MRI-超声融合引导下前列腺靶向穿刺活检的最新进展

摘要

Prostate cancer is currently diagnosed by prostate biopsy performed by the transrectal ultrasound-guided technique.However,overdetection of clinical insignificant tumours and missed detection of clinical significant tumours have become problematic.MRI of the prostate,particularly if performed with multiparametric imaging,is capable of detecting clinical significant prostate cancer,which has brought the opportunity to use those images as targets for needle biopsy.Three methods of fusing MRI for targeted biopsy have been recently described:MRI-ultrasound fusion,MRI-MRI fusion ('in-bore' biopsy) and cognitive fusion.Fusion of MRI with ultrasound allows urologists to progress from blind,systematic biopsies to biopsies,which are mapped,targeted and tracked.In the future,MRI-ultrasound fusion for lesion targeting is likely to result in fewer and more accurate prostate biopsies than the present use of systematic biopsies with ultrasound guidance alone.%通过经直肠超声引导下的前列腺穿刺活检进行病理诊断是当前确诊前列腺癌的主要方法,但存在漏诊临床有意义肿瘤及过度检测无临床意义肿瘤的可能.多参数磁共振成像(mpMRI)能够检测出临床有意义的前列腺癌,并精确定位可疑病灶,因此可实现靶向穿刺.目前MRI引导有3种方法可用于靶向前列腺穿刺活检:认知融合、MRI直接引导、MRI-超声融合引导.MRI-超声融合技术使得泌尿外科医师从对前列腺的盲穿、系统性穿刺发展为有针对性的对于肿瘤病灶的靶向穿刺.未来,MRI-超声融合靶向穿刺技术有望以更少的穿刺针数及更准确的穿刺结果,取代目前传统的超声引导下系统性穿刺活检术.