多参数MRI与经直肠超声实时融合引导前列腺靶向穿刺研究

Multiparametric magnetic resonance imaging/transrectal ultrasound （mpMRI/TRUS） fusion： a preliminary approach in targeted prostate biopsy

目的 评价多参数MRI与经直肠超声（TRUS）实时融合引导前列腺靶向穿刺的可行性与有效性.方法 2014年4月至2015年5月对32例经多参数MRI发现可疑前列腺癌病灶的患者行MRI/TRUS融合前列腺靶向穿刺.每例患者多参数MRI发现可疑灶数目1～2个.年龄47～ 82岁,中位年龄64岁.穿刺前PSA 1.11 ～33.54 ng/ml,中位PSA 8.73 ng/ml,其中PSA＜ 10 ng/ml者13例,10～20 ng/ml者10例,＞20 ng/ml者9例.患者首先行经直肠超声引导下12针前列腺系统穿刺,后将患者MRI DICOM格式文件导入超声系统（GE,Logiq E9）,将TRUS图像与MRI影像实时融合,锁定平面,对可疑病灶进行靶向穿刺,每个可疑灶穿刺2～3针.结果 本组32例多参数MRI发现可疑病灶患者,行前列腺系统穿刺活检和靶向穿刺活检共诊断前列腺癌21例.其中,4例系统穿刺结果阳性靶向穿刺结果阴性,1 1例系统穿刺结果和靶向穿刺结果均阳性,6例靶向穿刺结果阳性而系统穿刺结果阴性.前列腺系统穿刺诊断共15例,靶向穿刺诊断共17例.系统穿刺Gleason评分6～8分,平均7.13分,Gleason评分≤6分、7分、≥8分者分别占20％ （3/15）、46.7％ （7/15）、33.3％ （5/15）;靶向穿刺Gleason评分6～10分,平均7.47分,Gleason评分≤6分、7分、≥8分者分别占17.6％（3/17）、47.1％ （8/17）、35.3％ （6/17）.11例系统穿刺和靶向穿刺结果均阳性的患者中,3例靶向穿刺Gleason评分较系统穿刺高.结论 MRI/TRUS融合靶向穿刺可有效提高前列腺穿刺阳性率并降低高Gleason评分前列腺癌的漏诊率,其进一步推广依赖于前列腺肿瘤病灶精确成像和影像融合技术的发展.

Objective To evaluate the feasibility and efficacy of multiparametric magnetic resonance imaging/transrectal ultrasound （mpMRI/TRUS） fusion guided targeted prostate biopsy.Methods From March 2014 to May 2015, 32 patients with a suspected lesion of prostate cancer （PCa） by mpMRI examinations had undergone mpMRI/TRUS fusion prostate biopsy.The age of the patients was 47 ～ 82 years （median 64 years）.Serum PSA before biopsy was 1.11 ～33.53 ng/ml （median 8.73 ng/ml）.There were 13 cases with PSA 〈 10ng/ml, 10 cases PSA 10 ～ 20ng/ml, and 9 cases PSA 〉 20ng/ml.A 12-core systematic prostate biopsy guided by TRUS was performed, followed by real-time fusion of TRUS and MRI images after import of MRI DICOM images to the ultrasound system （GE, Logiq E9）.The plane for biopsy was located, and a 2-to 3-core targeted biopsy was performed for each suspected lesion.Results 21 of 32 patients （65.6%） were diagnosed with PCa.For each individual, one to two suspected lesions were located by mpMRI, with 2 to 3 cores sampled at each suspect lesion.Four cases were diagnosed by systematic biopsy only, 11 were diagnosed by both systematic and targeted biopsy, and 6 were diagnosed by targeted biopsy only.For systematic biopsies, Gleason Scores were 6-8 （mean： 7.13）, in which ≤6, 7, and ≥8 recorded 20% （3/15）、 46.7% （7/15）、 33.3% （5/15） , respectively.For targeted biopsies, Gleason Scores were 6 ～ 10 （mean： 7.47）, in which ≤6, 7, and ≥ 8 recorded 17.6% （3/17）、47.1% （8/17）、 35.3%（6/17）, respectively.For the 11 patients who were diagnosed both by systematic and targeted biopsy, three patients had a higher Gleason Score in targeted biopsy than in systematic ones.Conclusions mpMRI/TRUS fusion markedly increases positive rate in prostate biopsy and reduces misdiagnosis of PCa with a higher Gleason Score.Further application of such technique relies on a more precise imaging of PCa lesions and future development of fusion imaging technology.