弥散加权磁共振联合经直肠超声定位的前列腺穿刺活检诊断前列腺癌的价值

摘要

Objective To retrospectively analyze the clinical value of diffusion-weighted MR imaging in the detection of prostate cancer in suspected patients.Methods Between January 2009 and December 2010,the 551 patients suspected as prostate cancer underwent prostate biopsy.Patients in group A were accepted to a transrectal ultrasound (TRUS) guided transrectal prostate biopsy (n =410),while patients in group B were accepted to a diffusion weighted imaging (DWI) and TRUS jointly guided transrectal prostate biopsy ( n =141 ).The two groups were divided into 4 subgroups by prostate specific antigen(PSA) ＜ 10 μg/L,10 μg/L≤ PSA ＜ 20 μg/L,20 μg/L≤ PSA ＜ 50 μg/L and PSA ≥50 μg/L.Then,the diagnostic rates of prostate biopsy guided by combination of DWI and TRUS with only TRUS were compared.Results The diagnostic rate of patients with PSA ＜ 10 μg/L,10 μg/L ≤ PSA ＜ 20 μg/L,20μg/L≤PSA ＜50 μg/L and PSA≥50 μg/L were 12.1％,31.1％,48.0％,91.2％ in group A,and 23.7％,35.5％,66.7％,96.3％ in group B,respectively.In the patients with PSA less than 10 μg/L,there were significant differences in diagnostic rate between the two biopsy techniques ( x2 =4.405,P ＜0.05 ).Conclusion The combination of DWI and TRUS showed the potential to guide biopsy to cancer foci in patients suspected as prostate cancer.For patients with PSA ＜ 10 μg/L,a DWI and TRUS jointly guided transrectal prostate biopsy was recommended.%目的 探讨DWI在前列腺穿刺活检中的运用价值.方法 回顾性分析2009年1月至2010年12月在我院行常规经直肠超声(TRUS)定位下经直肠前列腺穿刺(A组)的410例患者和DWI联合TRUS定位下行前列腺穿刺(B组)的141例患者资料,按前列腺特异性抗原(PSA)＜10μg/L、10 μg/L≤PSA ＜20 μg/L、20 μg/L≤PSA ＜50 μg/L和PSA≥50 μg/L将A、B两组各分为4个亚组,分别比较DWI联合TRUS定位与单纯TRUS定位下经直肠前列腺穿刺活检的诊断率.结果 A组PSA＜ 10 μg/L、10μg/L≤PSA ＜20 μg/L、20 μg/L≤PSA＜ 50 μg/L和PSA≥50 μg/L的患者穿刺诊断率分别为12.1％、31.1％、48.0％和91.2％,B组中对应的患者穿刺诊断率分别为23.7％、35.5％、66.7％和96.3％,两种穿刺方法的诊断率在PSA＜ 10 μg/L的患者中有统计学差异(x2=4.405,P＜0.05).结论 对于PSA＜ 10 μg/L的可疑患者,建议行DWI及TRUS联合定位的可疑病灶加系统穿刺法,从而提高前列腺穿刺的诊断率.