经直肠前列腺超声造影在不同总前列腺特异性抗原区间前列腺癌诊断中的应用  

Application of transrectal contrast-enhanced ultrasound in the diagnosis of prostate cancer in different tPSA intervals

作　　者：张明[1] 高庆禄 孟庆松[1] 田晖[2] 王东彬[1] 汪鑫[1] 倪守全 齐进春[1] ZHANG Ming;GAO Qinglu;MENG Qingsong;TIAN Hui;WANG Dongbin;WANG Xin;NI Shouquan;QI Jinchun(Department of Urology,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Abdominal Ultrasound,The Second Hospital of Hebei Medical University,Shijiazhuang 050000,China;Department of Urology,Shexian Hospital,Handan 056400,China)

机构地区：[1]河北医科大学第二医院泌尿外科,河北石家庄050000 [2]河北医科大学第二医院腹部超声科,河北石家庄050000 [3]邯郸市涉县医院泌尿外科,河北邯郸056400

出　　处：《现代泌尿外科杂志》2023年第10期851-855,共5页Journal of Modern Urology

基　　金：河北省医学科学研究课题计划项目(No.20200903)。

摘　　要：目的探讨经直肠前列腺超声造影在不同总前列腺特异性抗原(tPSA)区间前列腺癌诊断中的应用价值。方法依据血清tPSA水平将符合纳入标准的患者分为3组:4~10、>10~20、>20 ng/mL组。该项研究共纳入96例患者,行经直肠前列腺超声造影检查,以前列腺穿刺病理结果作为对照,分析经直肠前列腺超声造影在不同tPSA区间的诊断应用价值。结果96例患者中,经病理诊断证实前列腺癌患者62例,良性前列腺增生症(BPH)患者34例;前列腺癌在超声造影下的主要血流灌注特征为快速增强(64.52%)、快速廓清(70.97%)、不均匀增强(83.87%)、高增强(61.29%);BPH患者超声造影下的主要血流灌注特征为非快速增强(70.59%)、非快速廓清(73.53%)、均匀增强(76.47%)、非高增强(52.94%)。前列腺癌与BPH在超声造影下的增强速度、廓清速度、增强均匀度3个方面比较,差异有统计学意义(P<0.05),在增强强度之间比较差异无统计学意义(P>0.05)。经直肠前列腺超声造影在PSA低、中、高3个浓度组对前列腺癌诊断的灵敏度分别为58.33%、70.37%、95.65%,特异度分别为83.33%、76.92%、66.67%,准确度分别为73.33%、72.50%、92.31%。经直肠前列腺超声造影在3个不同血清PSA浓度区间对前列腺癌诊断具有较好的一致性,差异有统计学意义,且在4.0~10.0 ng/mL组诊断的特异度最高。结论经直肠前列腺超声造影有助于前列腺良恶性病变的鉴别诊断;对于不同血清PSA浓度区间前列腺癌的诊断具有一定的临床应用价值。Objective To investigate the clinical value of transrectal contrast-enhanced ultrasound(CEUS)in the diagnosis of prostate cancer in different total prostate specific antigen(tPSA)intervals.Methods According to serum tPSA levels,96 patients meeting the inclusion criteria were divided into 3 groups:4-10 ng/mL,>10-20 ng/mL and>20 ng/mL groups.All patients underwent transrectal CEUS.With pathological results as reference,the diagnostic value of transrectal CEUS in different tPSA intervals was evaluated.Results Of the 96 cases,62 were confirmed by pathology as prostate cancer and 34 as benign prostatic hyperplasia(BPH).The main perfusion characteristics of prostate cancer under CEUS were rapid enhancement(64.52%),rapid clearance(70.97%),uneven enhancement(83.87%)and high enhancement(61.29%);the main characteristics of BPH were non-rapid enhancement(70.59%),non-rapid clearance(73.53%),uniform enhancement(76.47%)and non-high enhancement(52.94%).There were significant differences in terms of enhancement speed,clearance speed and enhancement uniformity between prostate cancer and BPH(P<0.05),but no significant difference in the enhancement intensity.The sensitivity of transrectal CEUS in the diagnosis of prostate cancer in low,medium and high tPSA groups were 58.33%,70.37%and 95.65%,the specificity were 83.33%,76.92%and 66.67%,and the accuracy were 73.33%,72.50%and 92.31%,respectively.Transrectal CEUS showed consistency at different serum tPSA levels for the diagnosis of prostate cancer,with statistical significance.Moreover,in the 4.0 ng/mL≤tPSA<10.0 ng/mL group,the diagnostic specificity was the highest.Conclusion Transrectal CEUS is helpful in the differential diagnosis of benign and malignant prostatic lesions,especially for patients with different serum tPSA levels.

关 键 词：前列腺癌 经直肠超声 前列腺超声造影 前列腺特异抗原 病理诊断 

分 类 号：R737[医药卫生—肿瘤] R697.32[医药卫生—临床医学]