经直肠超声造影在鉴别诊断前列腺良恶性病灶中的应用价值  

Application value of contrast-enhanced transrectal ultrasound in differential diagnosis of benign and malignant prostate nodules

作　　者：朱连华[1] 郭燕丽[1] 陈萍[1] 唐春霖[1] 陈凯旋[1] 谭鹰[1] 方可敬[1] Zhu Lianhua;Guo Yanli;Chen Ping;Tang Chunlin;Chen Kaixuan;Tan Ying;Fang Kejing(Department of Ultrasonography, Southwest Hospital, Third Military Medical University, Chongqing 400038, Chin)

机构地区：[1]第三军医大学西南医院超声科,重庆400038

出　　处：《中华医学超声杂志（电子版）》2018年第3期233-238,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：重庆市社会民生科技创新专项(cstc2016shmszx130080); 第三军医大学第一附属医院临床创新基金课题(SWH2013LC02)

摘　　要：目的探讨经直肠超声造影在鉴别诊断前列腺良恶性病灶中的应用价值。方法回顾性分析2014年1月至2016年12月在第三军医大学西南医院行经直肠超声造影检查的72例前列腺疾病患者共88个病灶。所有患者均经超声引导下经直肠前列腺穿刺活检确诊。采用独立样本t检验比较前列腺癌与前列腺良性疾病患者前列腺体积、前列腺内腺体积。以超声引导下经直肠前列腺穿刺活检病理结果作为诊断"金标准",计算经直肠超声造影诊断前列腺病灶良恶性的敏感度、特异度、准确性。结果本组72例前列腺疾病患者中,52例为前列腺良性疾病患者共67个病灶,20例为前列腺癌患者共21个病灶。前列腺癌患者与前列腺良性疾病患者前列腺体积、前列腺内腺体积差异均无统计学意义[(58.33±34.99)cm^3 vs(57.14±24.42)cm^3,t=0.185,P=0.854;(34.98±19.96)cm^3vs(33.89±17.65)cm^3,t=0.213,P=0.832]。前列腺癌病灶多位于前列腺外腺区(15/21),其超声造影特征多为动脉期呈高增强,且造影剂消退较周围正常组织迅速(16/21);前列腺良性病灶多位于前列腺内腺区(47/67),其超声造影特征多为动脉期等增强,且静脉期与周围正常组织同时消退(47/67)。以超声引导下经直肠前列腺穿刺活检病理结果作为诊断"金标准",经直肠超声造影诊断前列腺病灶良恶性的敏感度为85.71%,特异度为91.04%,准确性为89.77%。漏诊的3个前列腺癌病灶中,2个位于前列腺内外腺交界区,且Gleason评分均为中高分化。误诊的6个前列腺良性病灶,超声引导下经直肠前列腺穿刺活检病理证实5个为前列腺增生伴慢性炎症,1个为肉芽肿性炎伴凝固性坏死。结论经直肠超声造影能有效鉴别前列腺良恶性病灶,可为前列腺癌的准确诊断提供可靠信息。Objective To investigate the application value of contrast-enhanced transrectal ultrasound（CE-TRUS） in differential diagnosis of prostate benign and malignant lesions. Methods A retrospective analysis of patients with prostate lesions detected by CE-TRUS from January 2014 to December 2016 in Southwest Hospital of Third Military Medical University was performed. Seventy-two cases of prostate disease with 88 lesions were confirmed by transrectal prostate biopsy under ultrasound guidance. The age of patients with benign and malignant lesions, serum prostate specific antigen（PSA）, and the size of prostate and prostate inner gland were compared by independent sample t test. Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, and the sensitivity, specificity and accuracy of CE-TRUS in diagnosis of benign and malignant prostate lesions were calculated. Results Sixty-seven lesions in 52 patients were benign prostatic diseases, and 21 lesions in 20 patients were prostate cancer in this study. The size of prostate and prostate inner gland were not different between patients with prostate cancer and benign prostatic diseases [（58.33±34.99） cm^3 vs（57.14±24.42） cm^3, t=0.185, P=0.854;（34.98±19.96） cm^3 vs（33.89±17.65） cm^3, t=0.213, P=0.832]. Most of prostate cancer lesions were in prostate outer gland area（15/21）, and contrast-enhanced ultrasound imaging showed contrast enhancement increased mostly in arterial phase and faded faster than the surrounding tissues（16/21）. However, most of prostate benign lesions were in prostate inner gland（47/67）, and contrast-enhanced ultrasound imaging showed contrast enhancement was mostly equal with the surrounding tissue in arterial phase and faded the same as the surrounding tissues in venous phase（47/67）. Pathologic results of transrectal prostate biopsy under ultrasound guidance were used as diagnostic gold standard, the sensitivity of CE-TRUS in diagnosis of benign and malignant

关 键 词：前列腺肿瘤 超声检查 造影剂 诊断 鉴别 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]