磁共振弥散加权成像联合经直肠超声定位经直肠前列腺穿刺活检术

Magnetic resonance diffusion-weighted imaging combined with transrectal ultrasound localization and transrectal prostate puncture

目的探讨磁共振弥散加权成像(MRDWI)联合经直肠超声(TRUS)定位经直肠前列腺穿刺活检术在前列腺癌诊断中的效果。方法选取2017年9月至2018年12月因筛查血清前列腺特异抗原(PSA)异常或前列腺肛诊阳性的住院患者75人,随机分为观察组(N=38)和对照组(N=37)。对照组患者在TRUS定位引导下经直肠行前列腺系统性穿刺活检,观察组患者则采用MRDWI检查联合TRUS定位引导下经直肠进行前列腺融合穿刺。以术后病理诊断为标准,比较MRDWI联合TRUS定位穿刺诊断及单独TRUS定位穿刺诊断的灵敏度及特异度。结果观察组共获取630个前列腺组织标本,其中诊断为前列腺癌阳性的标本共229个,对照组共获取609个前列腺组织标本,其中诊断为前列腺癌的标本共180个。以术后病理诊断为标准,MRDWI联合TRUS定位穿刺诊断前列腺癌的灵敏度、特异度分别为82.05%、90.66%,单独TRUS定位穿刺诊断前列腺癌的灵敏度及特异度分别为56.75%、89.64%,MRDWI联合TRUS定位穿刺诊断灵敏度高于单独TRUS定位穿刺诊断(P<0.05)。结论MRDWI联合TRUS定位下进行经直肠前列腺融合穿刺活检术能提高前列腺癌诊断的效果,提高灵敏度,减少临床漏诊率,具有进一步推广的价值。

Objective To investigate the effect of magnetic resonance diffusion-weighted imaging (MRDWI) combined with transrectal ultrasound (TRUS) localization in the diagnosis of prostate cancer.Methods From September 2017 to December 2018, 75 inpatients with abnormal serum prostate specific antigen (PSA) or positive prostate anal diagnosis were randomly divided into observation group (N=38) and control group (N=37).The patients in the control group underwent systematic prostate biopsies through rectum under the guidance of TRUS localization, while the patients in the observation group underwent prostate fusion puncture under the guidance of MRDWI combined with TRUS localization.Based on the criteria of postoperative pathological diagnosis, the sensitivity and specificity of MRDWI combined with TRUS localization puncture and TRUS localization puncture alone were compared.Results 630 prostate tissue specimens were obtained in the observation group, 229 of which were diagnosed as prostate cancer positive, and 609 prostate tissue specimens were obtained in the control group, of which 180 were diagnosed as prostate cancer.According to the criteria of postoperative pathological diagnosis, the sensitivity and specificity of MRDWI combined with TRUS localization puncture in the diagnosis of prostate cancer were 82.05% and 92.66% respectively, and the sensitivity and specificity of TRUS localization puncture alone in the diagnosis of prostate cancer were 56.75%, respectively.The sensitivity of MRDWI combined with TRUS localization puncture was higher than that of TRUS localization puncture alone (P<0.05).Conclusion Transrectal prostate fusion puncture with MRDWI combined with TRUS can improve the diagnosis of prostate cancer, improve the sensitivity and reduce the clinical missed diagnosis rate, which has the value of further promotion.