mpMRI与超声融合导航技术在前列腺靶向穿刺的临床研究

Clinical study of multiparameter magnetic resonance imaging and ultrasound fusion navigation technology in prostate targeted puncture

目的研究多参数磁共振成像(multiparameter magnetic resonance imaging,mpMRI)与超声融合导航技术在前列腺靶向穿刺中的临床价值。方法以2018年5月至2019年1月就诊于天津市第一中心医院且经mpMRI诊断后发现的40例前列腺癌疑似患者作为研究对象,将mpMRI与超声融合导航技术应用于患者前列腺靶向穿刺活检,同时进行12针系统性穿刺活检,并对穿刺病理结果进行观察和分析。结果40例前列腺癌疑似患者中,靶向穿刺及前列腺系统穿刺确诊27例,阳性率为67.50%。靶向穿刺确诊患者21例(52.50%),系统穿刺确诊患者18例(45.00%),两种穿刺方法的确诊率差异无统计学意义(P=0.607)。系统穿刺的单针阳性率为14.41%(69/479),靶向穿刺的单针阳性率为47.57%(49/103),差异有统计学意义(P<0.05)。靶向穿刺以及系统穿刺均显示为阳性的12例患者中,有5例患者的靶向穿刺Gleason评分比系统穿刺更高。结论MRI与超声融合导航技术在前列腺靶向穿刺的应用具有较高价值,能够以较少的穿刺针数检出高危的前列腺癌,同时联合系统穿刺,可提高前列腺癌穿刺活检的阳性检出率,同时减少高Gleason评分的前列腺癌患者的漏诊率。联合应用前列腺影像报告和数据系统(prostate imaging reporting and data system,PI-RADS)评分,靶向穿刺可提高有临床意义的前列腺癌检出率,有助于减少高危前列腺癌患者的漏诊。

Objective To study the clinical value of multiparameter magnetic resonance imaging(mpMRI)and ultrasound fusion navigation technology in targeted prostate puncture.Methods Totally 40 patients with suspected prostate cancer who were diagnosed by mpMRI were selected as the subjects.mpMRI and ultrasound fusion technology were applied in targeted prostate biopsy,and the pathological results were observed and analyzed.Results A total of 27 patients were diagnosed by targeted puncture and prostate system puncture,with the positive rate 67.50%.Among 27 diagnosed cases,21 patients were diagnosed by targeted puncture(52.50%)and 18 by systematic puncture(45.00%),without significant difference between the two groups(P=0.607).The positive rate of single needle for systematic puncture was 14.41%(69/479)and that of single needle for targeted puncture was 47.57%(49/103),with significant difference(P<0.05).Conclusion The MRI and ultrasound fusion technology in targeted prostate puncture show high value.It can detect high-risk prostate cancer with fewer puncture needles.Combination with systematic puncture can improve the positive detection rate of prostate puncture biopsy and reduce the missed diagnosis of prostate cancer patients with high Gleason score.Targeted puncture with prostate imaging reporting and data system(PI-RADS)scoring system can improve the detection rate of clinically significant prostate cancer and help to reduce the number of missed high-risk prostate cancer patients.