前列腺结核的磁共振弥散加权成像及超声表现

The manifestations of MRI-DWI and ultrasound in prostate tuberculosis

目的探讨前列腺结核的磁共振弥散加权成像(MRI-DWI)和超声表现。方法收集2014年1月至2018年12月临床诊断为前列腺结核的3例患者,其中1例伴双侧精囊腺结核。回顾性分析3例患者的超声及磁共振成像(MRI)表现,探寻超声、MRI-DWI在前列腺结核中的特征性表现。结果3例患者中1例经前列腺活检病理证实,2例经前列腺液结核分枝杆菌培养阳性证实。超声检查发现3例患者前列腺病灶位于外腺区、内腺区,以低回声为主,另可见混合回声结节,彩色多普勒显示在病灶周围有较丰富的血流信号。MRI表现为前列腺信号不均匀,其内见T1WI等信号、T2WI稍高信号及弥散加权成像(DWI)明显扩散受限的结核结节,及呈结节样T2WI低信号、T1WI等或略低信号、DWI低信号,ADC值减低为(1.08~1.10)×10^-3mm^2/s的结核肉芽肿。结论MRI-DWI和超声显示的前列腺结核的结核性肉芽肿具有一定特征性,可为临床明确诊断提供参考依据。

Objective To investigate the manifestations of MRI-DWI and ultrasound in prostate tuberculosis.Methods 3 patients with clinically diagnosed prostate tuberculosis from January 2014 to December 2018 were collected,including 1 patient with bilateral seminal vesicle tuberculosis.The imaging manifestations of ultrasound and MRI were retrospectively analyzed to explore the characteristic manifestations of ultrasound,MRI and DWI in the diagnosis of prostate tuberculosis.Results The diagnosis was confirmed by the pathology of prostate biopsy in 1 of the 3 patients,while prostatic fluid tuberculous bacilli culture was positive in the remaining 2 cases.Ultrasound examination revealed that the prostate lesions of 3 patients were located in the external gland area and the internal gland area,mainly with hypo-echogenicity,occasionally with mixed echogenicity.Abundant color blood flow around the lesions was also detected on color doppler.MRI findings included heterogeneous signal intensity in prostate signal and tuberculosis nodules with T1 isointense signal,T2 slightly high signal and obviously restricted diffusion on DWI.In addition,tuberculosis granuloma was shown as nodular T2 low signal,T1 iso-intense or slightly lower signal,low signal on DWI,and the ADC value of(1.08-1.10)×10^-3mm^2/s.Conclusion Ultrasound,MRI and DWI could show certain characteristics for tuberculous granuloma of prostate tuberculosis,which provides evidence for clinical diagnosis tuberculosis granuloma.