MRI、TRUS联合血清PSA诊断前列腺癌的价值观察

Value of MRI and TRUS Combined with Serum PSA in Diagnosis of Prostate Cancer

目的分析磁共振成像(MRI)、经直肠超声(TRUS)联合血清前列腺特异性抗原(PSA)诊断前列腺癌(PCA)的价值。方法纳入140例疑似PCA患者,均行MRI检查、TRUS引导下的前列腺穿刺活检、血清PSA检测,分析MRI、TRUS下PCA病灶影像学特点,比较PCA与非PCA的血清PSA水平,并以最终病理结果为“金标准”,分析MRI、TRUS、血清PSA对PCA的诊断效能。结果140例疑似病例经病理确诊为非PCA 59例(包括前列腺良性增生33例、前列腺炎26例)、PCA 81例;MRI下PCA病灶T2WI呈斑片状低信号,DWI病灶部位存在异常高信号,ADC呈低信号,TRUS下病灶呈低密度阴影、边缘毛躁、与周围组织分界不清,血流信号丰富;PCA患者血清PSA水平较前列腺良性增生及前列腺炎患者更高(P﹤0.05);ROC曲线显示,MRI、TRUS及血清PSA诊断PCA的灵敏度、特异度、曲线下面积高于三者单独诊断(P﹤0.05)。结论MRI、TRUS、血清PSA三者均对PCA有一定诊断价值,尤其是将其联合后可进一步提高诊断效能,值得在临床推广实践。

Objective To analyze the value of magnetic resonance imaging(MRI)and transrectal ultrasound(TRUS)combined with serum prostate specific antigen(PSA)in the diagnosis of prostate cancer(PCA).Methods 140 patients with suspicion of PCA were enrolled,and all of them completed MRI examination,prostate biopsy under the guidance of TRUS and serum PSA detection.MRI and TRUS characteristics of PCA lesions were analyzed.Serum PSA levels in patients with PCA and those without were compared.With final pathological results as the golden standard,the diagnostic efficacies of MRI,TRUS and serum PSA for PCA were analyze.Results 59 of 140 suspected cases were diagnosed without PCA by pathology,including 33 cases with benign prostatic hyperplasia and 26 cases with prostatitis,and 81 cases were diagnosed with PCA.MRI of PCA lesions showed patchy low signals on T2WI,abnormal high signals on DWI,and low signals on ADC.Lesions under TRUS showed low-density shadows,rough margins,unclear boundaries with surrounding tissues,and rich blood flow signals.Serum PSA levels were higher in patients with PCA than those with benign prostatic hyperplasia and prostatitis(P﹤0.05).ROC curve showed that the sensitivity,specificity and area under the curve of MRI and TRUS combined with serum PSA in the diagnosis of PCA were higher than those of each method alone(P﹤0.05).Conclusion MRI,TRUS and serum PSA all have certain value in the diagnosis of PCA.Besides,the combination of them can further improve the diagnostic efficiency.