MR引导聚焦超声治疗局限性前列腺癌的初步临床观察  

MR-guided focused ultrasound surgery for localized prostate cancer:a preliminary investigation

作　　者：沈枨 谷涛 李喆 张金涛 王淼 杜翔华 刘明 王建业 陈敏 Shen Cheng;Gu Tao;Li Zhe;Zhang Jintao;Wang Miao;Du Xianghua;Liu Ming;Wang Jianye;Chen Min(Department of Radiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Anesthesiology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]国家老年医学中心、中国医学科学院老年医学研究院、北京医院放射科,北京100730 [2]国家老年医学中心、中国医学科学院老年医学研究院、北京医院泌尿外科,北京100730 [3]国家老年医学中心、中国医学科学院老年医学研究院、北京医院麻醉科,北京100730

出　　处：《中华放射学杂志》2023年第6期673-678,共6页Chinese Journal of Radiology

基　　金：中央高校基本科研业务费专项资金(3332019122)。

摘　　要：目的探讨MR引导下聚焦超声(MRgFUS)治疗局限性前列腺癌的安全性及有效性。方法前瞻性纳入2020年8月至2021年9月共6例就诊于北京医院并接受MRgFUS治疗的局限性前列腺癌患者,年龄均超过18岁,既往未接受任何前列腺癌治疗。在治疗前行盆腔MR及CT扫描评估治疗靶区,治疗前依据病灶部位给予不同导尿措施,经全身麻醉后在治疗床上以前列腺专用直肠超声探头行聚焦超声消融治疗。治疗后1、3、6个月随访,后年度随访。随诊中检测前列腺特异性抗原(PSA)水平,复查盆腔MR扫描,行国际前列腺症状评分(IPSS)、国际勃起功能指数-15评分(IIEF-15)问卷评估及并记录治疗相关不良事件。结果(1)全部6例患者的6处病灶进行了MRgFUS治疗,耗时(126±56)min,每个病灶的聚焦超声脉冲次数为(7.3±3.2)次,非灌注体积为(3.8±1.1)cm3,均覆盖治疗靶区,未记录到治疗相关的不良事件。(2)术前和术后1、3、6、12个月PSA水平分别为(6.6±0.8)、(3.6±1.3)、(3.4±3.0)、(2.5±1.7)、(2.3±1.8)ng/ml,2例患者随访中发现PSA水平升高,后盆腔MR扫描发现复发病灶,其余4例PSA续下降,复查盆腔MR扫描未发现病灶。(3)治疗前和治疗后1、3个月IPSS评分分别为13.0(4.0,16.0)、10.0(4.0,12.0)、5.0(3.0,6.0)分;3例性活跃患者的治疗前IIEF-15评分分别为40、51、14分,治疗后1个月IIEF-15分别为9、8、14分;3个月IIEF-15分别为9、66、26分。(4)1例患者术后10个月确诊复发,1例患者术后6个月发现新病灶。结论MRgFUS可能是一种安全、无创、有效的局限性前列腺癌治疗手段,但应重视后续规律复查,以及时发现肿瘤复发。Objective To investigate the safety and efficacy of MR-guided focused ultrasound surgery(MRgFUS)in treating localized prostate cancer.Methods Six patients with localized prostate cancer who underwent MRgFUS treatment from August 2020 to September 2021 in Beijing Hospital were prospectively enrolled in this study.The patients were all over 18 years old,with an average age of(68±10)years,and had not received any prior treatment for prostate cancer.Pretreatment pelvic MR and CT scans were performed to determine the region of treatment(ROT).Different urinary catheterization measures were given based on the location of the lesion.Under general anesthesia,the lesions were treated by MRgFUS using a specialized rectal ultrasound transducer on the treatment bed.The patients were followed up at 1,3,and 6 months after treatment and annually thereafter.During follow-up,prostate-specific antigen(PSA)levels,pelvic MR scans,International Prostate Symptom Score(IPSS),International Index of Erectile Function-15(IIEF-15)scores,and adverse events were assessed.Results(1)All six patients underwent MRgFUS treatment for six lesions,with an average duration of(126±56)minutes,an average number of(7.3±3.2)focal ultrasound pulses per lesion,and an average non-perfusion volume of(3.8±1.1)cm3,which covered the entire treatment target area.No treatment-related adverse events were reported.(2)The PSA levels at baseline,1,3,6,and 12 months after treatment were(6.6±0.8),(3.6±1.3),(3.4±3.0),(2.5±1.7),and(2.3±1.8)ng/ml,respectively.PSA levels increased in 2 out of 6 patients during follow-up,and pelvic MR scan revealed recurrent lesions,while PSA levels continued to decrease in the remaining 4 patients,and pelvic MR scan were normal.(3)The IPSS scores at baseline,1,and 3 months after treatment were 13.0(4.0,16.0),10.0(4.0,12.0),and 5.0(3.0,6.0)points,respectively.For the three sexually active patients,the IIEF-15 scores at baseline were 40,51,and 14 points,respectively,and IIEF-15 at 1 month after treatment were 9,8,and 14 points,respect

关 键 词：磁共振成像 介入性 聚焦超声消融 局限性前列腺癌 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.25[医药卫生—诊断学]