弹性成像与磁共振对前列腺癌诊断价值的对比研究

Comparison of Elastography and Magnetic Resonance in the Diagnosis of Prostate Carcinoma

目的对比分析经直肠超声(transrectal ultrasound,TRUS)联合实时弹性成像(transrectal real-time elastography,TRTE)与磁共振T2加权成像(T2-weighted imaging,T2WI)联合弥散加权成像(diffusion weighted imaging,DWI)对不同Gleason分级前列腺癌(prostate carcinoma,Pca)的诊断价值。方法对78例可疑Pca患者行TRUS、TRTE及T2WI、DWI检查,穿刺病理证实良性组20例,Pca组58例。Pca组按Gleason评分分为低危组(<7分)27例、中危组(7分)18例、高危组(> 7分)13例。应用统计学软件进行统计分析。结果低危组、中危组、高危组弹性应变率(SR)比值均大于良性组(P <0.05),高危组SR比值大于低危组、中危组,差异具有统计学意义(P <0.05);T2WI+DWI对低危组的阳性检出率高于TRUS+TRTE,差异具有统计学意义(P <0.05),对中危组及高危组的阳性检出率与TRUS+TRTE比较,差异无统计学意义(P> 0.05)。结论 TRTE可以定性和定量分析前列腺病灶的硬度,对不同Gleason分级Pca具有一定的诊断价值。对于低危组Pca,T2WI+DWI的诊断价值高于TRUS+TRTE,对于中危组和高危组Pca,两种方法的诊断价值相当。

Objective To comparatively analyze the value of transrectal real-time elastography （TRTE） with transrectal ultrasound （TRUS） and magnetic resonance T2-weighted imaging （T2WI） with difusion weighted imaging （DWI） in diagnosis of different Gleason score Prostate carcinoma （Pca）. Methods 78 cases of suspected Pca patients were examined by TRUS, TRTE and T2WI, DWI examinations, and finally were confrmed by biopsy pathology, including 20 cases of benign group and 58 cases of malignant group, which were divided into the low-risk group （〈 Gleason score 7） of 27 cases, the average risk group （Gleason score 7） 18 cases, the high-risk group of 13 cases （〉 Gleason score 7）.The results were dealed by using statistical software. Results The SR of low-risk group, average risk group and high-risk group was higher than benign group, the diference was statistically signifcant （P 〈 0.05）, the SR of high-risk group was higher than low-risk group and average risk group, the difference was statistically significant （P〈0.05）. The positive detection rate of low-risk group by T2WI ＋ DWI was higher than TRUS＋TRTE, the diference was statistically signifcant （P〈0.05）. In the average risk and high-risk group, the positive detection rates of T2WI＋DWI and TRUS＋TRTE were approximately equal, the diference was not statistically signifcant （P〉0.05）. Conclusion TRUS＋TRTE is available for qualitative and quantitative analysis of prostate lesions hardness, and has certain value in diagnosis of diferent Gleason score Pca. In the low-risk group, the diagnostic value of T2WI ＋ DWI is higher than TRUS＋TRTE, while in the average risk group and high-risk group, the diagnostic value is approximately equal.