MR波谱诊断T3N0M0期前列腺癌冷冻治疗后局部复发的价值  

MR spectroscopy in diagnosis of local recurrence of T3N0M0 of prostate cancer after cryotherapy

作　　者：刘明[1] 郭志[1] 司同国[1] 王海涛[1] 肖渤瀚[1] 

机构地区：[1]天津医科大学附属肿瘤医院肿瘤介入治疗科天津市肿瘤防治重点实验室,300060

出　　处：《中华放射学杂志》2012年第6期529-534,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金资助项目（30973438）;国家青年科学基金资助项目（81001002）;天津市应用基础及前沿技术研究计划资助项目（09JCYBJC10400）;天津市卫生局科技基金资助项目（2010R271）

摘　　要：目的探讨MRS诊断T3N0M0期前列腺癌冷冻治疗后复发的临床价值。方法回顾性分析以行前列腺癌冷冻治疗为主的65例T3N0M0期前列腺癌患者的临床资料。患者冷冻治疗术前均行常规MRI、MRS及病理穿刺活检。术后每个月检测前列腺特异性抗原（PSA）。当PSA升高（〉0．5μg/L）时，于1周内行MRI、MRS及病理活检；如PSA小于0．5μg/L，于术后12个月时行MRI、MRS检查及超声引导下活组织穿刺病理检查。术前根据穿刺活检结果，将前列腺分为癌区和非癌区；通过MRS测量手术前、后前列腺癌癌区和非癌区的胆碱（Cho）、枸橼酸盐（Cit）的信噪比及（Cho＋Cre）／Cit[肌酸（Cre）]比值水平。术后复查根据病理活检结果分为无复发组、局部复发组。比较不同分组冷冻治疗前后癌区和非癌区Cho、Cit的信噪比及（Cho＋Cre）／Cit比值水平。数据经正态性检验证实为正态分布后，采用独立样本的t检验进行比较。结果（1）术后12个月病理活检证实局部复发患者15例，其中11例PSA在12个月内升高、4例12个月内PSA未见升高。（2）65例患者冷冻治疗前癌区与非癌区Cho峰、Cit峰的信噪比及（Cho＋Cre）／Cit比值分别为25±9和11±5，18±5和39±12，2．33±0．60和0．53±0．19，癌区与非癌区比较差异均有统计学意义（t值分别为11．36、9．81和13．39，P值均为0．00）。（3）冷冻治疗后局部未复发的患者，癌区与非癌区的Cho峰、Cit峰的信噪比分别是4±2和3±2（t=1．024，P=0．305），2±2和4±3（t=1．147，P=0．178），癌区与非癌区比较差异无统计学意义；但癌区冷冻治疗术前、后的Cho峰（t=25．22，P=0．00）、Cit峰（t=32．06，P=0．00）和非癌区冷冻治疗前、后的Cho峰（t=17．42，P=0．00）、Cit峰（t=38．60，P=0．00）的信噪比差异均有统计学意义；冷冻治疗术后癌区及非癌区可见有大量坏死区，Cho和Cit的信噪比较�Objective To evaluate the usefulness of magnetic resonance spectroscopic imaging in detecting local recurrence in patients with TaNoM0 prostate cancer after cryotherapy. Methods Sixty-five patients with T3 NO Mo prostate cancer underwent eryotherapy. The preoperative data of conventional MRI, MRS, transrectal ultrasound （TRUS）-guided prostate biopsy were collected. After eryotherapy, the prostatespecific antigen （PSA） of all patients was detected monthly. If PSA 〉 5 μg/L, MRI, MRS, and TRUS- guided prostate biopsy were planned within a week. If PSA was unremarkable, MRI, MRS, and TRUS- guided prostate biopsy were planned 12 months after cryotherapy. The prostate was divided 6 regions and the cancerous and noncancerous were marked. The signal-to-noise ratio（S/N） of choline （Cho）, citrate （Cit） and the ratios of Cho ＋ creatine （ Cre ）/Cit of each regions were measured in pre-operation and post- operation. The patients were divided into non-recurrence and recurrence group according to TRUS-guided biopsy. The SiN of Cho, Cit, and the ratio of Cho ＋ Cre/Cit were compared between the groups before and after cryotherapy by using independent samples t-test. Results （ 1 ） Fifteen patients were confirmed local recurrence 12 months after cryotherapy, including 11 patients with an evaluate PSA level and 4 patients with PSA unremarkable. （2） The S/N of Cho, Cit and the ratios of Cho ＋ Cre/Cit in the cancerous and noncancerous regions before cryotherapy in the sixty-five patients were 25±9,11±5, and 18±5, and 39 ± 12, 2. 33 ±0. 60, and 0. 53 ±0. 19. There had significant difference between that of two groups （t values were 11.36, 9.81, and 13.39, respectively, P = 0. 00）. （3） In the patients with non-recurrence, The S/N of Cho, Cit in the cancerous and noncancerous regions were 4 ± 2 and 3± 2 （ t = 1. 024, P = 0. 305 ）, and 2 ±2 and 4 ±3 （t = 1. 147,P =0. 178） and no difference was found. In necrotic area, the ratios of Cho ＋ Cre/Cit could not be calculated b

关 键 词：前列腺肿瘤 磁共振波谱学 冷冻疗法 

分 类 号：R737.25[医药卫生—肿瘤]