多种超声模式在前列腺癌诊断中的应用价值比较

The value of multiple ultrasound modalities in the diagnosis of prostate cancer

目的:比较灰阶超声(GSU)、多普勒超声(CDU/PDU)、实时组织弹性成像(TRTE)、超声造影(CEUS)在前列腺癌(PCa)诊断中的准确性。方法:分析153个可疑PCa病灶的超声表现及穿刺活检结果,所有患者在前列腺根治术前均行GSU、CDU/PDU、TRTE、CEUS检查,以病理结果为金标准,比较GSU、CDU/PDU、TRTE、CEUS诊断PCa的准确性,绘制受试者工作特征曲线并计算曲线下面积(AUC),来评估4种超声模式单独及联合使用时诊断PCa的准确性,二元Logistic回归分析用来评估4种模式的预测价值。结果:153个病灶中,穿刺活检诊断恶性病变81个,良性病变72个。卡方检验结果显示:TRTE对PCa诊断的灵敏度、特异度、阳性预测值、阴性预测值及正确率均高于CEUS(P<0.05)。ROC曲线分析结果显示:TRTE对PCa的诊断效能高于CEUS(P=0.046);4种超声模式联合使用诊断PCa的准确性明显高于GSU(AUC:0.873 vs.0.532;P<0.05)、CDU/PDU(AUC:0.873 vs.0.547;P<0.05)和CEUS(AUC:0.873 vs.0.727;P<0.05),高于TRTE但无明显统计学差异(AUC:0.873 vs.0.826;P=0.06)。多因素二元Logistic回归分析显示,CEUS的增强程度和TRTE的蓝色区域是PCa的独立预测因子。结论:TRTE诊断PCa的准确性高于CEUS。CEUS的早期高增强病灶和TRTE的蓝色僵硬组织对诊断PCa有较高的预测价值。与单一超声模式相比,由GSU、CDU/PDU、TRTE、CEUS组成的多种超声模式联合可提高PCa诊断的阳性率。

Objective:To evaluate the performance of grayscale ultrasound(GSU),color Doppler ultrasound/power Doppler ultrasound(CDU/PDU),transrectal real-time tissue elastography(TRTE)and contrast-enhanced ultrasound(CEUS)in the diagnosis of prostate cancer(PCa).Methods:Ultrasonic features and histological results of 153 suspicious prostate nodules were analyzed.All patients underwent GSU,CDU/PDU,TRTE and CEUS examinations before radical prostatectomy.Using pathological results as the gold standard,the diagnostic performance of GSU,CDU/PDU,TRTE and CEUS were compared.A receiver operating characteristic curve was drawn and the area under the curve(AUC)was calculated when the four ultrasound modalities were used alone and in combination.Binary Logistic analysis was used to evaluate the predictive value of the 4 models.Results:Among the 153 lesions,81 were malignant nodules and 72 were benign nodules diagnosed by needle biopsy.The results of chi-square test showed that the sensitivity,specificity,positive predictive value,negative predictive value and accuracy rate of TRTE for diagnosing PCa were higher than those of CEUS(P<0.05).The analysis of ROC curves showed that the diagnostic performance of TRTE for PCa was higher than that of CEUS(P=0.046).Moreover,the diagnostic accuracy of PCa was signifi-cantly higher when the four ultrasound modes were combined than that of GSU(AUC:0.873 vs.0.532;P<0.05),CDU/PDU(AUC:0.873 vs.0.547;P<0.05)and CEUS(AUC:0.873 vs.0.727;P<0.05).The diagnostic accuracy of the combination was higher than that of TRTE,but there was no significant difference(AUC:0.873 vs.0.826;P=0.06).Multivariate binary Logistic regression analysis showed that enhanced strength and elastic blue area were independent predictors for diagnosing PCa.Conclusion:The diagnostic accuracy of TRTE is higher than that of CEUS.Early hyperenhancing lesions on CEUS and stiff tissues on TRTE have high predictive value for the diagnosis of PCa.The combination of multiple ultrasonic modalities can improve the diagnostic positive rate of PCa compared to single ultrasound mode.