的探讨适合于高龄患者的简便、高效、无创性前列腺磁共振波谱(MRS)检查方法。方法 40例临床可疑前列腺癌的患者(平均年龄76岁),在3T场强下采用体外线圈行前列腺MRI和前列腺多体素质子磁共振波谱(1HMRS)检查。以系统穿刺活检病理诊断为标准,计算并比较前列腺正常外周带、外周带病变、前列腺增生及内腺癌灶的(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]比值。结果 40例疑似患者均顺利完成检查。其中前列腺增生15例,前列腺癌18例,不典型增生2例,前列腺上皮内瘤2例,前列腺炎2例,前列腺结核1例。前列腺外周带癌、不典型增生与前列腺炎及前列腺结核单凭MRI很难鉴别;但MRS表现有助于鉴别诊断,前列腺癌、不典型增生及前列腺上皮内瘤(Cho+Cre)/Cit增高,与正常外周带差异有统计学意义(P<0.01),前列腺炎及(Cho+Cre)/Cit与正常外周带差异无统计学意义。前列腺结核(Cho+Cre)/Cit较正常外周带下降。以间质增生为主的前列腺增生需注意与发生在内腺的前列腺癌鉴别,但内腺癌MRI病灶周围无低信号环围绕,且内腺癌(Cho+Cre)/Cit比值高于前列腺增生,二者间差异有统计学意义(P<0.01)。结论用体外线圈行MRS检查简便、高效、无创,对前列腺疾病有鉴别诊断作用,尤其适合高龄前列腺疾病患者。

Objective To investigate the convenient and high performance magnetic resonance spectroscopy（MRS）method without invasion that suitable in advanced age patients.Methods Forty suspicious prostate cancer patients（mean age 76）accepted 1HMRS（H-1 magnetic resonance spectroscopy）and MRI（magnetic resonance imaging）at 3 T with external coil.Combined with T2WI,voxels were divided into healthy peripheral zone,cancer tissue in peripheral zone,central gland,cancer tissue in central gland,by ultrasound guided systemic biopsy histopathologic findings as standard.Ratios of（Cho＋Cre）/Cit were calculated and compared among different groups.Results All the patients completed the examination.There were 15 cases of benign prostatic hyperplasia,18 cases of prostate cancer patients and 2 cases of prostatic intraepithelial neoplasia,2 cases of atypical hyperplasia,2 cases of prostatitis,one of prostate tuberculosis.There weren＇t clear discrimination among prostate cancer in peripheral zone,intraepithelial neoplasia,atypical hyperplasia,prostatitis and prostate tuberculosis.Ratios of voxels from healthy peripheral zone were statistically difference from cancer tissue of peripheral zone,but not in prostatitis and prostate tuberculosis.Hyperplasia could be differentiating from prostate cancer in central gland,which hadn＇t low signal around and had higher ratios.Conclusions MRS with external coil was convenient and high performance without invasion,which is suitable especially in advanced age patients,it helps differentiation for prostatic diseases.