多指数磁共振与经直肠超声图像融合靶向引导经会阴前列腺穿刺活检的初步研究

Transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound

目的探讨多指数磁共振（mpMRI）与经直肠超声（TRUS）图像融合靶向经会阴前列腺穿刺活检对前列腺癌诊断的价值。方法回顾性分析经术前mpMRI诊断为可疑前列腺癌同时血清前列腺特异性抗原（PSA）〉4．0μg／L的62例患者的临床及影像资料。对全部可疑癌结节行靶向穿刺活检（TB），随后行12针系统性穿刺活检（SB）。对TB和SB的组织分别进行病理学分析。结果SB和TB共确诊PCa患者34例（54．8％），SB和TB穿刺针数的阳性率分别为7．53％和26．2％（P〈0．001），SB和TB穿刺阳性组织的长度分别为（3．71±2．77）mm和（5．00±3．04）mm（P=0．016），SB和TB穿刺阳性组织所占穿刺组织的比率分别为（28．77±20．13）％和（35．76±18．73）％（P=0．048）。通过SB和TB确诊为需要临床干预的前列腺癌针数分别为19针（2．6％）和48针（18．5％）（P〈0．001）。结论mpMRI与TRUS图像融合经会阴前列腺TB可以提高穿刺标本的质量，与SB协同使用可以提高前列腺癌的检出率。

Objective To evaluate the value of transperineal targeted biopsy with real-time fusion images of transrectal ultrasound （TRUS） and multiparametric magnetic resonance imaging （mpMRI） for the diagnosis of prostate cancer （PCa）. Methods Clinical and imaging data of 62 consecutive patients suspected of PCa at the mpMRI scan and PSA〉4.0 μg/L were retrospectively analyzed. Targeted biopsies （TB） were carried out for each cancer-suspicious lesion, and followed a systematic 12-core biopsy （SB） protocol. Pathological findings of TB and SB were analyzed. Results The age of the patients was （68.38 ± 6.57）years （range 51 - 79 years）. The preoperative PSA value was （10.21 ±5.57）~g/L （range 4.5 - 30. 1 μg/L）. Preoperative prostate volume was （34.05 ± 9.86）ml （range 19 - 64 ml）. The PCa patients detected by SB and/or TB were 34 （54.8%）. Cancer-detected rates of SB and TB cores were 7.53% and 26.2%, respectively （ P 〈0.001）. The positive core length of SB and TB cores were （3.71± 2.77）mm （range 1 - 14 mm） and （5.00 ± 3.04）mm （range 2- 17 mm）,respectively （ P = 0.016）. The positive core percent of SB andTBcores were （28.77 ± 20.13）% （range 7- 100%） and （35.76 ± 18.73）% （range 11% - 100%）, respectively （ P = 0.048）. Moreover,clinically cores detected by the SB and TB for final diagnosis of PCa were 19 cores （2.6%） and 48 cores （18.5%）,respectively （ P 〈0.001）. Conclusions Transperineal TB using real-time TRUS and mpMRI fusion imaging can improve sampling quality and elevate clinically detection rate of PCa when application combined with SB.