超声造影参数在血清总前列腺特异性抗原4~10μg/L前列腺疾病良恶性鉴别诊断中的价值  

Value of contrast-enhanced ultrasound parameters to the differential diagnosis of benign and malignant prostate diseases in patients with serum total prostate-specific antigen 4 to 10 μg/L

作　　者：刘慧[1] 红华 梁丹艳 汪峰 LIU Hui;HONG Hua;LIANG Danyan;WANG Feng(Department of Ultrasound Medicine,People’s Hospital of Inner Mongolia Autonomous Region,Inner Mongolia Medical University,Hohhot 010017,China;Department of Ultrasound Medicine,People’s Hospital of Inner Mongolia Autonomous Region,Hohhot 010017,China;Department of Pathology,People’s Hospital of Inner MongoliaAutonomous Region,Hohhot 010017,China)

机构地区：[1]内蒙古自治区人民医院超声医学科,内蒙古医科大学,呼和浩特010017 [2]内蒙古自治区人民医院超声医学科,呼和浩特010017 [3]内蒙古自治区人民医院病理科,呼和浩特010017

出　　处：《中华实用诊断与治疗杂志》2020年第7期722-725,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：内蒙古自治区自然科学基金(2015MS08141)。

摘　　要：目的探讨超声造影靶向穿刺区造影时间-强度曲线参数在血清总前列腺特异性抗原(total prostate specific antigen, tPSA)值为4~10μg/L前列腺增生症与前列腺癌鉴别诊断中的作用。方法血清tPSA为4~10μg/L且直肠指检异常的疑诊前列腺癌患者103例,均行超声造影,依据造影图像行靶向穿刺及系统穿刺活检,依据组织病理结果分为前列腺癌组47例、前列腺增生组56例。比较2组超声造影靶向穿刺区造影时间-强度曲线参数上升时间(rise time, RT)、达峰时间(time to peak, TTP)、平均通过时间(mean transit time, MTT)、强度降半时间(peak to one half time, HT)、峰值强度(peak intensity, PI)、曲线下面积(area under the curve, AUC)、上升支斜率(wash in slope, WIS);绘制ROC曲线分析各参数对血清tPSA为4~10μg/L前列腺癌的诊断价值。结果前列腺癌组RT[6.18(5.41,9.17)s]、TTP[25.70(23.55,30.18)s]较前列腺增生组[9.53(6.11,16.99)、35.76(26.47,44.90)s]短(P<0.05),PI[8.70(6.89,10.84)dB]、AUC[536.31(396.28,772.11)dBs]、WIS[1.10(0.73,1.57)dB/s]较前列腺增生组[5.23(3.41,7.96)dB、288.84(172.71,402.50)dBs、0.49(0.26,0.99)dB/s]高(P<0.05),MTT[31.68(23.83,37.48)s]、HT[45.54(32.44,53.87)s]与前列腺增生组[27.48(21.07,40.63)s、39.54(30.30,50.29)s]差异无统计学意义(P>0.05)。ROC曲线分析结果显示,超声造影靶向穿刺区造影时间-强度曲线参数AUC、PI分别以413.62 dBs、5.23 dB为最佳截断值,诊断血清tPSA为4~10μg/L前列腺癌的AUC分别为0.807(95%CI:0.717~0.878,P<0.001)、0.779(95%CI:0.686~0.855,P<0.001);RT、TTP、WIS分别以9.88 s、36.02 s、0.66 dB/s为最佳截断值,诊断血清tPSA为4~10μg/L前列腺癌的AUC分别为0.677(95%CI:0.577~0.766,P=0.002)、0.734(95%CI:0.637~0.816,P<0.001)、0.744(95%CI:0.648~0.825,P<0.001)。结论对血清tPSA为4~10μg/L的疑诊前列腺癌患者,超声造影时间-强度曲线参数AUC>413.62 dBs或PI>5.23 dB时,应行前列腺穿刺活检明确诊断。Objective To investigate the role of time-intensity curve parameters in the differential diagnosis of hyperplasia of prostate and prostate cancer in patients with total prostate-specific antigen(tPSA)value of 4 to 10μg/L.Methods Totally 103 suspected prostate cancer patients with serum tPSA of 4 to 10μg/L and abnormal rectal examination result underwent contrast-enhanced ultrasound(CEUS).The targeted puncture and systematic puncture biopsy were performed based on the CEUS images,and according to the histopathologic results,these patients were divided into prostate cancer group(n=47)and prostate hyperplasia group(n=56).The contrast time-intensity curve rise time(RT),time to peak(TTP),mean transit time(MTT),peak to one half time(HT),peak intensity(PI),area under the curve(AUC)and wash in slope(WIS)were compared between two groups.ROC curve was drawn to analyze the value of each parameter to the diagnosis of prostate cancer in patients with tPSA of 4 to 10μg/L.Results RT and TTP were shorter in prostate cancer group(6.18(5.41,9.17),25.70(23.55,30.18)s)than those in prostatic hyperplasia group(9.53(6.11,16.99),35.76(26.47,44.90)s)(P<0.05).PI,AUC and WIS were higher in prostate cancer group(8.70(6.89,10.84)dB,536.31(396.28,772.11)dBs,1.10(0.73,1.57)dB/s)than those in prostatic hyperplasia group(5.23(3.41,7.96)dB,288.84(172.71,402.50)dBs,0.49(0.26,0.99)dB/s)(P<0.05).MTT and HT showed no significant differences between prostate cancer group(31.68(23.83,37.48),45.54(32.44,53.87)s)and prostatic hyperplasia group(27.48(21.07,40.63),39.54(30.30,50.29)s)(P>0.05).When the optimal cut-offvalues of AUC and PI were 413.62 dBs and 5.23 dB,the AUCs for diagnosing prostate cancer in patients with tPSA of 4 to 10μg/L were 0.807(95%CI:0.717-0.878,P<0.001)and 0.779(95%CI:0.686-0.855,P<0.001),respectively.When the optimal cut-offvalues of RT,TTP and WIS were 9.88 s,36.02 sand 0.66 dB/s,the AUCs for diagnosing prostate cancer in patients with tPSA of 4 to 10μg/L were 0.677(95%CI:0.577-0.766,P=0.002),0.734(95%CI:0.637-0.816,P<0.001)

关 键 词：前列腺癌 超声造影 靶向穿刺区 造影时间-强度曲线参数 总前列腺特异性抗原 

分 类 号：R737.25[医药卫生—肿瘤]