常规超声、超声造影及剪切波弹性成像联合临床指标诊断前列腺癌的价值

Value of conventional ultrasound,contrast-enhanced ultrasound and shear wave elastography combined with clinical index in the diagnosis of prostate cancer

目的探讨常规超声、超声造影及剪切波弹性成像联合临床指标对前列腺癌的诊断价值。方法选取我院拟行前列腺病灶切除术的患者175例,其中良性组87例和恶性组98例,术前均行经直肠常规超声、剪切波弹性成像及超声造影检查。应用Logistic回归分析对各超声检查参数进行单因素及多因素分析,先建立不同超声技术诊断前列腺癌的回归模型A,在此模型的基础上联合临床指标建立诊断前列腺癌的回归模型B。绘制受试者工作特征(ROC)曲线分析模型A、模型B及临床指标对前列腺癌的诊断效能,计算曲线下面积。结果两组年龄、前列腺特异抗原(PSA)比较差异均有统计学意义(均P<0.05);两组内部回声、边缘、弹性模量最大值(Emax)、弹性模量平均值(Esd)、增强强度(SI)、达峰时间(TTP)、时间-强度曲线下面积比较差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,Emax、SI、TTP差异均有统计学意义(均P<0.05),建立模型A的回归方程:Y(P)=-11.928+0.026Emax+0.822SI-0.169TTP。模型A联合年龄和PSA进行单因素及多因素Logistic回归分析,结果显示模型A、年龄、PSA差异均有统计学意义(均P<0.05),建立模型B的回归方程:Y(P)=-16.396+0.183年龄+0.061PSA+3.350模型A。模型B诊断前列腺癌的曲线下面积为0.902,敏感性91.1%,特异性70.0%,阳性预测值77.4%,阴性预测值87.1%;曲线下面积高于模型A、年龄及PSA,差异均有统计学意义(均P<0.05)。结论常规超声、超声造影及剪切波弹性成像联合临床指标对前列腺癌有较高的诊断价值。

Objective To investigate the value of conventional ultrasound,contrast-enhanced ultrasound and shear wave elastography combined with clinical index in the diagnosis of prostate cancer.Methods Totally 175 patients who planned to underwent prostatectomy in our hospital were selected,including 87 cases in the benign group and 98 cases in the malignant group.They were examined by conventional ultrasound,shear wave elastography and contrast-enhanced ultrasound before operation.Logistic regression analysis was used to analyze the single factor and multi factor of ultrasound parameters.Firstly,the regression model A of different ultrasound techniques for the diagnosis of prostate cancer was established.On the basis of this model,the regression model B for the diagnosis of prostate cancer was established in combination with clinical indexes.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of model A,model B and clinical index for prostate cancer,and the area under the curve was calculated.Results There were significant differences of age and prostatespecific antigen(PSA)between benign and malignant group(both P<0.05).Univariate Logistic regression analysis showed that there were significant differences of internal echo,edge,maximum value of the elastic modulus(Emax),average value of the elastic modulus(Esd),signal intensity(SI),time to peak(TTP)and area under time-intensity curve between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that Emax,SI and TTP were statistically significant,regression equation of model A was Y(P)=-11.928+0.026 Emax+0.822 SI-0.169 TTP.The results of univariate and multivariate Logistic regression analysis showed that model A,age and PSA were statistically signifant,and the regression equation of model B was Y(P)=-16.396+0.183 age+0.061 PSA+3.350 model A.The area under the curve of model B in the diagnosis of prostate cancer was 0.902,the sensitivity was 91.1%,the specificity was 70.0%,the positive predictive value was 77.4%,and the negative predictive value was 87.1%.The area under of model B was higher than that of model A,age and PSA,there were significant differences(all P<0.05).Conclusion Conventional ultrasound,contrast-enhanced ultrasound and shear wave elastography combined with clinical index has higher value in the diagnosis of prostate cancer.