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目的:检测前列腺癌影像学诊断新技术-磁共振弥散加权成像(MRDWI)诊断前列腺癌的准确性(敏感度和特异度),探索TRUS引导的MRDWI图像上可疑病灶穿刺方法,并比较联合MRDWI及TRUS定位与单纯TURS定位经会阴前列腺穿刺活检的准确性。方法:2007年4月～2008年12月间MRDWI或TRUS检查提示可疑前列腺结节的前列腺穿刺患者90例(平均年龄69岁,平均PSA 10.9μg/l);MRI医师、超声医师、泌尿外科医师联合读片确定可疑病灶(MRDWI表观弥散系数减低及B超低回声结节);穿刺方案为TRUS引导下经会阴可疑病灶穿刺加系统10针前列腺穿刺;MRDWI可疑结节在TRUS图像上的定位方法:在MRDWI上详细定位病灶(病灶直径,病灶中心距中线X,距膀胱颈部L、距前列腺背侧缘距离H),再在TRUS图像上依据L确定病灶所在横断面,根据X及H确定病灶中心,再测量该横断面上病灶中心距B超探头距离O,在通过病灶中心的纵切面上以高于探头平面O的距离平行进针,即可在TRUS图像上实时精确的穿刺到MRDWI可疑结节。穿刺各针标本注明穿刺部位后分瓶送病理检查;统计各针的影像学诊断及对应的病理,分别计算MRDWI和TRUS的敏感度和特异度。结果:共获963条前列腺穿刺组织标本。前列腺癌阳性针数171个,其中MRDWI阳性123个,敏感度为71.9%(123/171),阳性预测值(PPV)54.7%(123/225);B超阳性39个,敏感度为22.8%(39/171),PPV 56.5%(39/69)。阴性针数792个,其中MRDWI阴性690个,特异度为87.1%(690/792),B超阴性762个,特异度为96.2%(762/792)。MRDWI发现而B超未发现90处(52.6%),B超发现而MRDWI未发现6处(3.5%),MRDWI、B超均发现33处,两者均未发现42处(24.6%)。联合定位穿刺敏感度75.4%(129/171),较之传统B超定位敏感度提高52.6%。结论:MR弥散加权成像诊断前列腺癌的初步结果显示准确性较高,敏感度显著优于TRUS。TRUS引导穿刺MRDWI可疑前列腺结节简单、准确、易行,可藉此联合MRDWI及TRUS联合定位进行前列腺穿刺,提高前列腺癌病灶直接穿刺的敏感度。但目前情况下,仍需要结合系统穿刺来减少漏诊率。
OBJECTIVE: To detect the accuracy (sensitivity and specificity) of magnetic resonance diffusion-weighted imaging (MRDWI) in the diagnosis of prostate cancer and to explore the suspicious lesions puncture method in TRUS-guided MRDWI images. TRUS Positioning and TURS Positioning Accuracy of Perineal Prostate Biopsy. METHODS: From April 2007 to December 2008, 90 patients (mean age 69 years, mean PSA 10.9 μg / l) with prostate biopsy suspicious prostatic nodules undergoing MRDWI or TRUS examination were included. MRI, ultrasound and urology The combination of readings to determine suspicious lesions (MRDWI apparent diffusion coefficient reduction and B ultra-low echo nodules); puncture program for the TRUS guided by the perineal suspected lesions puncture plus system 10-pin prostatic biopsy; MRDWI suspicious nodules in the TRUS image localization Methods: The lesions (diameter of lesion, center of lesion from centerline X, distance L from bladder neck and distance H from dorsal edge of prostate) were located on MRDWI. The cross section of lesion was determined on TRUS images according to X. According to X and H Determine the focus of the lesion, and then measure the cross-sectional focus of the lesion from the B-probe distance O, in the longitudinal section through the center of the lesion at a higher level than the probe plane O parallel needle into the TRUS image in real-time accurate puncture MRDWI suspicious nodules. Puncture needle specimens were marked puncture site after the bottle delivery pathological examination; statistics of each needle imaging diagnosis and the corresponding pathology, were calculated MRDWI and TRUS sensitivity and specificity. Results: A total of 963 prostate biopsy specimens were obtained. The positive number of prostatic cancer was 171, of which 123 were MRDWI positive, with a sensitivity of 71.9% (123/171) and a positive predictive value (PPV) of 54.7% (123/225). B-positive was 39 with a sensitivity of 22.8% (39/171) and PPV 56.5% (39/69). The number of negative stitches was 792, of which 690 were MRDWI negative, the specificity was 87.1% (690/792), 762 were negative for B, and the specificity was 96.2% (762/792). None of MRDWI found 90 (52.6%) in B ultrasound, 6 in MRDWI (3.5%) found in B ultrasound, 33 in MRDWI (B ultrasound) and 42 (24.6%) in B ultrasound. The sensitivity of combined positioning and puncturing was 75.4% (129/171), which was 52.6% higher than the traditional B-positioning sensitivity. CONCLUSIONS: Preliminary results of MR diffusion weighted imaging in the diagnosis of prostate cancer show higher accuracy and sensitivity than TRUS. TRUS guided puncture MRDWI suspicious prostate nodules simple, accurate and easy to use this combination of MRDWI and TRUS prostate biopsy to improve the sensitivity of direct puncture of prostate cancer lesions. However, the current situation still needs to be combined with system puncture to reduce the misdiagnosis rate.