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实时二维剪切波弹性成像在前列腺癌诊断中的作用
作者:白奇峰 
单位:绍兴市中心医院超声科  浙江 绍兴 312030 
关键词:前列腺肿瘤/诊断 前列腺肿瘤/病理学 前列腺增生/诊断 弹性成像技术/方法 诊断 鉴别 对比敏感度 
DOI:R737.25;R730.4
出版年,卷(期):页码:2017,32(5):454-457
摘要:

目的 探讨实时二维剪切波弹性成像在诊断前列腺癌中的作用。方法 收集92例前列腺癌或前列腺增生患者,给予常规超声和实时二维剪切波弹性成像分析,记录分级成像情况与剪切波弹性成像相关指标。结果 92例患者中,穿刺病理诊断为前列腺增生50例,前列腺癌42例;实时二维剪切波弹性成像诊断为前列腺增生52例,前列腺癌40例。弹性成像在诊断前列腺癌中的敏感度与特异度为100.0%和95.2%。52例前列腺增生患者中,弹性成像分级为Ⅰ级32例,Ⅱ级16例,Ⅲ级4例,Ⅳ级0例;40例前列腺癌患者中,弹性成像分级为Ⅰ级0例,Ⅱ级0例,Ⅲ级30例,Ⅳ级10例;二者比较差异具有统计学意义(P<0.05)。前列腺癌患者的Emax与Emean分别为(68.44±2.49)kPa与(53.40±3.10)kPa,均高于前列腺增生患者的(54.11±8.24)kPa与(39.20±4.51)kPa(均P<0.05)。分别以48.1 kPa和65.5 kPa作为前列腺增生与前列腺癌的Emean与Emax临界值时,诊断敏感度为91.8%和92.1%,特异度为89.7%和87.5%。结论 实时二维剪切波弹性成像应用于前列腺癌诊断可客观显示前列腺病灶的硬度变化,提供Emean和Emax,有助于医师更好地了解组织特征和病理形态。

Objective To assess the application of real time two dimensional shear wave elastography in the diagnosis of prostate cancer. Methods Ninety-two patients with prostate cancer or benign prostatic hyperplasia were enrolled and examined with conventional ultrasound and real-time two-dimensional shear wave elastography.The grades of imaging and the related indexes of shear wave elastography were recorded. Results In the 92 patients,50 cases were diagnosed as benign prostatic hyperplasia and 42 cases were diagnosed as prostate cancer by biopsy and pathological examination.Fifty-two cases of prostate hyperplasia and 40 cases of prostate cancer were diagnosed by real time two-dimensional shear wave elastography with a sensitivity of 100.0% and specificity of 95.2% for prostate cancer,respectively.According to elastography,in the 52 cases of benign prostatic hyperplasia,32 cases were diagnosed as grade Ⅰ,16 cases as grade Ⅱ,4 cases as grade Ⅲ,and none as grade Ⅳ.In the 40 cases of prostate cancer,none was diagnosed as grade Ⅰ and grade Ⅱ,30 cases as grade Ⅲ and 10 cases as grade Ⅳ.The elastography grades between benign prostatic hyperplasia and prostate cancer were significantly different (P<0.05).The Emax and Emean of prostate cancer were (68.44±2.49)kPa and (53.40±3.10)kPa,respectively,which were both significantly higher than those of benign prostatic hyperplasia patients [(54.11±8.24)kPa and (39.20±4.51)kPa,respectively,P<0.05].When using 48.1 kPa and 65.5 kPa as the Emean and Emax cut-off values for the differential diagnosis of benign prostatic hyperplasia and prostate cancer,the sensitivities were 91.8% and 92.1%,and the specificities were 89.7% and 87.5%,respectively. Conclusion The real time two-dimensional shear wave elastography can reliably detect the hardness changes of prostate lesions.The values of Emean and Emax may facilitate to better understand the tissue characteristics and pathological morphology.

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