“一平面三点”双探头超声定位局部麻醉下经会阴前列腺mpMRI-TRUS多模态AI影像融合靶向穿刺的应用初探  

Application of mpMRI-TRUS AI fusion targeted transperineal biopsy under local anesthesia with“one-plane three-point”dual probe ultrasound localization

作　　者：杨勇军[1] 贺显雅 曾一鸣 卢强 李远伟[1] YANG Yongjun;HE Xianya;ZENG Yiming;LU Qiang;LI Yuanwei(Department of Urology,The First Affiliated Hospital of Hunan Normal University,Hunan Provincial People's Hospital,Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院,湖南省人民医院泌尿外科,湖南长沙410005

出　　处：《现代泌尿外科杂志》2024年第6期540-546,共7页Journal of Modern Urology

基　　金：湖南省自然科学基金项目(No.2021JJ40513);湖南教育厅优秀青年项目(No.22B0099);湖南省卫生健康委一般资助课题项目(No.B202304056636)。

摘　　要：目的探讨“一平面三点”双探头超声定位局部麻醉下经会阴前列腺多参数磁共振-经直肠彩超(mpMRI-TRUS)多模态人工智能(AI)影像融合靶向穿刺的安全性和有效性。方法回顾性分析2023年1—9月湖南师范大学附属第一医院(湖南省人民医院)收治的134例可疑前列腺癌(PCa)患者的临床资料,所有患者均采用“一平面三点”双探头超声定位局部麻醉下行经会阴前列腺mpMRI-TRUS多模态AI影像融合靶向穿刺活检,由同一名医生应用视觉模拟评分(VAS)和视觉数字评分(VNS)评估患者前列腺穿刺活检时(VAS-1和VNS-1)和术后1 h(VAS-2和VNS-2)的疼痛度和满意度,记录患者围手术期临床资料和穿刺活检有临床意义前列腺癌(csPCa)阳性检出率。结果患者VAS-1为(1.60±0.68)分,VAS-2为(1.13±0.55)分;VNS-1为(2.84±0.41)分,VNS-2为(3.74±0.44)分,手术时间(16.12±3.35)min。靶向穿刺活检病理结果提示csPCa阳性检出率为65.67%(88/134)。根据前列腺影像报告和数据系统(PI-RADS)v2.1评分进行亚组分析,PI-RADS v2.1评分中2、3、4和5分患者的csPCa阳性检出率分别为23.08%(6/26)、52.94%(18/34)、62.50%(15/24)和98.00%(49/50)。穿刺术后20.90%(28/134)患者出现肉眼血尿,4.00%(5/125)患者出现尿潴留,经对症治疗后缓解。所有患者均未出现会阴穿刺区域血肿、尿路感染、血精、迷走神经反应和感染性休克等并发症。结论“一平面三点”双探头超声定位局部麻醉下经会阴前列腺mpMRI-TRUS多模态AI影像融合靶向穿刺为可疑PCa患者提供了一种安全且耐受性好的确诊手段,具有较高的csPCa阳性检出率,值得临床进一步推广应用。Objective To explore the efficacy and safety of multi-parametric magnetic resonance imaging and transrectal ultrasonography(mpMRI-TRUS)fusion targeted transperineal biopsy(TPB)under local anesthesia(LA)with“one-plane three-point”dual probe ultrasound localization.Methods Clinical data of 134 suspected prostate cancer(PCa)patients treated with this method in our hospital during Jan.and Sep.2023 were retrospectively analyzed.The same doctor applied visual analog scale(VAS)and visual digital scale(VNS)to evaluate the pain level and satisfaction of patients during TPB(VAS-1 and VNS-1)and 1 hour after TPB(VAS-2 and VNS-2),and recorded the perioperative clinical data and detection rate of clinically significant prostate cancer(csPCa).Results VAS-1 score was(1.60±0.68)and VAS-2 score was(1.13±0.55);VNS-1 score was(2.84±0.41),and VNS-2 score was(3.74±0.44).The operation time was(16.12±3.35)minutes.The postoperative pathological results showed that the detection rate of csPCa was 65.67%(88/134).According to the PI-RADS score in subgroup analysis,the detection rates of patients with PI-RADS scores of 2,3,4,and 5 were 23.08%(6/26),52.94%(18/34),62.50%(15/24)and 98.00%(49/50),respectively.After TPB,gross hematuria occurred in 20.90%(28/134)patients,and urinary retention occurred in 4.00%(5/125)patients,which were relieved after symptomatic treatment.No complications such as perineal puncture area hematoma,urinary tract infection,hematospermia,vagal nerve reaction,and septic shock occurred.Conclusion The mpMRI-TRUS fusion targeted TPB under LA with“one-plane three-point”dual probe ultrasound localization provides a feasible and tolerable surgical procedure for suspected PCa patients with a high detection rate of csPCa,which is worthy of further clinical promotion and application.

关 键 词：前列腺癌 经会阴 穿刺 多参数磁共振-经直肠彩超 一平面三点 靶向穿刺 有临床意义前列腺癌 人工智能 

分 类 号：R737.25[医药卫生—肿瘤]