磁共振波谱成像联合直肠指检及血清PSA在前列腺癌诊断中的价值  

Magnetic resonance spectroscopy combined with serum PSA and digital rectal examination in diagnosis of prostate cancer

作　　者：易强[1] 王庆伟[1] 车英玉 张玉瑞[1] 袁璞[1] 杨小明[1] 李琦[1] 杨阳[1] 师磊[1] 宋东奎[1] 

机构地区：[1]郑州大学第一附属医院泌尿外科,450052 [2]磁共振室

出　　处：《第三军医大学学报》2012年第15期1548-1551,共4页Journal of Third Military Medical University

基　　金：国家自然科学基金(30901485);河南省科技攻关项目(72102310106)~~

摘　　要：目的初步探讨磁共振波谱成像(MRS)联合直肠指检(DRE)与血清前列腺特异抗原(PSA)在前列腺癌诊断中的应用。方法选取血清PSA异常84例男性患者行前列腺MRS和DRE并与病理结果对照。再分析MRS联合DRE及不同水平PSA(低危组4 ng/ml<PSA<10 ng/ml,中危组10 ng/ml≤PSA≤20 ng/ml和高危组PSA>20 ng/ml)诊断前列腺癌的灵敏度(Se)、特异度(Sp)和准确度(AR)。结果病理证实前列腺癌41例、非前列腺癌43例(良性增生41例,炎症1例,结核1例)。单纯MRS诊断前列腺癌的Se、Sp和AR分别为85.4%、83.7%和84.5%,与病理诊断有统计学一致性(K=0.69,P<0.05);MRS联合PSA低危组、中危组和高危组诊断的Se、Sp和AR分别为75.0%、90.0%和84.4%,66.7%、73.3%和71.4%,95.7%、87.5%和93.5%;MRS联合DRE诊断Se、Sp和AR分别为88.9%、87.5%和88.6%;MRS同时联合PSA高危组及DRE诊断Se、Sp和AR分别增加至95.7%、100%和95.8%,差异均有统计学意义(P<0.05)。结论 MRS诊断前列腺癌具有无创和简便优点,其联合直肠指检及PSA有助于提高诊断的准确性。Objective To investigate the significance of combining magnetic resonance spectroscopy（MRS） with serum level of prostate-specific antigen（PSA） and digital rectal examination（DRE） in the diagnosis of prostate cancer（PCa）.Methods A total of 84 male patients with abnormal serum PSA level were enrolled and underwent further prostate MRS examination and DRE.The results were contrasted with pathology obtained by prostate biopsy or transurethral resection of the prostate（TURP）.The sensitivity,specificity and accuracy of MRS combined with DRE and different serum levels of PSA（low-risk group： 4 ng/ml〈PSA〈10ng/ml,moderate-risk group： 10 ng/ml≤PSA≤20 ng/ml,high-risk group： PSA〉20 ng/ml） in the diagnosis of PCa were evaluated.Results According to the pathological outcome,41 cases were identified as PCa,43 cases were non-prostate cancer（benign prostatic hyperplasia 41 cases,prostatitis 1 case,and tubercular 1 case）.MRS had a sensitivity,specificity and accuracy of 85.4%,83.7% and 84.5% respectively.There was a perfect concordance between MRS and the pathological outcome（K=0.69,P〈0.05）.The sensitivity,specificity and accuracy of MRS combined serum different levels of PSA were 75.0%,90.0% and 84.4% in low-risk group,66.7%,73.3% and 71.4% in moderate-risk group,and 95.7%,87.5% and 93.5% in high-risk group.The sensitivity,specificity and accuracy of MRS combined with DRE positive group were 88.9%,87.5% and 88.6% respectively.The sensitivity,specificity and accuracy of MRS combined with PSA in high-risk group with DRE positive group at same time were 95.7%,100% and 95.8% respectively.All the difference of them is significant（P〈0.05）.Conclusion MRS is non-invasive and convenient in the diagnosis of PCa,and the efficiency can be improved obviously combing with PSA and DRE.

关 键 词：磁共振波谱成像 前列腺肿瘤 前列腺特异性抗原 直肠指检 

分 类 号：R730.4[医药卫生—肿瘤] R737.25[医药卫生—临床医学]