多模态磁共振成像对前列腺外周带弥漫病变的鉴别诊断  

Differential diagnosis of diffuse lesion in peripheral zone of prostate by using multi-parametric MRI

作　　者：王伟[1] 邵志红[1] 王国良[1] 吴登龙[2] 高晓龙[1] 王培军[1] 

机构地区：[1]同济大学附属同济医院医学影像科,上海200065 [2]同济大学附属同济医院泌尿外科,上海200065

出　　处：《中华临床医师杂志（电子版）》2016年第9期33-37,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨多模态磁共振成像对外周带弥漫前列腺癌和前列腺炎的鉴别诊断价值。方法回顾性分析经直肠超声(TRUS)引导下饱和穿刺活检或前列腺根治术后病理证实前列腺病例33例,其中前列腺炎18例,前列腺癌15例。所有患者均采用Siemens Verio 3.0 T磁共振扫描,成像序列包括横断位、矢状位高分辨T2WI,横断位弥散加权成像(DWI)及动态对比增强(DCE)扫描。结果前列腺炎T2WI呈均匀或不均匀低、稍低信号,14例与中央带分界清,包膜完整;DWI呈稍高或高信号,平均ADC值为(1.12±0.15)×10-3 mm2/s;DCE 9例呈速升平台型,6例呈流入型,3例表现为不均匀强化,可伴有小脓肿或囊肿形成。前列腺癌呈均匀低信号,9例病灶与中央带分界不清,累及包膜;DWI呈高或稍高信号,平均ADC值(0.85±0.19)×10-3 mm2/s,与前列腺炎之间存在统计学差异(t=4.563,P<0.01);DCE 10例呈流出型,5例呈速升平台型。结论多模态磁共振成像有利于外周带弥漫前列腺癌和前列腺炎的鉴别诊断。Objective To determine the utility of multi-parametric MR imaging（Mp-MRI） for differential diagnosis of diffuse prostate cancer and prostatitis in peripheral zone. Methods A retrospective study of 33 cases of prostate diseases was conducted, included 18 cases of prostatitis, 15 cases of prostate cancer, all of cases were confirmed histopathologically by transrectal ultrasound guided saturation biopsy or radical prostatectomy. All MR imaging examinations were performed using a 3.0 T Siemens Verio MR scanner. The imaging protocol consisted of high-resolution axial and sagittal T2-weighted scans, axial diffusion weighted imaging（DWI） and dynamic contrast-enhanced（DCE） scans. Results All cases of prostatitis were homogeneous or heterogeneous hypotensity or slightly hypotensity on T2 WI, with clear boundary between transitional zone and intact capsule in 14 cases. Prostatitis showed slightly hyperintensity or hyperintensity on DWI, and mean ADC value was（1.12±0.15）×10-3 mm2/s. 9 cases of prostatitis showed plateau of enhancement, and 6 cases were progressive enhancement on DCE, and 3 cases of prostatitis showed heterogeneous enhancement with small abscess or cyst. All prostate cancer cases showed uniform hypotensity, with unclear boundaries between transitional zone and capsular invasion in 9 cases. Prostate cancer presented hyperintensity or slightly hyperintensity on DWI, and mean ADC value was（0.85±0.19）×10-3 mm2/s. Mean ADC value of prostate cancer was significantly lower than prostatitis（t=4.563, P〈0.01）. 10 cases of prostate cancer showed wash-out enhancement, and 5 cases were plateau of enhancement on DCE. Conclusion Mp-MRI is helpful in the differential diagnosis of diffuse prostate cancer and prostatitis in peripheral zone.

关 键 词：前列腺炎 前列腺肿瘤 磁共振成像 磁共振成像 弥散 动态对比增强磁共振 

分 类 号：R737.25[医药卫生—肿瘤] R697.3[医药卫生—临床医学] R445.2