PI-RADS评分5分前列腺活检良性病变患者的临床和磁共振影像特点

The comprehensive analysis of clinical characteristics and magnetic resonance imaging of non-malignant patients assigned to PI-RADS 5 score

目的探讨前列腺影像报告和数据系统(PI-RADS)评分5分前列腺活检良性病变患者的临床和磁共振影像特点。方法回顾性分析2019年5月至2021年7月于南京医科大学第一附属医院行磁共振超声靶向联合系统活检的289例PI-RADS评分5分患者的临床资料。中位年龄72(66,77)岁。中位体质量指数(BMI)24.4(22.3,27.1)kg/m^(2)。中位前列腺体积(PV)37.39(29.39,48.86)ml。中位前列腺特异性抗原(PSA)22.24(10.91,62.69)ng/ml。中位PSAD 0.53(0.30,1.52)ng/ml2。根据活检病理结果将患者分为良性病变组和前列腺癌组,比较两组的PSA、PSAD、PV、磁共振检查的表观扩散系数(ADC)值,分析良性病变组的磁共振影像和临床特点。结果本研究289例,良性病变组11例(3.8%),前列腺癌组278例(96.2%)。良性病变组中位年龄69(66,79)岁,中位BMI 22.0(21.0,25.5)kg/m^(2);直肠指检异常5例;吸烟7例、饮酒4例;中位PV 62.90(38.48,71.96)ml,中位PSA 5.55(2.99,20.52)ng/ml,中位PSAD 0.16(0.07,0.24)ng/ml^(2),中位ADC值714.47(701.91,801.26)×10^(-6)mm^(2)/s。良性病变组和前列腺癌组的PV[62.90(38.48,71.96)ml与37.21(29.22,47.82)ml,P<0.01],PSA[5.55(2.99,20.52)ng/ml与23.53(11.14,65.98)ng/ml,P<0.01],PSAD[0.16(0.07,0.24)ng/ml2与0.58(0.31,1.57)ng/ml^(2),P<0.01]比较差异均有统计学意义。良性病变组的病理结果为5例慢性前列腺炎,2例急性前列腺炎(1例伴有局灶腺腔积脓),2例肉芽肿性炎,2例结核肉芽肿性炎。良性病变组11例中,7例PSA<10 ng/ml;7例伴尿频、尿急、尿不尽等症状;8例磁共振检查提示病灶面积超过所在轴位前列腺总面积的50%,弥漫性分布,形态规则,信号均一,其中6例为对称分布。结论PI-RADS评分5分前列腺活检良性患者的病理类型包括慢性炎症、急性炎症、肉芽肿性炎和结核肉芽肿性炎,其中前列腺炎症为最常见类型;大部分良性病例PSA<10 ng/ml,伴有尿频、尿急、尿不尽等症状;磁共振检查特点为病灶弥漫性、对称分布,形态规则,信号均一。

Objective To analyze the clinical features and magnetic resonance imaging of non-malignant patients assigned to Prostate Imaging Reporting And Data System(PI-RADS)5 score.Methods We performed a retrospective review of 289 patients who underwent magnetic resonance ultrasound targeted combined system biopsy with PI-RADS 5 lesions in the First Affiliated Hospital of Nanjing Medical University between May 2019 and July 2021.The median age 72(66,77)years,median body mass index 24.4(22.3,27.1)kg/m2,median prostate volume(PV)37.39(29.39,48.86)ml,median PSA 22.24(10.91,62.69)ng/ml,and median PSAD 0.53(0.30,1.52)ng/ml^(2) were recorded.According to the biopsy pathological results,all patients were divided into benign lesion group and prostate cancer group.PSA,PSAD,PV,and apparent diffusion coefficient(ADC)values were compared,and magnetic resonance imaging and clinical characteristics of patients with biopsy benign lesions were analyzed.Results There were 11 cases(3.8%)with benign lesion and 278 cases(96.2%)with prostate cancer.The characters of 11 negative biopsy cases were displayed as follows:median age 69(66,79)years,median body mass index 22.0(21.0,25.5)kg/m^(2),median PV 62.90(38.48,71.96)ml,median PSA 5.55(2.99,20.52)ng/ml,median PSAD 0.16(0.07,0.24)ng/ml^(2),median ADC 714.47(701.91,801.26)×10^(-6) mm^(2)/s,abnormal digital rectal and amination in 5 cases,smoking in 7 cases,and alcohol consumption in 4 cases.The median PV[62.90(38.48,71.96)vs.37.21(29.22,47.82)ml,P<0.01],the PSA value[5.55(2.99,20.52)vs.23.53(11.14,65.98)ng/ml,P<0.01],and the PSAD value[0.16(0.07,0.24)vs.0.58(0.31,1.57)ng/ml2,P<0.01]were significantly different between benign condition group and prostate carcinoma group.Benign condition group included 5 chronic prostatitis,2 acute prostatitis(1 with focal adenocarcinoma),2 granulomatous inflammation,and 2 tuberculous granulomatous inflammation.In 7 benign cases,PSA was less than 10 ng/ml,combined with frequent urination,urgency of urination and incontinence were founded.In 8 benign cases,the area of lesion was more than 50%of the total prostate area in the axial position and the imaging of magnetic resonance were diffused,with regular shape and uniform signal.The imaging of symmetrical distribution was in 6 cases.Conclusions The benign condition with PI-RADS 5 lesions included chronic prostatitis,acute prostatitis,granulomatous inflammation and tuberculous granulomatous inflammation,among which prostatitis was the most common cause.The PSA value were less than 10 ng/ml in most benign cases,with symptoms such as frequent urination,urgency of urination and incontinence.The imaging of magnetic resonance were diffused,symmetrically distributed,with regular shape and uniform signal.