【摘要】 目的探讨经直肠超声与磁共振（TRUS/MRI）融合成像实时精准前列腺穿刺（targeted biopsy,TB）诊断前列腺癌的价值。方法符合以下标准的24例患者纳入本研究:血清PSA4²0ng/ml,直肠指检前列腺表面未触及结节或孤立的小结节,3.0T多参数MRI（mpMRI）T₂WI、弥散加权成像和动态增强扫描至少一个参数提示前列腺癌。使用实时超声多影像融合系统对MRI显示的每个靶病灶穿刺2针,同时对前列腺左右2侧叶进行6¹2针的系统穿刺（systematic biopsy,SB）,以组织活检病理结果为依据,比较两种穿刺方法的前列腺癌检出率,以及mpMRI诊断结果与穿刺活检结果的一致性。结果TB与SB的前列腺癌检出率分别为58.3%（14/24）和37.5%（9/24）,两组比较差异无统计学意义（P=0.248）;14例TB阳性患者共穿刺36针,其中30针阳性（83.3%）,9例SB阳性患者共穿刺78针,其中37针阳性（47.4%）,两组穿刺针数阳性率比较差异有统计学意义（P<0.001）;mpMRI参数提示前列腺癌存在可能性高的16例中穿刺阳性13例（81.3%）,mpMRI参数提示前列腺癌存在可能性低的8例中穿刺阳性1例（12.5%）,两组比较差异有统计学意义（P=0.002）。结论 TRUS/MRI融合成像实时精准前列腺穿刺可以提高前列腺癌的检出率,穿刺标本的阳性率显著高于系统性穿刺,mpMRI诊断结果与穿刺活检病理结果有较好的一致性。更多还原

【Abstract】 Objective To address the value of real-time precision targeted prostate biopsy using transrectal ultrasound-magnetic resonance fusion(TRUS/MRI). Methods Twenty four patients with elevated prostate-specific antigen value of 4-20ng/ml,normal or abnormal digital rectum examination,and suspicious mutiparametric magnetic resonance(mpMRI)imaging of T2-weighted or diffusion weighted or dynamic contrast enhanced were enrolled in present study from August 2015 to September 2015.Suspicious areas on mpMRI were delineated and marked by a radiologist.TRUS/MRI fusion biopsy was performed by a urologist and a ultrasonography doctor using Hitachi real-time virtue sonography(RVS)system.At first suspected lesions were biopsied transperineally using RVS system(TB)and then followed by the conventional transperineal systematic biopsy(SB)under general anesthesia.Two cores and 6-12 cores specimens were obtained respectively.The pathological results of TB and SB were compared.The correlation of mpMRI with biopsy results was also evaluated. Results TB revealed prostate cancer(PCa)in 14 of 24men(58.3%),and demonstrated a trend of increasing the cancer detection rate(CDR)compared to SB with a CDR of 37.5%.The positive rate of core in the TB men with PCa was significantly higher than in the SB men(P<0.001).Degree of suspicion on mpMRI had a significant association with CDR(P=0.002). Conclusions TRUS/MRI fusion biopsy provides improved detection of PCa in men with elevated PSA levels and suspicious MR imaging.TB specimens were significant superior to SB.The predictor value of mpMRI has a good concordance with the results of TRUS/MRI fusion biopsy.更多还原