不同Gleason评分前列腺癌超声造影表现

The difference in enhancement patterns of prostate cancer with different Gleason scores

目的探讨不同Gleason评分前列腺癌的超声造影表现差异。方法 65例经直肠前列腺超声引导下穿刺活检确诊为前列腺癌的患者纳入本研究。穿刺前首先先进行经直肠前列腺超声造影与超声引导下前列腺穿刺活检。根据前列腺癌Gleason分级分为Gleason评分≥4+3组(35例)和Gleason评分≤3+4组(30例)。记录两组前列腺癌超声造影表现并进行统计分析。结果 33.3%(10/30)Gleason评分≤3+4与62.9%(22/35)Gleason评分≥4+3的前列腺癌造影表现为快速增强(P=0.018),30.0%(9/30)Gleason评分≤3+4与68.6%(24/35)Gleason评分≥4+3的前列腺癌造影表现为高增强(P=0.002),80.0%(28/35)Gleason评分≥4+3的前列腺癌造影可以观察到不对称血管结构的存在,33.3%(10/30)Gleason评分≤3+4的前列腺癌造影表现存在不对称血管结构(P=0.000),54.3%(19/35)Gleason评分≥4+3与13.3%(4/30)Gleason评分≤3+4的前列腺癌造影表现为快退(P=0.001),53.3%(16/30)Gleason评分≤3+4的前列腺癌造影后病灶边界清楚,91.4%(32/35)Gleason评分≥4+3的前列腺癌造影后病灶边界清楚(P=0.001)。43.3%(13/30)Gleason评分≤3+4与80.0%(28/35)Gleason评分≥4+3的前列腺造影呈不均匀性增强(P=0.002)。结论不同Gleason评分的前列腺癌超声造影表现存在差异,通过观察超声造影表现差异对判断前列腺癌的Gleason分级具有一定临床价值。

Objective To compare enhancement patterns in prostate cancer（PCa） with different Gleason scores（GS） by contrast-enhanced transrectal ultrasound（CETRUS）.Methods A total of 65 conspicuous prostatic cancers detected by transrectal ultrasound（TRUS） were enrolled in this study.Each patient had successive grey-scale TRUS,CETRUS,and targeted-biopsy of prostate under ultrasound guidance on the same day.Patients were classified into two groups of PCa with GS≤3＋4=7（n=30） and PCa with GS≥4＋3=7（n=35） according to the pathological findings.The videotapes and cineloops of CETRUS were reviewed by two radiologists blinded to the final diagnosis,who answered identical questions about enhancement patterns of the lesion.The κ values were calculated for interreaders agreement.Results One third of PCa with GS≤3＋4=7 and 62.9% of PCa with GS≥4＋3=7 displayed rapid enhancement,30% of PCa with GS≤3＋4=7 and 68.6% of PCa with GS≥4＋3=7 were shown with increased enhancement（P=0.002）;The suspiciously asymmetric vessels could be observed in one third of PCa with GS≤3＋4=7 and 80% of PCa with GS≥4＋3=7（P=0.000）;54.3% of PCa with GS≥4＋3=7 and 13.3% of PCa with GS≤3＋4=7 appeared as rapid washout of agent（P=0.001）;clear border of lesion after enhancement could be observed in 91.4% of PCa with GS≥4＋3=7 and 53.3% of PCa with GS≤3＋4=7（P=0.001）.Conclusion There were significant difference in enhancement patterns between PCa with different GS.Observing enhancement patterns could be benefit for identification of PCa with different GS.