经直肠超声造影在前列腺外腺良恶性病变鉴别诊断中的作用  

Contrast-enhanced transrectal ultrasonography for discrimination of malignant and benign hypoechoic lesions in outer gland of the prostate

作　　者：杨敬春[1] 唐杰[2] 罗渝昆[2] 李俊来[2] 李岩密[2] 姚克纯[1] 

机构地区：[1]解放军空军总医院超声科,北京100036 [2]解放军总医院超声科

出　　处：《中华超声影像学杂志》2007年第11期979-981,共3页Chinese Journal of Ultrasonography

基　　金：国家自然科学基金资助项目（30670549）

摘　　要：目的探讨经直肠超声造影检查在前列腺外腺低回声良恶性病变诊断和鉴别诊断中的价值。方法对66例超声显示前列腺外腺低回声病灶患者行经直肠超声造影检查,观察病灶造影增强模式,用ACQ软件系统对病灶及其周围外腺组织造影参数进行分析比较。超声造影后对患者行经直肠超声引导外腺低回声病灶穿刺活检及常规6针前列腺穿刺活检。结果穿刺活检病理证实30例患者病灶为前列腺癌,36例病灶为良性。以超声造影表现为无增强、增强强度高于、等于、低于周围实质为标准,良、恶性病灶分别为14、8、4、10例和2、20、3、5例,二者差异有统计学意义（P〈0.05）。外腺低回声良性病灶以内部无增强或增强强度低于周围实质为主,而恶性病灶以增强强度高于周围实质为主。病灶相对造影增强强度可作为前列腺癌鉴别诊断指标（曲线下面积0.73,95%可信区间：0.57～0.89）。结论经直肠超声造影检查有助于前列腺外腺低回声良恶性病变的鉴别诊断。Objective To evaluate the role of contrast-enhanced transrectal ultrasonography（CETRUS）in discriminatory performance of malignant and benign hypoechoic lesions in outer gland of the prostate.Methods Sixty six patients with hypoechoic lesions（36 biopsy-proven benign diseases and 30 prostate cancer）in outer gland of the prostate underwent CETRUS.With bolus injection of contrast agent（SonoVue）via a vein in the antecubital fossa and the imaging technique of contrast pulse sequence,CETRUS was performed on all cases.The enhancement patterns of the lesions were observed,and the parameters of the lesions and their surrounding peripheral zone tissues were measured with ACQ time-intensity curve analysis software.After CETRUS,lesion-specific TRUS-guided biopsy and the routine sextant biopsy were performed subsequently.Results The intensity of enhancement within the lesions were of no,increased,equal,decreased compared to surrounding normal outer gland tissue on ultrasound in 2,20,3,5 in the prostate cancer group and 14,8,4,10 in the benign disease group,respectively,the difference was statistically significant（P〈0.05）.There were significant differences in relative peak intensity and relative arrival time between benign and malignant lesions（P〈0.05）.Malignant lesions showed significant increased peak intensity and earlier arrival time compared with their surrounding outer gland tissue,while benign lesions showed nearly equal peak intensity and time to enhancement compared with their surrounding outer gland tissue.There was no difference in relative time to peak intensity between malignant and benign lesions（P=0.26）.Relative peak intensity of enhancement would be the parameter in discriminatory performance（AUC 0.73,95% CI 0.57-0.89）.Conclusions CETRUS could be helpful in discriminatory performance of malignant and benign hypoechoic lesions in outer gland.

关 键 词：腔内超声检查 造影剂 前列腺肿瘤 诊断 鉴别 

分 类 号：R686[医药卫生—骨科学]