应用经直肠超声造影微血管成像、弹性成像及常规超声靶向引导对疑似前列腺癌患者行穿刺活检的诊断效能比较  

Application of value contrast-enhanced ultrasound microangiography,elastography and conventional ultrasound-guided prostate cancer puncture biopsy in the diagnosis of prostate diseases

作　　者：熊飞 王红 李峰 薛力[1] XIONG Fei;WANG Hong;LI Feng;XUE Li(Department of Urology,The Second Affiliated Hospital of Xi an Jiaotong University,Xi an 710004,China)

机构地区：[1]西安交通大学第二附属医院泌尿外科,陕西西安710004

出　　处：《现代泌尿外科杂志》2024年第1期18-22,共5页Journal of Modern Urology

基　　金：陕西省自然科学基金青年项目(No.2020JQ-544)。

摘　　要：目的探讨经直肠超声造影(CEUS)微血管成像、弹性成像及常规超声靶向引导前列腺癌穿刺活检在前列腺病变诊断中的应用价值,为前列腺癌的早期诊断提供参考。方法选取2021年1月-2022年12月在西安交通大学第二附属医院泌尿外科就诊的疑似前列腺癌患者156例,根据患者采取的穿刺活检方法分为A组(n=52)、B组(n=49)和C组(n=55),其中A组给予常规超声靶向引导前列腺癌穿刺活检,B组给予弹性成像引导前列腺癌穿刺活检,C组给予CEUS微血管成像引导前列腺癌穿刺活检,比较各组前列腺穿刺阳性针比例及前列腺癌诊断价值,同时分析CEUS微血管成像、弹性成像参数诊断前列腺癌的价值。结果B组和C组前列腺穿刺阳性针比例分别24.18%和25.71%,明显高于A组的13.15%(P<0.05)。B组和C组前列腺癌诊断准确率分别为93.88%和94.55%,高于A组的75.00%(P=0.002)。B组恶性病灶弹性成像参数Emax和Emean分别为(65.56±14.43)kPa和(59.59±11.02)kPa,高于良性病灶(P<0.001);良恶性病灶CEUS微血管血流分级比较差异有统计学意义(P<0.05),其中恶性病灶血流分级3级比例达到95.65%。弹性成像参数Emean诊断前列腺癌的受试者工作特征(ROC)曲线下面积为0.810(95%CI:0.690~0.930,P<0.05);CEUS微血管成像血流分级诊断前列腺癌的ROC曲线下面积为0.965(95%CI:0.913~1.000,P<0.05)。结论相比较常规超声靶向引导前列腺癌穿刺活检,CEUS微血管成像及弹性成像引导前列腺癌穿刺活检在前列腺病变诊断中有更好的应用价值,同时CEUS微血管成像和弹性成像可为诊断前列腺病变提供半定量/定量参数依据。Objective To explore the application value of transrectal contrast-enhanced ultrasound(CEUS)microangiography,elastography and conventional ultrasound-guided prostate cancer puncture biopsy in the diagnosis of prostate diseases,so as to provide reference for the early diagnosis of prostate cancer.Methods A total of 156 patients suspected of prostate cancer treated in our hospital during Jan.2021 and Dec.2022 were selected.The patients were divided into group A(n=52,conventional ultrasound),group B(n=49,elastography)and group C(n=55,CEUS microangiography)according to the puncture methods.The positive rate of puncture and diagnostic value of the three methods were analyzed.Results The positive rate of puncture was 24.18%in group B and 25.71%in group C,which was significantly higher than that in group A(13.15%,P<0.05).The diagnostic accuracy of prostate cancer was 93.88%in group B and 94.55%in group C,higher than that in group A(75.00%,P=0.002).In group B,the Emax and Emean of malignant lesions were(65.56±14.43)kPa and(59.59±11.02)kPa,respectively,which were higher than those of benign lesions(P<0.001).The difference in blood flow grade detected by CEUS microangiography was statistically significant between benign and malignant lesions,and grade 3 blood flow accounted for 95.65%of malignant lesions.The area under the receiver operating characteristic(ROC)curve(AUC)of Emean in elastography in the diagnosis of prostate cancer was 0.810(95%CI:0.690-0.930,P<0.05).The AUC of CEUS microangiography in the diagnosis of prostate cancer was 0.965(95%CI:0.913-1.000,P<0.05).Conclusion Compared with conventional ultrasound-guided prostate cancer puncture biopsy,CEUS microangiography and elastography guided prostate cancer puncture biopsy have better application value in the diagnosis of prostate diseases,which can provide semi-quantitative/quantitative parameter basis for the diagnosis of prostate diseases.

关 键 词：经直肠超声造影微血管成像 弹性成像 常规超声 靶向引导前列腺癌穿刺活检 前列腺病变 

分 类 号：R737[医药卫生—肿瘤]