基于MRI/US认知融合的超声造影对前列腺癌诊断价值

刘红艳; 马素平; 向莉华

doi:10.13898/j.cnki.issn.1000-2200.2024.09.016

基于MRI/US认知融合的超声造影对前列腺癌诊断价值

Value of contrast-enhanced ultrasound based on MRI/US cognitive fusion in the diagnosis of prostate cancer

摘要

摘要:
目的探讨基于MRI/US认知融合的超声造影(融合超声造影)对前列腺癌的诊断价值。
方法选取因前列腺特异性抗原(PSA)升高(≥4 ng/mL)或直肠指检异常临床诊断疑似前列腺癌病人83例。所有病人均接受MRI及融合超声造影检查，均行经会阴前列腺系统穿刺。对于MRI或融合超声造影图像有阳性发现者，增加融合超声造影引导的经会阴前列腺靶向穿刺。以穿刺病理组织学检查结果作为金标准，分析融合超声造影对前列腺癌的诊断效能，并与MRI诊断效能进行对比。
结果 83例病人中穿刺阳性诊断为前列腺癌37例(恶性组)，穿刺阴性诊断为良性病变46例(良性组)。良性组和恶性组年龄差异无统计学意义(P>0.05)，PSA、游离PSA、PSA密度和PI-RADS评分差异均有统计学意义(P < 0.05~P < 0.01)。融合超声造影诊断前列腺癌24例，良性病变39例，敏感性为64.86%(24/37)，特异性为84.78%(39/46)，准确度为75.90%(63/83)；MRI诊断前列腺癌20例，良性病变43例，敏感性为54.05%(20/37)，特异性为93.48%(43/46)，准确度为75.90%(63/83)。融合超声造影和MRI鉴别不同位置前列腺癌差异均有统计学意义(P < 0.05)。融合超声造影诊断前列腺癌较MRI具有更高敏感性和准确度(P < 0.01)，二者特异性差异无统计学意义(P>0.05)。ROC曲线分析显示，融合超声造影诊断前列腺癌AUC为0.75，高于MRI的0.74。
结论融合超声造影有助于提高前列腺癌检出率，进一步减少前列腺癌的漏诊。

Abstract:
Objective To explore the diagnostic value of contrast-enhanced ultrasound based on MRI/US cognitive fusion in prostate cancer.
Methods A total of 83 patients with suspected prostate cancer were selected due to prostate specific antigen (PSA) elevation(≥4 ng/mL) or abnormal digital rectal examination.All patients were detected by the MRI, fusion contrast-enhanced ultrasound and perineal prostatic system puncture.For patients with positive findings in MRI or fusion contrast-enhanced ultrasound images, the fusion contrast ultrasound-guided transperineal prostate targeted puncture was added.Using the puncture histopathology as the gold standard, the diagnostic efficacy of fusion contrast-enhanced ultrasound in prostate cancer was analyzed and compared with that of MRI.
Results Among the 83 patients, 37 cases were diagnosed as the prostate cancer(malignant group) and 46 cases were diagnosed as the benign lesions(benign group).There was no statistcial significance in the age between the benign group and malignant group(P>0.05), but the differences of the PSA, free PSA, PSA density and PI-RADS scores were statistically significant between the benign group and malignant group(P < 0.05 to P < 0.01).There were 24 cases of prostate cancer and 39 cases of benign lesions by the diagnosis of fusion contrast ultrasound, with sensitivity of 64.86%(24/37), specificity of 84.78%(39/46) and accuracy of 75.90%(63/83).Twenty cases of prostate cancer and 43 cases of benign lesions were diagnosed by MRI, the sensitivity was 54.05%(20/37), the specificity was 93.48%(43/46), and the accuracy was 75.90%(63/83).The differences of the identification of prostate cancer at different locations were statistically significant between fusion contrast ultrasound and MRI(P < 0.01).Compared with MRI, the fusion contrast ultrasound showed higher sensitivity and accuracy in the diagnosis of prostate cancer(P < 0.01), but there was no statistical significance in specificity between the two(P>0.05).The results of ROC curve analysis showed that the AUC of fusion contrast ultrasound for diagnosis of prostate cancer was 0.75, which was higher than that of MRI(0.74).
Conclusions The fusion contrast-enhanced ultrasound can improve the detection rate of prostate cancer, and further reduce the missed diagnosis of prostate cancer.

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