经直肠剪切波弹性成像技术在前列腺癌与良性前列腺增生鉴别诊断中的应用价值

摘要

目的 探讨经直肠剪切波弹性成像技术在前列腺癌与良性前列腺增生鉴别诊断中的应用价值.方法 选取127例疑诊为前列腺癌的患者行经直肠超声检查和经直肠剪切波弹性成像检查,测量其弹性模量值获得病变的弹性最大值(Emax值)、平均值(Emea值)后,行经直肠超声引导下穿刺活检,以穿刺病理结果为金标准,绘制ROC曲线图,取得Emax值、Emea值的弹性界值.评价经直肠剪切波弹性成像技术在前列腺良恶性病变鉴别诊断中的应用价值.结果 病理诊断37例为前列腺癌,90例为良性前列腺增生.前列腺癌的Emax值和Emea值分别为(65.07±13.49)kPa、(44.05±7.62) kPa,良性前列腺增生的Emax值和Emea值分别为(51.64±10.16) kPa、(36.55±5.92)kPa,两组间的Emax值和Emea值的差异具有统计学意义(t=11.113、10.444,P均＜0.05).Emax值和Emea值在ROC曲线下面积分别为0.941、0.925.取53.25、42.35 kPa作为Emax值和Emea值的诊断界值时,其灵敏度分别为89.2％、91.9％,特异度分别为95.6％、82.2％;经直肠剪切波弹性成像鉴别诊断前列腺良恶性病灶的灵敏度、特异度、准确度分别为78％、80％、79.5％,明显高于经直肠二维超声检查,两者检查方法对前列腺良恶性病变鉴别诊断的灵敏度、特异度、准确度相比具有统计学意义(x2=0.047、0.009、0.001,P＜0.05).结论 经直肠剪切波弹性成像技术根据病灶的弹性模量值定量评价病灶的硬度,在前列腺癌与良性前列腺增生鉴别诊断中有较高的应用价值,有助于提高前列腺癌的检出率.%Objective To assess the value of transrectal shear wave elastograpy in differential diagnosis of benign prostatic hyperplasia and prostatic cancer.Methods One-hundred twenty seven with suspected prostate cancer were enrolled in this study.The transrectal ultrasound and the transrectal shear wave elastograpy were performed for all patients,measuring the maximum elastic and mean elastic modulus.Each patient underwent sonography-guided prostatic biopsy,With the pathologic results as reference,ROC curves were used to determine the optimal diagnostic cut off value,assessing diagnostic performance of transrectal shear wave elastograpy.Results Pathological results showed that 90 cases were benign prostatic hyperplasia and 37 cases were prostatic cancer.The maximum and mean elasticity values for benign prostatic hyperplasia were (51.64 ± 10.16) kPa,(36.55 ± 5.92) kPa respectively,which prostatic cancer were (65.07 ± 13.49)kPa,(44.05 ± 7.62)kPa respectively.The maximum and mean elastic values had statistically significant differences between benign and malignant lesions(t=11.113,10.444,P均＜0.05).The area under ROC curves of the maximum and mean elastic values were 0.941,0.925 respectively.Taking 53.25 kPa as the threshold of maximun elasticity value,the sensitivity was 89.2％ and specificity was 95.6％.Taking 42.35 kPa as the threshold of the mean elasticity value,the sensitivity was 91.9％ and the specificity was 82.2％.The sensitivity,specificity and accuracy in differentiating benign and malignant prostatic lesions by the transrectal shear wave elastograpy which obviously increased compared with the transrectal ultrasound were 78 ％,80 ％,79.5 ％,respectively (x2 =0.047,0.009,0.001,P＜0.05).Conclusions The transrectal shear wave elastograpy provides quantitative elasticity measurements,adding information that can potentially differentiate benign and malignant prostatic lesions.Thus it can help improve the detective rate of prostatic cancer.