PSA灰区值时MRI+MRS在早期诊断前列腺癌中临床意义

Role of MRI + MRS in early diagnosis of prostate cancer of PSA gray zone

目的探讨PSA灰区值时,MRI+MRS在早期诊断前列腺癌中临床意义。方法对92例PSA4-10ng/ml患者行MRI+MRS检查,对MRI异常和(或)MRS检查(胆碱+肌酸)/枸橼酸盐(Cho+Cre/Cit)≥0.75患者进行前列腺穿刺活检,MRI+MRS无异常者,有手术指征行前列腺电切术,术后行病理检查,无手术指征定期随访。结果 73例MRI异常和(或)Cho+Cre/Cit≥0.75穿刺后,12例前列腺癌,其中1例前列腺癌患者MRI示前列腺肿瘤已侵及前列腺包膜,19例MRI+MRS无异常者术后病理1例前列腺癌。阳性组(前列腺癌组)Cho+Cre/Cit值与阴性组(前列腺增生)相比差异显著(P<0.05)。结论 PSA4-10ng/ml前列腺增生患者,常规行MRI+MRS,有助于前列腺癌早期诊断及临床分期,以Cho+Cre/Cit≥1.29为穿刺的最佳临界值,但有待大样本研究进一步证实及界定。

Objective To discuss MRI＋MRS clinical significance for the early diagnosis of prostate cancer When PSA in a gray zone. Methods 92 patients whose PSA was 4-10ng/ml underwent MRI＋MRS examination,those patients whose MRI（or） MRS was abnormal[（choline＋creatine）/citrate（Cho＋Cre/Cit）≥0.75] underwent prostate biopsy,other patients whose MRI＋MRS was normal underwent transurethral resection of the prostate if they have the operation indications,and pathological examination after opera-tion. We follow up the patients without operation indication. Results 73 patients with Cho＋Cre/Cit≥0.75 underwent puncture,12 cases of prostate cancer,One example of prostate cancer MRI showed the tumor has invaded the prostate capsule,and 1 patient of prostate cancer in 19 cases of normal MRI＋MRS. Positive group （prostate cancer） Cho＋Cre/Cit value and negative （benign prostatic hyperplasia） compared to the significant difference （P〈0.05）. Conclusion The patients with PSA4-10ng/ml underwent routine MRI＋MRS,which contribute to the early diagnosis of prostate cancer and clinical stage,the best critical value of prostate biopsy is Cho＋Cre/Cit≥1.29,but the conclusion must be confirmed and defined through a large sample study further.