剪切波弹性成像在前列腺癌诊断中的应用价值

摘要

目的 探讨实时剪切波弹性成像技术诊断前列腺癌的应用价值.方法 回顾性分析49例前列腺癌患者(前列腺癌组)和15例前列腺良性病变患者(良性病变组)的剪切波弹性成像资料,测量并比较其杨氏模量值,包括最大值(Emax)、最小值(Emin)、平均值(Emean)及可疑病灶区与邻近周缘带内正常组织的平均杨氏模量值之比(Eration).绘制Emean诊断前列腺癌的受试者工作特征曲线,确定其截断点并计算敏感性、特异性、阳性预测值、阴性预测值及曲线下面积.比较不同前列腺Gleason评分患者Eration值的差异.结果 前列腺癌组的Emin、Emax、Emean及Eration分别为(44.3±11.2)kPa、(73.2±15.9)kPa、(57.6±11.7)kPa及5.8±2.9,良性病变组的Emin、Emax、Emean及Eration分别为(24.3±10.5)kPa、(42.2±9.7)kPa、(30.3±10.4)kPa及2.8±1.3,两组比较差异均有统计学意义(P=0.020、0.018、0.013、0.010).当Emean截断点为41 kPa时,其诊断前列腺癌的效能最高,敏感性91.0%,特异性78.0%,阳性预测值64.6%,阴性预测值为95.3%,曲线下面积0.934.Gleason评分为8分、9分的前列腺癌患者Eration值明显高于Gleason评分为6分、7分的患者,二者比较差异有统计学意义(P<0.01).结论 剪切波弹性成像对前列腺癌有较高的诊断价值.%Objective To evaluate the application value of shear wave elastography in diagnosis of prostate cancer. Methods Forty-nine patients with prostate cancer(malignant group) and 15 patients with benign prostatic lesions(benign group) were enrolled in this study.Data get from the shear wave elastography of two groups were retrospectively analyzed. The Young's value(Emax,Emin,Emean and Eration) of the suspected modulus were measured and compared.The ROC curve of the Emean was plotted to determine the diagnostic threshold.The sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were calculated,respectively. The correlation between Eration and Gleason score was analyzed. Results The malignant group:Emin(44.3±11.2)kPa,Emax(73.2±15.9)kPa,Emean(57.6± 11.7)kPa,Eration 5.8±2.9.The benign group:Emin (24.3 ±10.5)kPa,Emax(42.2 ±9.7)kPa,Emean(30.3 ±10.4)kPa,Eration 2.8 ±1.3.There were statistically difference between two groups (P=0.020,0.018,0.013,0.010). Taking Emean 41 kPa as a cut-off value,the sensitivity was 91.0%,the specificity was 78.0%,the positive predictive value was 64.6%,the negative predictive value was 95.3%,the area under the curve was 0.934. The value of Eration of prostate cancer with Gleason score 8~9 points was significantly higher than that with the Gleason score of 6~7 points(P<0.01). Conclusion The diagnostic value of shear wave elastography for prostate cancer is valuable,and have a higher detection accuracy.