弥散加权磁共振联合经直肠超声定位的前列腺穿刺活检的初步运用

Combined usage of diffusion-weighted magnetic resonance imaging and transrectal ultrasound for transrectai prostate biopsy： a preliminary study

目的 检测弥散加权磁共振（MRDWI）诊断前列腺癌的敏感度和特异度.方法 回顾性分析2009年1月至2010年12月在复旦大学附属肿瘤医院泌尿外科行MRDWI联合经直肠超声（ TRUS）定位下前列腺穿刺的141例患者资料,按前列腺特异抗原（PSA） ＜10 μg/L、10 μg/L≤PSA＜20 μg/L、20 μg/L≤PSA ＜50.μg/L和PSA≥50 μg/L将可疑患者分为4组（A～D）,按照前列腺6分区法将所得图像数据分区测量,统计各区的影像学诊断及对应穿刺标本的病理,并分别计算MRDWI和TRUS的敏感度和特异度.结果 A、B、C、D4组的穿刺诊断率分别为23.7％、35.5％、66.7％和96.3％.MRDWI敏感度显著优于TRUS,以患者为研究单位时,MRDWI在PSA＜ 10μg/L、10 μg/L≤PSA ＜20 μg/L、20 μg/L≤PSA＜ 50μg/L和PSA≥50 μg/L的患者中诊断敏感度分别为85.7％、72.7％、97.8％和100.0％,TRUS在各组对应的诊断敏感度为35.7％、36.4％、43.8％和65.4％.以穿刺标本为研究单位时,MRDWI在各组的诊断敏感度分别为85.5％、71.9％、91.5％和94.4％,TRUS在各组对应的敏感度为23.4％、34.5％、68.9％和89.3％.结论 MR弥散加权成像诊断前列腺癌的初步结果显示其敏感度显著优于TRUS,且临床操作便捷、高效.对于前列腺癌可疑患者,建议行MRDWI及TRUS联合定位的可疑病灶加系统穿刺法.

Objective To retrospectively analyze the clinical value of difftision-weighted magnetic resonance imaging （MRDWI） in the detection of prostate cancer in suspected patients.Methods Between January 2009 and December 2010,141 patients with suspected prostate cancer underwent MRDWI and transrectal ultrasound （TRUS） guided prostate biopsy.They were divided into 4 groups by prostate surface antigen （PSA） 〈10 μg/L,10 μg/L≤PSA 〈20 μg/L,20 μg/L≤PSA 〈50 μg/L and PSA≥50 μg/LThen the diagnostic accuracy of MRDWI was tested.Results The diagnostic rate of patients with PSA 〈10 μg/L,10 μμg/L ≤ PSA 〈 20 μg/L,20 μg/L ≤ PSA 〈 50 μg/L and PSA ≥ 50 μg/L were 23.7%,35.5%,66.7% and 96.3% respectively.The sensitivity of MRDWI was significantly better than TRUS.In patients with PSA 〈 10 μg/L,10 μg/L≤PSA 〈20 μμg/L,20 μg/L-≤PSA 〈50 μg/L and PSA≥50 μg/L,the patient-based sensitivities were 85.7%,72.7%,97.8%,100.0% respectively; when based by segment of specimen,the sensitivities were 85.5%,71.9%,91.5% and 94.4% respectively.Conclusion The sensitivity of MDWI is significantly better than TRUS in the diagnosis of prostate cancer.The combined use of MDWI and TRUS has the benefit of guiding the biopsy of cancer foci in patients with suspected prostate cancer.