MRS与MRI对前列腺癌与前列腺增生鉴别诊断中的应用  

The value of MRS integratel MRI in the differential diagnosis of prostate adenocarcinoma and benign prostate hyperplasia

作　　者：张琳琳[1] 袁曙光[1] 闫东[1] 赵新湘[1] 李文娣[1] 郭立[1] 马悦[1] 

机构地区：[1]昆明医学院第二附属医院放射科,云南昆明650101

出　　处：《医学影像学杂志》2008年第5期521-524,共4页Journal of Medical Imaging

摘　　要：目的:分析前列腺癌和前列腺增生的MRI表现和磁共振波谱成像(magnetic resonance spectroscopy,MRS)代谢特征,探讨MRI和MRS相互结合在前列腺癌和增生鉴别诊断中的价值。方法:分析经手术或穿刺活检证实的26例前列腺癌和32例增生患者的临床资料及MRI、MRS所见。MRI分析前列腺的大小、形态、病变位置、信号特点和肿瘤侵犯程度等。MRS测量枸橼酸盐(Citrate)、胆碱(Choline)、肌酸(Creatine)的峰值、(胆碱+肌酸)/枸橼酸盐〔(Cho+Cr)/Cit,CC/C〕的比值。结果:前列腺癌中有20例在T2WI像上有明显的前列腺癌征象,其中18例侵犯精囊,14例侵犯膀胱,12例侵犯盆腔周围骨组织,5例侵犯直肠,5例盆腔内见多个肿大淋巴结并部分相互融合成团;余6例未见明显的前列腺癌征象。MRS上将前列腺分成六个区,在MRS代谢图上标记出体素(测量点)归入相应分区。每例取4个体素(体素或MRI上疑点),58例中一共取232个体素进行测量,前列腺癌cit峰值均明显下降,Cho峰值均升高,标记出手术或穿刺活检取材癌区的CC/C平均值为2.3730±1.97548,增生的波谱形态和癌相反,CC/C平均值为0.5450±0.48842,两组间差异有统计学意义(t=-4.605,P=0.000<0.05)。结论:MRI能对前列腺癌定位,了解侵犯部位及转移情况。MRS能根据MRI提示的病变及可疑部位进行定量分析、显示其代谢情况。MRI与MRS相结合能提高对肿瘤的定性诊断,具有重要的诊断价值。Objective：To describe MR imaging （MRI） and spectroscopic （MILS） appearances of prostate adenocarcinoma and benign prostate hyperplasia and to evaluate MRS connecting with MRI in the differential diagnosis of prostate adenocareinoma and benign prostate hyperplasia.Methods： Clinical date together with MRI and MRS findings were reviewed in 26 cases with pathologically confirmed prostate diseases and 32 cases of benign prostate hyperplasia. MRI observation was focused on the size of the gland, the location of the lesion, the signal features and the extent of the tumor. MRS observations included the chemical shift of citrate （Cit）, choline （Cho） and creatine （Cr） spectra, and the ratio of Citr ＋ Cho/Cr.Results：On MRI, 20 cases had apparent sign of pc, of these, the affected structures included seminal vesicle （n= 18）, bladder （n= 14）, hone of pelvic （n= 12）, rectum （n= 5） and pelvic lymph nodes fused in mass （n = 5）. While, no apparent sign of PCa was found in 6 cases. On MRS, prostate was divided into four regions and marked cancer paint on MRS metabolic picture. Six cancer paints were abstracted from every case, in all 58 cases, 232 paints were selected, Cit peak was obvioasly declined and choline peak was ascended of prostate cancer. The average ratio of Cho ＋ Cre/Cit for prostate cancer was 2.3730 ± 1.97548, benign prostate hyperplasias＇ was 0.5450 ± 0.48842. Conclusion： MRI can well display localization of tumor and detect extracapsular spread of disease. MRS can provide the quantitative analysis and metabolic information of PCa or suspected position. MRS together with MRI can improve the experience of the radiologists and may have an important value of diagnosis.

关 键 词：前列腺癌 磁共振成像 磁共振波谱 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]