经直肠超声联合超声造影对前列腺低回声病灶良恶性诊断的价值

Value of transrectal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of benign and malignant prostate hypoechoic lesions

目的探讨经直肠超声(transrectal ultrasonography,TRUS)联合超声造影(contrast-enhanced ultrasound,CEUS)对前列腺低回声病灶良恶性诊断的价值。方法选取2022年9月-2023年8月本院收治的54例疑似前列腺癌患者(共75个前列腺低回声病灶),均接受TRUS联合CEUS检查,以病理检查结果作为金标准,统计病灶良恶性情况,并进行单因素分析与多因素logistic回归分析以明确对前列腺低回声病灶良恶性诊断的价值。结果75个前列腺低回声病灶中,经病理检查检出恶性病灶39个、良性病灶36个;恶性组病灶包膜不完整、病灶内有钙化、病灶形态不规则、造影峰值高增强的占比更高,两组声像图特征、造影模式差异有统计学意义(P<0.05);多因素logistic回归分析结果显示,病灶包膜不完整(OR=10.592)、“污渍”样低回声(OR=13.325)、快进快退(OR=12.960)、造影峰值高增强(OR=16.025)是前列腺低回声病灶恶性的独立危险因素(P<0.05);绘制受试者工作特征(receiver operating characteristic,ROC)曲线显示,TRUS、CEUS、二者联合诊断前列腺低回声病灶良恶性的曲线下面积(area under curve,AUC)分别为0.889、0.837、0.953,二者联合的AUC较TRUS、CEUS更高。结论采用TRUS联合CEUS诊断前列腺低回声病灶良恶性,具有较高的诊断价值,需要重点关注病灶包膜、声像图特征、造影模式、造影峰值强度等超声特征。

Objective To explore the value of transrectal ultrasound(TRUS)combined with contrast-enhanced ultrasound(CEUS)in the diagnosis of benign and malignant prostate hypoechoic lesions.Methods A total of 54 suspected prostate cancer patients(75 hypoechoic lesions of the prostate)from September 2022 to August 2023 who were admitted in our hospital were selected.All patients underwent TRUS and CEUS.With the pathological examination results as the gold standard,the capacity of TRUS combined with CEUS in distinguishing benign from malignant prostate lesions was evaluated.Univariate and multivariate logistic regression analyses were performed to clarify the value of TRUS combined with CEUS in diagnosing benign and malignant prostate hypoechoic lesions.Results Among 75 prostate hypoechoic lesions,39 malignant lesions and 36 benign lesions were detected through pathological examination.The proportion of lesions with incomplete capsule,calcification within the lesion,irregular lesion morphology,and enhanced contrast peak value was significantly higher in malignant lesions than those of benign lesions.There were significant differences in sonographic characteristics and contrast patterns between the benign and malignant lesions(P<0.05).Multivariate logistic regression analysis showed that the lesion with an incomplete capsule(OR=10.592),stain-like hypoechoic lesions(OR=13.325),fast-in and fast-out(OR=12.960),and high peak contrast enhancement(OR=16.025)were independent risk factors for malignant prostate hypoechoic lesions(P<0.05).The receiver operating characteristic(ROC)curve showed that the area under curve(AUC)of TRUS,CEUS,and their combination for diagnosing benign and malignant prostate hypoechoic lesions was 0.889,0.837,and 0.953,respectively.The AUC of TRUS combined with CEUS was higher than that of a single examination.Conclusion TRUS combined with CEUS for the diagnosis of benign and malignant prostate hypoechoic lesions has a high diagnostic value.Ultrasound features,such as lesion capsule,ultrasound features,contrast mode,and contrast peak intensity should be concerned.