经直肠常规超声联合超声造影在前列腺良恶性病灶鉴别诊断中的应用  

Application of Conventional Transrectal Ultrasound Combined with Contrast-enhanced Ultrasound in Differential Diagnosis Between Benign and Malignant Prostate Lesions

作　　者：李渝 罗季平 但思宇 杨芳[1] 何秀利 岳文胜[1] Li Yu;Luo Jiping;Dan Siyu;Yang Fang;He Xiuli;Yue Wensheng(Department of Ultrasound,Academician Workstation,Ultrasound Laboratory,The Affiliated Hospital of North Sichuan Medical College,Medical Imaging Key Laboratory of Sichuan Province,Nanchong Key Laboratory of Medical Ultrasound Engineering,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院超声科,医学影像四川省重点实验室,超声医学工程南充市重点实验室,川北医学院附属医院院士工作站,四川省南充市637000

出　　处：《中国超声医学杂志》2023年第3期287-291,共5页Chinese Journal of Ultrasound in Medicine

摘　　要：目的 探讨经直肠常规超声(TRUS)联合超声造影(TR-CEUS)对前列腺良恶性病灶的鉴别诊断价值。方法 选取前列腺病灶91例,根据病理结果分为良性组44例和恶性组47例。详细观察并记录病灶TRUS及TR-CEUS表现,应用单因素分析比较两组间差异,建立多因素Logistic回归模型,分析前列腺癌(PCa)独立危险因素并计算模型预测概率,运用受试者操作特征(ROC)曲线评价两种方法单独及联合运用诊断效能。结果 单因素分析表明,PCa的PSA水平较高、双侧叶不对称、包膜不光滑、内外腺分界不清晰、病灶位于外腺、低回声、形态不规则、境界不清晰、内部有钙化、彩色血流丰富及TR-CEUS特征为高增强、增强时间早、不对称血管结构、造影剂分布不均匀及廓清快的比例较高。多因素分析显示前列腺内外腺分界不清晰、病灶形态不规则及造影为高增强是PCa独立危险因素。TRUS及TR-CEUS用于诊断前列腺病灶良恶性的AUC分别为0.917、0.838(P>0.05),二者联合应用时诊断效能最佳,AUC为0.953(P<0.05)。结论 TRUS及TR-CEUS对前列腺病灶均具有较好的鉴别诊断能力。与单独应用相比,二者联合对前列腺癌诊断效能更高。Objective To investigate the value of conventional transrectal ultrasound(TRUS) combined with transrectal contrast-enhanced ultrasound(TR-CEUS) in the differential diagnosis of benign and malignant prostate lesions. Methods A total of 91 cases with prostate lesions were enrolled and divided into benign group(44 cases) and malignant group(47 cases) according to the pathological results. The TRUS and TR-CEUS performance of the lesions were observed and recorded. Univariate analysis was applied to compare the differences between the two groups, and multivariate Logistic regression model was established to analyze the independent risk factors for prostate cancer(PCa). The receiver operating characteristic curve was used to evaluate the diagnostic efficacy of the two methods applied individually and in combination. Results Univariate analysis demonstrated that elevated levels of PSA, asymmetric bilateral lobes, non-smooth capsule, unclear demarcation between transition zone and peripheral zone, lesion located in the transition zone, hypoechoic, irregular shape, indistinct margin, internal calcification, rich color Doppler flow, and high-enhancement, early-enhancement, asymmetrical vascular structure, uneven distribution of contrast agent, and rapid clearance on TR-CEUS were associated with a higher incidence of PCa. Multivariate analysis revealed that unclear demarcation between transition zone and peripheral zone, irregular shape, and high-enhancement on TR-CEUS were independent risk factors for PCa. The area under the curve(AUC) of TRUS and TR-CEUS for distinguishing between benign and malignant prostate lesions were 0.917 and 0.838(P>0.05), whereas the combined use of both techniques yielded the highest diagnostic efficacy with an AUC of 0.953(P<0.05). Conclusions Both TRUS and TR-CEUS have good differential diagnostic ability for prostate lesions. Compared with single application, the combined of the two methods is more effectively in diagnosis of prostate cancer.

关 键 词：前列腺癌 经直肠超声检查 超声造影 二元LOGISTIC回归 诊断效能 

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]