磁共振弥散联合超声造影在前列腺穿刺中的运用价值

Value of prostate biopsy guided by diffusion weighted MRI and contrast enhanced ultrasonography

目的:探讨磁共振弥散(DWI)联合超声造影(CEUS)在引导前列腺靶向穿刺中的运用价值。方法:收集2015年7月~2017年5月在我院行前列腺穿刺的160例患者的临床资料,所有患者穿刺前3d内完善DWI和CEUS检查,并按照结果进行个体化靶向穿刺活检,比较DWI、CEUS以及二者联合运用下的敏感度、特异度及准确率。结果:160例患者中病理阳性62例,阴性98例。DWI诊断的敏感度和特异度分别为74.2%(46/62)和81.6%(80/98);CEUS诊断的敏感度和特异度分别为66.1%(41/62)和60.2%(59/98);DWI+CEUS联合运用诊断的敏感度和特异度分别为93.5%(58/62)和86.7%(85/98)。二者联合运用指导下前列腺靶向穿刺活检诊断前列腺癌(PCa)敏感度和特异度均高于单独运用时的敏感度和特异度(P<0.05)。共计穿刺1012针,DWI引导靶向穿刺诊断PCa的敏感度、特异度及准确率分别为61.89%、84.94%、77.47%;CEUS为40.85%、94.01%、76.78%;二者联合运用时为90.24%、80.56%、83.70%。将联合运用与单独运用DWI或CEUS结果比较,差异均有统计学意义(P<0.05)。结论:DWI联合CEUS靶向引导前列腺穿刺,能有效互补,提高PCa诊断的敏感度和准确率。

Objective：To explore the value of prostate biopsy guided by DWI and CEUS.Method：From July2015 to May 2017,160 patients with suspected prostate cancer（PCa）were analyzed.Each patient underwent DWI and CEUS of prostate according to a standardized protocol before biopsy.The suspected lesion was confirmed by specialists of MRI,ultrasound and urology together.The sensitivity,specificity and accuracy of DWI,CEUS alone and combination of them were analyzed.Result：The results of pathologic examination revealed 62 cancers in160 patients.The sensitivity and specificity of DWI,CEUS and combination of them were 74.2%（46/62）,81.6%（80/98）,66.1%（41/62）,60.2%（59/98）and 93.5%（58/62）,86.7%（85/98）,respectively.Totally 1012 foci were done.The sensitivity,specificity and accuracy of DWI,CEUS and combination of them were61.89%,84.94%,77.47%;40.85%,94.01%,76.78% and 90.24%,80.56%,83.70%,respectively,The sensitivity and specificity of biopsy guided by both DWI and CEUS were higher than those of each alone,with statistically significant difference.Conclusion：DWI and CEUS can complement each other so as to elevate clinical detection rate of PCa.