经直肠多模态超声影像评分系统诊断前列腺癌的临床研究

The clinical study of multi-mode trans-rectal ultrasonic imaging scoring system in the diagnosis of prostate cancer

目的建立前列腺癌多模态超声影像评分系统,并评价该评分系统对前列腺癌的诊断价值。方法选取2016年5月至2017年12月在解放军总医院行超声引导下穿刺活检和(或)手术切除的86例可疑前列腺癌患者,术前对前列腺行经直肠常规超声、剪切波弹性成像、超声造影检查,分析三种模态超声影像特征,并与手术或穿刺病理进行对照。总结前列腺癌经直肠多模态超声影像特征,建立评分系统,并评价该系统对前列腺癌的诊断价值。结果前列腺癌常规超声表现为低回声、边界不清、形态不规则、内外腺分界不清、包膜侵犯、血流信号丰富且为中心血流;剪切波弹性成像表现为非对称分布,前列腺癌病灶平均弹性模量高于良性病灶[(94.7±44.2)k Pa vs(60.8±26.0)k Pa],差异有统计学意义(t=-3.578,P=0.001);超声造影表现为快速高增强,分布不均匀(低增强区伴点状血管结构,点状、片状或结节状高增强),内外腺分界不清,包膜或直肠壁侵犯。常规超声、超声造影、弹性成像有1项阳性即诊断为前列腺癌,其敏感度、阴性预测值和准确性分别为98.0%、96.7%和89.5%;三者均为阳性诊断为前列腺癌,其特异度和阳性预测值分别为97.3%和97.1%。结论经直肠多模态超声影像评分系统可提高超声对前列腺癌的诊断价值。

Objective To establish a multi-modal trans-rectal ultrasonic imaging scoring system for prostate cancer and to evaluate its diagnostic value. Methods From May 2016 to December 2017, 86 patients with suspected prostate cancer who received ultrasound (US) guided biopsy and/or surgery were enrolled in the study. The characteristics of trans-rectal conventional US (TRUS), shear wave sonoelastography (SWE) and contrast enhanced ultrasound (CEUS) were analyzed for each prostate with comparison of pathological results. And multi-mode scoring system were established for the diagnosis of prostate cancer. Results For prostate cancer, TRUS showed low echo, unclear boundary, irregular shape, unclear internal and external gland boundary, capsule invasion, rich blood flow signal and center vascularization;SWE showed asymmetric distribution with higher average elastic modulus [(94.7±44.2) kPa] than that of benign lesions [(60.8±26.0) kPa], the difference was statistically significant (t=-3.578, P=0.001);CEUS showed rapid and high enhancement, heterogeneous distribution (low enhanced area with punctate vascular structure), punctate or nodular enhancement, unclear internal and external gland boundary, capsular or rectal wall invasion. If any of TRUS, SWE and CEUS findings was positive, the sensitivity, negative predictive value and accuracy of multi-mode trans-rectal US were 98.0%, 96.7% and 89.5% respectively. If all of TRUS, SWE and CEUS findings were positive, the specificity and positive predictive value of multi-mode trans-rectal US were 97.3% and 97.1% respectively. Conclusion Trans-rectal multimodal ultrasonic imaging scoring system can improve the diagnostic value of ultrasound on prostate cancer.