弥散加权磁共振联合直肠超声经会阴前列腺穿刺56例报告

Report of 56 cases about transperineal prostate puncture through magnetic resonance diffusion weighted imaging combined with transcrectal ultrasound

目的探讨弥散加权磁共振(MRDWI)诊断前列腺癌(PCa)的敏感度和特异度。方法回顾性分析2011年7月至2012年8月在郑州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56例患者资料,按前列腺特异抗原(PSA)<10μg/L,10μg/L≤PSA<20μg/L,PSA≥20μg/L将可疑患者分为3组(A～C)。MRI医师、超声医师、泌尿外科医师联合读片确定可疑病灶;穿刺方案为TRUS引导下进行经会阴可疑病灶穿刺加系统10针前列腺穿刺,穿刺各针标本注明穿刺部位后分瓶送病理检查。统计各针的影像学诊断及对应的病理,分别计算MRDWI和TRUS的敏感度和特异度。结果 MRDWI敏感度显著优于TRUS,MRDWI在A、B、C 3组的患者中诊断敏感度分别为88.9%、93.3%、94.6%,TRUS在各组对应的诊断敏感度为27.8%、53.3%、51.8%。结论 MRDWI诊断PCa的初步结果显示准确性较高,敏感度显著优于TRUS,TRUS引导穿刺MRDWI可疑前列腺结节简单、准确、易行,对于可疑PCa患者,建议行MRDWI及TRUS联合定位的可疑病灶加系统穿刺活检。

Objective To detect the sensitivity and specificity of using MRDWI on diagnosis of prostate cancer（PCa）.Methods A retrospective analysis of the urology line MRDWI combined TRUS localization of 56 patients′ prostate puncture data from Affiliated Tumor Hospital of Zhengzhou University in July 2011 to August 2012,prostate-specific antigen（PSA） 10 μg/L,10 μg/L ≤ PSA 20 μg/L,PSA≥20 μg/L,suspicious patients were divided into three groups（A,B,C）.Joint reading piece from MRI physician,sonographer and urologists to identify suspicious lesions;the puncture scheme for TRUS guided suspicious lesions puncture plus transperineal 10-pin prostate biopsy system,indicated the puncture site of puncture bottle after each needle specimens and sent for pathological examination.Statistics of each needle imaging diagnosis and the corresponding pathological were conducted,MRDWI and the sensitivity and specificity of TRUS were calculated.Results Sensitivity of MRDWI was significantly better than TRUS lesions,diagnostic sensitivities of MRDWI in groups A,B,C,were 86.1%,73.2%,98.2%,and those of TRUS in three groups were 36.1%,36.8% and 51.2%.Conclusion Preliminary results showed that the accuracy and sensitivity of MRDWI in the diagnosis of PCa was significantly better than TRUS lesions,and TRUS guided puncture MRDWI suspicious prostate nodule was simple,accurate,and easy,suspicious PCa patients will propose line MRDWI and TRUS co-locating suspicious lesions plus system puncture.