实时超声造影在经直肠前列腺穿刺活检中的应用

Application value of real-time contrast-enhanced ultrasound in transrectal prostate biopsy

目的：探讨实时超声造影技术提高经直肠超声引导下前列腺穿刺活检阳性率的应用价值。方法：PSA异常升高（4-20μg/L）、直肠指检（DRE）异常或前列腺MRI异常的男性患者,经积极肠道准备后进行前列腺穿刺活检,穿刺方案为12＋X针（左右侧叶前列腺尖部、中部及基底部腺体各穿刺1针＋可疑结节靶向穿刺X针）。穿刺前先对前列腺进行常规超声检查,然后进行超声造影。比较超声造影前后发现前列腺结节内可疑前列腺癌结节数目差异,以及常规超声引导和实时超声造影引导下前列腺穿刺活检前列腺癌检出率的差异。结果：常规经直肠超声发现可疑结节86个,检出前列腺癌57个,阳性率为66.3%。超声造影发现异常结节118个,其中108个检测出前列腺癌,阳性率91.5%。超声造影诊断前列腺异常结节效率明显高于常规经直肠超声（P〈0.01）。超声造影引导下穿刺检出前列腺癌39例（42.8%）,而常规经直肠超声检查仅能检出28例（30.8%）,两者差异显著（P=0.033）。结论：实时超声造影可提高前列腺可疑结节的检出率,为前列腺靶向穿刺提供更精确定位。靶向穿刺可有效提高前列腺癌的检出率,有利于早期发现前列腺癌。

Objective： To explore the application value of real-time contrast-enhanced ultrasound（RTCEU） in improving the detection rate of transrectal ultrasound-guided prostate biopsy. Methods： This prospective study included 91 male patients with abnormally high PSA（4- 20 μg / L） or abnormalities in DRE or MRI,who underwent 12 ＋ X prostate biopsy following conventional transrectal ultrasonography（ TRUS） and RTCEU examination. We compared the numbers of suspected prostatic nodules before and after RTCEU as well as the detection rates of prostate cancer between conventional TRUS-guided 12 PBx and 12 PBx plus lesion-targeted biopsy procedures. Results： Totally,57 of the 86 suspected lesions on TRUS（66. 3%）,and 108 of the 118 abnormal nodules on RTCEU（91. 5%） were confirmed to be prostate cancer. RTCEU achieved a significantly higher detection rate than TRUS（ P 0. 01）. A total of 39 cases of prostate cancer（42. 8%） were detected by RTCEU,while only 28（30. 7%） by TRUS,with statistically significant difference in the detection rate between the two procedures（ P = 0. 033）. Conclusion： Real-time contrast-enhanced ultrasound can significantly improve the detection rate of prostate cancer and provide a valuable guide to targeted prostate biopsy.