摘要
目的探讨经直肠多模态超声检查在老年前列腺结节诊断中的应用价值。方法2015年12月至2016年12月，64例怀疑前列腺癌（PCA）可能的老年患者，行经直肠超声检查（TRUS）发现前列腺异常结节后再行经直肠前列腺超声造影检查（CETRUS）及经直肠实时组织超声弹性成像（TRTE），并予前列腺穿刺活检。穿刺方案采用系统穿刺加上述检查可疑部位针对性活检。以病理活检结果作为金指标来评价上述检查方法在老年前列腺结节诊断中的作用。结果64例患者共72个结节中，病理确诊为前列腺增生31例，前列腺炎5例，PCA35例，前列腺淋巴瘤1例。良恶性前列腺结节CETRUS、TRTE结果比较，在增强强度、增强时间快进、两组弹性分级结果中差异有统计学意义（x2=28．794、10．889和52．898，P=0．000、0．001和0．000）。35个PCA结节根据Gleason评分不同分为两组，不同组间比较在增强强度、增强均度、增强时间快进、快退上差异有统计学意义（x2=6．073、12．315、4．717和18．093，P=0．048、0．001、0．030和0．000）。计算联合使用CETRUS与TRTE这2种检查方法诊断前列腺结节良恶性的敏感度83．3％、特异度86．1％、准确度84．7％、阴性预测率83．8％、阳性预测率85．7％，均高于单独使用其中一种检查方法。结论经直肠多模态超声检查可以提供更多的老年前列腺结节的灌注与弹性信息，对判断老年前列腺结节良恶性方面有积极的作用。
Objective To assess the value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients. Methods Sixty-four elderly patients suspected of prostate cancer （PCA） were enrolled from December 2015 to December 2016. Sixty-four patients with 72 nodules underwent transrectal ultrasound （TRUS）,contrast-enhanced transrectal ultrasound （CETRUS） and transrectal real-time tissue elastography （TRTE）. A combination of systematic biopsy and suspicious sitetargeted biopsy was conducted. The accuracies of different detection methods for prostate cancer were assessed against the gold standard of histological examination of prostate biopsy samples. Results Among the 72 nodules,31 were prostatic hyperplasia,5 were chronic prostatitis,35 were prostatic cancer,and one was prostatic lymphoma. There were significant differences in enhancement strength,enhancement time fast-in and degree of elasticity on TRTE and CETRUS between the malignant and benign groups （x2 = 28. 794,10. 889, 52. 898; P=0. 000,0, 001,0. 000,respectively）. When the 35 PCA nodules were divided into two subgroups based on the Gleason score, there were statistically significant differences in enhancement strength, homogeneity of enhancement,and enhancement time fast-in and fast-out between them （x2 = 6. 073,12. 315, 4. 717,18. 093 ; P = 0. 048,0. 001,0. 030,0. 000, respectively）. The combination of CETRUS and TRTE in diagnosing prostate nodules produced a sensitivity of 83.3 % ,a specificity of 86.1% ,an accuracy of 84. 7%, a positive predictive value of 85.7%, and a negative predictive rate of 83.8% , better than either method alone. Conclusions Multi-modal image-guided transreetal ultrasonography has an advantage in providing information on the perfusion and elasticity of prostate nodules in the elderly patients and thus has important clinical value for the diagnosis of prostate nodules.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2017年第12期1330-1334,共5页
Chinese Journal of Geriatrics
关键词
前列腺肿瘤
超声检查
造影剂
弹性成像技术
Prostatic neoplasms
Ultrasonography
Contrast media
Elasticity imaging techniques
