经直肠实时组织超声弹性成像在前列腺良恶性病灶中的诊断价值  

Diagnostic value of transrectal real-time elastography in prostatic benign and malignant lesions

作　　者：桂琦[1] 许长宝[1] 赵兴华[1] 王晓甫[1] 杨利霞[2] 段晓晓[2] 李会霞[2] 杨占锋[1] 胡文晖[1] 

机构地区：[1]郑州大学第二附属医院泌尿外科、郑州大学泌尿外科研究所,郑州450014 [2]郑州大学第二附属医院超声科

出　　处：《中国男科学杂志》2013年第5期14-17,21,共5页Chinese Journal of Andrology

基　　金：河南省科技厅重点攻关项目（112102310678）

摘　　要：目的探讨经直肠实时组织超声弹性成像技术（TRTE）在前列腺良恶性病灶中的诊断价值。方法对疑似前列腺癌（PCa）患者99例进行前瞻性研究。术前完善肛门指诊（DRE）、前列腺特异性抗原检测（PSA）、核磁共振（MRI）、经直肠超声检查（TRUS）及TRTE检查，并以穿刺活检病理结果为金标准分析比较各种不同方法对前列腺疾病诊断价值的差异。结果99例疑似PCa患者病理结果显示：良性47例，恶性52例。TRTE弹性分级法诊断前列腺良恶性病灶的敏感性82.69%、特异性89.36%、准确性85.86%、阳性预测值89.58%、阴性预测值82.35%，明显优于DRE、PSA、TRUS检查。MRI诊断前列腺良恶性病灶的敏感性较高为86.54%，与TRTE比较差异无统计学意义（P＞0.05）；而TRTE对前列腺良恶性病灶具有明显的特异性，明显高于传统检查方法（DRE、PSA、MRI、TRUS），差异比较均有统计学意义（P＜0.05）；前列腺良恶性病变弹性应变率比值（SR）两组差异比较具有统计学意义（P＜0.05）；TRTE对PCa的检出率与其临床分期的恶性程度呈现正相关性，具有一定的PCa早期诊断价值。结论 TRTE具有明显的特异性，可以提高对前列腺良恶性病灶的检出率，TRTE与TRUS结合经济易行，可作为诊断前列腺良恶性病灶的推荐检查方法。Objective To explore the diagnostic value of transrectal real-time elastography （TRTE） in prostatic benign and malignant lesions. Methods A total of 99 patients with suspected prostatic cancer （PCa） were prospectively studied. Preoperative examinations were performed, including digital rectal examination （DRE）, prostate specific antigen （PSA）, nuclear magnetic resonance （MRI）, transrectal ultrasonography （TRUS） and TRTE, These different methods in the diagnosis value of prostate disease were evaluated taking pathological result as a golden standard. Results The pathological results of the 99 patients with suspected PCa were as follows：47 benign, 52 malignant. TRTE diagnosis of benign and malignant prostate lesions showed the diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value was respectively 82.69%, 89.36%, 85.86%, 89.58%and 82.35%, which was significantly better than that of DRE, PSA, TRUS. MRI had higher sensitivity in diagnosis of benign and malignant prostate lesions which was 86.54%, but the difference compared with TRTE had no significant difference （P〉0.05）; while TRTE had obvious specificity of benign and malignant prostate lesions, obviously higher than the traditional examination method （DRE, PSA, MRI, TRUS）, the differences had statistical significances （P〈0.05）. There were significant differences in the strain ratio （SR） between prostate benign and malignant lesions （P〈0.05）;The diagnosis rate of PCa using TRTE showed a positive correlation with the malignant degree of the clinical stage, suggesting it had some value in the early diagnosis of PCa. Conclusion TRTE had high specificity in diagnosis of benign and malignant prostatic lesions. TRTE combined with TRUS, which are economic and feasible, can be used as the preferred inspection method in clinic for diagnosis of prostatic lesions.

关 键 词：前列腺疾病 超声检查 弹性成像技术 

分 类 号：R697.3[医药卫生—泌尿科学] R445.1[医药卫生—外科学]