经直肠前列腺超声造影靶向活检诊断前列腺癌的可行性研究  

Feasibility Study of Transrectal Prostate Contrast-enhanced Ultrasonography Targeted Biopsy in the Diagnosis of Prostate Cancer

作　　者：李丹丹[1] 高振森[1] 寇光玲 Li Dandan;Gao Zhensen;Kou Guangling(Department of Ultrasonography,Weifang People's Hospital,Weifang,Shandong 261041,China)

机构地区：[1]潍坊市人民医院超声科

出　　处：《中国超声医学杂志》2020年第1期63-66,共4页Chinese Journal of Ultrasound in Medicine

基　　金：山东省自然基金项目（No.Y2008C97）

摘　　要：目的评价超声造影对前列腺癌(PCa)的诊断价值,探讨PCa靶向活检(TB)的可行性。方法对164例前列腺特异度抗原(PSA)水平≥4ng/ml患者,在接受前列腺活检前行前臂静脉注射声诺维2.4ml (29.5μg),经直肠超声(TRUS)前列腺超声造影(CEUS)检查,评估CEUS的声像图表现。对92例CEUS显示前列腺异常灌注区行TB;并对260例PSA≥4ng/ml患者行前列腺系统活检(SB),然后对TB和SB的病理结果进行对比分析。结果 92例CEUS显示前列腺异常灌注区的患者于TRUS引导下行TB,平均每位患者取活检标本12.6条,病理诊断PCa阳性率66.3%(61/92),未见癌细胞33.7%(31/92);SB病理诊断PCa 19.6%(51/260),未见癌细胞199例76.5%(199/260),TB对PCa检出率明显高于SB的19.6%(优势比=3.3,P=0.002 7)。CEUS提示PCa的声像图表现多种多样:强对比增强、快速对比增强、血管灌注异常和低对比增强。结论 TRUS引导下CEUS靶向活检,可提高组织材料的质量,使患者避免不必要的穿刺,减少穿刺次数,从而提高PCa的诊断率,超声造影TB和SB结合,可以获得PCa较高的检出率,有较高的临床应用价值。Objective To evaluate the diagnostic value of contrast-enhanced ultrasonography(CEUS)for prostate cancer(PCa)and to explore the feasibility of targeted biopsy(TB)for PCa.Methods 164 patients with prostate specific antigen(PSA)level≥4 ng/ml,before the prostate biopsy,the forearm intravenous injection of Sonazoid 2.4 ml(29.5μg),were processed the CEUS examination of prostate by TRUS,evaluated the sonographic images of CEUS,targeted biopsy was performed on 92 cases of CEUS showing abnormal prostate perfusion area,In addition,260 patients with PSA ≥4 ng/ml were given Systematic biopsy(SB),and the pathological results of TB and SB were compared and analyzed.Results 92 patients with abnormal perfusion of prostate showed by CEUS underwent targeted biopsy of transrectal ultrasound guided.On average,12.6 biopsy specimens were taken from each patient.The positive rate of PCa was 66.3%(61/92)by TB,and no cancer cells were found in 31 cases(33.7%,31/92).The positive rate of PCa was 19.6%(51/260)by SB,and no cancer cells were found in 199 cases(76.5%,199/260).The detection rate of TB for PCa was significantly higher than that of SB 19.6%(odds ratio=3.3,P=0.0027).CEUS indicated a variety of sonographic appearance of PCa:intense contrast enhancement,rapid contrast enhancement,abnormal perfusion of blood vessels,and low contrast enhancement.Conclusions The CEUS targeted biopsy guided by transrectal ultrasound can improve the quality of the materials and make the patients avoid unnecessary puncture,it can also decrease the times of puncture so as to improve the diagnosis of PCa,TB by CEUS biopsy combined with SB can obtain higher detection rate of PCa,it has a high clinical application value.

关 键 词：前列腺癌 超声造影 前列腺活检 靶向活检 经直肠超声 

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]