剪切波弹性成像联合超声造影在良恶性前列腺结节鉴别诊断中的应用价值

Application value of shear wave elastography combined with ultrasonic contrast in differentiating benign from malignant prostate nodules

目的探讨剪切波弹性成像联合超声造影检查在良恶性前列腺结节鉴别诊断中的应用价值。方法选取96例临床可疑前列腺癌患者作为研究对象,患者均进行二维超声、剪切波弹性成像和超声造影检查,并在超声引导下行经直肠前列腺穿刺活检。以病理活检结果为金标准,比较剪切波弹性成像检查与剪切波弹性成像联合超声造影检查对前列腺良恶性结节鉴别诊断的效能。结果二维超声共检查出87个前列腺结节经病理检查诊断为良性结节40个,恶性结节47个。以病理检查结果为金标准,剪切波弹性成像技术诊断恶性前列腺结节的敏感度、特异性、准确性、阳性预测值、阴性预测值分别为66.0%、67.5%、55.1%、70.5%、62.8%,剪切波弹性成像联合超声造影技术诊断恶性前列腺结节的敏感度、特异性、准确性、阳性预测值、阴性预测值分别为80.9%、80.0%、80.5%、82.6%、62.8%。恶性前列腺结节超声造影表现为快速高增强,良性结节多表现为均匀等增强。恶性前列腺结节多位于外周带。结论剪切波弹性成像联合超声造影检查鉴别诊断良恶性前列腺结节的效能优于单纯剪切波弹性成像。

Objective To explore the application value of shear wave elastography combined with contrast-enhanced ultrasound examination in differentiating benign from malignant prostate nodules.Methods Ninety-six patients with clinically suspected prostate cancer were enrolled as research subjects. All patients underwent two-dimensional ultrasound, shear wave elastography and ultrasonic contrast examinations, and received ultrasound-guided transrectal prostate needle biopsy. Taking the findings of pathological biopsy as the gold standard, the efficacy for differentiating benign from malignant prostate nodules was compared between shear wave elastography examination and shear wave elastography combined with ultrasonic contrast examination.Results Totally 87 prostate nodules were identified by two-dimensional ultrasound examination. Among them, 40 benign and 47 malignant nodules were diagnosed by pathological examination. With the findings of pathological examination as the gold standard, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of shear wave elastography technology for diagnosing malignant prostate nodules were 66.0%, 67.5%, 55.1%, 70.5% and 62.8%, respectively;the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of shear wave elastography combined with ultrasonic contrast technology for diagnosing malignant prostate nodules were 80.9%, 80.0%, 80.5%, 82.6% and 62.8%, respectively. Malignant prostate nodules showed rapid and high enhancement and benign nodules commonly manifested homogeneous and identical enhancement on ultrasonic contrast. Most of malignant prostate nodules were observed in the peripheral zone.Conclusion Shear wave elastography combined with ultrasonic contrast examination is superior to shear wave elastography alone in the efficacy for differentiating benign from malignant prostate nodules.