MR扩散、灌注成像鉴别前列腺良恶性病变的价值

目的 探讨MR扩散成像(DWI)和灌注成像(PWI)在鉴别前列腺良恶性病变诊断中的应用价值. 资料与方法 对临床诊断为前列腺疾病的70例患者,其中良性前列腺增生(BPH)42例,前列腺癌(PCa)28例分别进行MR弥散成像和灌注成像,测算病灶的表观扩散系数(ADCs);并对标本进行免疫组织化学检测,分析病变的灌注曲线最大线性斜率(SSmax)、T2*弛豫率(ΔR2*peak)与免疫组织化学结果 (VEGF、MVD)的各自相关性. 结果 (1)BPH组前列腺中央带增生结节、外周带的平均ADC值分别为:(1.783±0.282)×10-3 mm2/ s,(2.025±0.358)×10-3 mm2/ s;PCa组前列腺中央带、外周带癌灶平均ADC值分别为:(1.632±0.082)×10-3 mm2/ s,(0.267±0.07)×10-3 mm2/ s.PCa组外周带癌灶平均ADC值明显低于BPH组增生结节(P<0.05);(2)BPH组增生结节灌注曲线的SSmax及ΔR2*peak分别为:33.5±3.1、1.5±0.1;PCa组癌灶灌注曲线的SSmax及ΔR2*peak分别为:58.4±4.7, 3.14±0.5, 两者之间差异有统计学意义(P<0.05);(3)BPH组VEGF阳性、阴性例数分别为9例和33例,MVD平均值为22.76±6.54;PCa组VEGF阳性、阴性例数分别为24例和4例,MVD平均值为71.38±9.17;PCa的VEGF和MVD的表达水平明显高于BPH(P<0.01),PCa、BPH的VEGF表达与MVD表达呈正相关性(P<0.01);灌注成像(PWI)参数SSmax、ΔR2*peak与VEGF、MVD具有相关性(P<0.01). 结论 DWI可对BPH与PCa的ADC值进行定量分析,PWI可反映前列腺良恶性疾病的血管生成情况,有助于鉴别前列腺良恶性病变.     

前列腺癌MR灌注成像与肿瘤血管生成相关性研究

目的　探讨MR灌注成像在前列腺癌中的应用 ,评价血管内皮生长因子 (VEGF)和微血管密度 (MVD)与MR灌注成像各指标的相关关系。资料与方法　对临床诊断为前列腺癌的 15例患者和 30名健康志愿者进行MR灌注成像 ,对前列腺癌标本进行免疫组织化学检测 ;分析病变的灌注曲线最大线性斜率 (SSmax)、T2 弛豫率 (ΔR2 peak)与免疫组织化学结果 (VEGF、MVD)的各自相关性。结果　 (1)健康志愿者灌注曲线的SSmax及ΔR2 peak分别为 :0 .4 30± 0 .0 11,2 .0 1± 0 .0 7;前列腺癌灌注曲线的SSmax及ΔR2 peak分别为 :5 7.8± 5 .0 ,3.0± 0 .6 ,两者之间存在显著性差异 (P <0 .0 1)。 (2 )前列腺癌的VEGF和MVD的表达水平明显升高。结论　灌注成像的有关指标(SSmax、ΔR2 peak)可以反映前列腺癌MVD和VEGF表达的高低 ,从而推测其血管生成情况 ,为外科医师提供大量关于前列腺癌诊疗的重要信息     

扩散加权成像鉴别前列腺癌及良性前列腺增生的价值

目的探讨良性前列腺增生(BPH)和前列腺癌(PCa)的扩散加权成像(DWI)和表观扩散系数(ADC)图表现,及对PCa的鉴别诊断价值。方法分析18例BPH和25例PCa的DWI和ADC图表现,并分别测量癌肿区的ADC值及BPH的外周带(PZ)及中央腺体(CG)的ADC值,比较其间是否存在差异。结果BPH的DWI和ADC图上PZ信号近似均一,CG信号欠均匀。PCa在DWI上呈高信号,ADC图呈低信号,均能直观显示癌灶范围。受侵犯的精囊和骨盆骨转移灶DWI上呈高信号,ADC图呈低信号。PCa的ADC值[(0．49±0．09)×10-3mm2／s]与BPH的PZ及CG的ADC值[(1．27±0．14)×10-3mm2／s、(0．96±0．14)×10-3mm2／s]比较,差异均有统计学意义(t值分别为-52．46、-31．49,P值均<0．01),PCa的ADC值与BPH的PZ无重叠,与CG也仅有少量重叠(1／127,0．7％)。结论DWI和ADC图可显示PCa位置、范围及周围侵犯、转移情况;根据DWI和ADC图上病变的信号特点及ADC值可以鉴别BPH和PCa。     

正常前列腺、前列腺癌和良性前列腺增生的MR波谱成像代谢特征并与病理结果对照

目的　以三维质子磁共振波谱成像 (magneticresonancespectroscopy,MRS)的方法定量分析正常前列腺、前列腺癌 (prostatecancer,PCa)和良性前列腺增生 (benignprostatehyperplasia ,BPH)的代谢特征 ,并与病理结果对照。方法　对经手术病理或穿刺活检证实的PCa 2 1例、BPH 2 3例和正常前列腺 1 7例进行MRS定量分析。将前列腺分为左、右两侧 ,每侧由上到下分为底部、中部和尖部 3部分 ,共 6分区。在MRS代谢图上标记出手术病理或穿刺活检取材位置归入相应的分区 ,测量其 (胆碱+肌酸 ) /枸橼酸盐 [(Choline +Creatine) /Citrate ,CC/C]的比值。结果　正常前列腺外周带、PCa癌区和BPH中央带的CC/C平均比值分别为 0 4 2± 0 1 9、2 1 3± 0 82和 0 6 2± 0 1 9,组间差异有统计学意义(F =2 77 4 6 4 ,P =0 0 0 0 )。PCa与正常前列腺和BPH之间的差异均有统计学意义 (t值分别为 0 72 5、0 6 84 ,P值均为 0 0 0 0 )。结论　PCa和BPH的代谢差异显著 ,MRS有助于PCa的鉴别诊断。     

前列腺上皮内瘤CT灌注成像表现初探

目的 了解前列腺增生(BPH)中前列腺上皮内瘤(PIN)的CT灌注成像表现,并初步探讨PIN与前列腺癌(PCa)及良性BPH的灌注成像表现的关系.资料与方法 BPH25例,其中PIN样变9例,良性BPH 16例.PCa 34例,行前列腺病变中心层面灌注扫描,得到各组灌注图(PF)、强化峰值图(PEI)、达峰时间图(TTP)、血容量(BV)值和时间密度曲线(TDC),并对各组灌注值进行对比分析.结果 PIN的PF值大于良性BPH,TTP值小于良性BPH,差异有统计学意义.PIN的TTP值大于PCa组,PF值小于PCa组,差异有统计学意义. 结论 PIN的CT灌注成像表现提示,PIN的PF值和邢值与PCa和良性BPH不同,介于两者间.这种灌注特征可能为早期发现PCa提供一定帮助.     

食管癌IVIM参数与VEGF和MVD的相关性

【摘要】目的：探讨食管癌体素内不相干运动（IVIM）多参数值与病理免疫组化指标血管内皮生长因子（VEGF）和微血管密度（MVD）的关系。方法：搜集36例食管癌患者,术前均由胃镜证实并且行3.0T MR食管癌常规序列和IVIM序列扫描,病理标本染色后获取VEGF及MVD,同时采用Spearman秩相关分析IVIM各参数值与免疫组化指标VEGF和MVD的相关性。结果：食管癌IVIM参数值ADC、D、D*及f值分别为（1.562±0.379）×10-3、（0.942±0.285）×10-3、（20.394±9.686）×10-3mm2/s和（0.505±0.109）,VEGF和MVD测量值分别为（5.556±0.695）和（37.389±22.360）。其中D*值与VEGF呈正相关（r=0.335,P<0.05), ADC值、D值及f值与VEGF无相关性（P>0.05)。D*值及f值与MVD呈正相关（r=0.374,P<0.05;r=0.387,P<0.05）,ADC值及D值与MVD无相关性（P>0.05）。结论：食管癌IVIM定量参数D*、f与VEGF和MVD呈正相关,体素内不相干运动成像定量参数D*及f可间接反映食管癌血管生成情况,可以作为食管癌术前无创性预测VEGF及MVD的影像学指标。     

表观扩散系数和MR动态增强对前列腺中央腺体疾病的价值

目的评估表观扩散系数(ADC)及MR动态增强(DCE-MRI)对前列腺中央腺体病变的诊断价值。方法对经病理证实的50例前列腺中央腺体疾病患者进行扩散加权扫描(DWI)和DCE-MRI扫描,其中16例为前列腺癌(PCa),34例为前列腺增生(BPH)。分析基质增生为主型BPH(sBPH)、腺体增生为主型BPH(gBPH)和PCa的ADC值差别特点及信号强度-时间(SI-T)曲线特征。结果 gBPH、sBPH和PCa的平均ADC值分别为(1.33±0.25)×10-3 mm2/s、(1.04±0.22)×10-3 mm2/s、(0.71±0.32)×10-3 mm2/s,两两比较各组间有统计学差异(P<0.05)。SI-T曲线参数:达峰时间(Tmax)从高到低依次为sBPH、gBPH及PCa(P<0.05),强化程度(SI%)从高到低依次为sBPH、PCa及gBPH(P<0.05),强化率(R)从高到低依次为PCa、gBPH及sBPH(P<0.05)。结论 MR动态增强及ADC对前列腺中央腺体的病变有重要的诊断价值。     

高危良性前列腺增生29例的微创经尿道前列腺电切的治疗观察

目的　探讨微创经尿道前列腺电切术 (TURP)治疗高危良性前列腺增生 (BPH)患者的疗效。方法　采用微创TURP ,改变传统的前列腺电切部位 ,治疗高危BPH 2 9例。结果　术后平均随访 12个月 ,2 9例有效 (10 0 % ) ,国际前列腺症状评分 (IPSS)由术前 2 7.7± 2 .1减少至 8.8± 2 .3(P <0 .0 1) ,生活质量评分 (Qol)由术前平均 4 .7± 0 .7下降至 2 .3± 0 .8(P <0 .0 5 ) ,最大尿流率 (Qmax) (8.7± 1.9)ml/s增加至 (14 .9± 1.7)ml/s ,剩余尿 (RU)从术前 (12 9± 4 2 .8)ml减少至 (36± 11.8)ml。结论　微创TURP是治疗高危前列腺增生合并尿潴留患者的有效方法     

MR动态增强、扩散成像和波谱分析在前列腺癌诊断中的价值

目的探讨MR动态增强扫描(DCE-MRI)、扩散加权成像(DWI)和三维氢质子MR波谱分析(3D1H-MRS)在前列腺癌诊断中的价值。方法经穿刺活检、手术病理或随访证实的32例前列腺癌及64例前列腺增生患者,以及29例健康志愿者经MR常规扫描、DCE-MRI、DWI和MRS扫描,分别测量前列腺癌、前列腺增生病灶和正常前列腺中央腺区和正常周围带强化后的相对信号强度值、DWI信号强度值和表观扩散系数(ADC)值,以及胆碱／枸橼酸盐(Cho／Cit)和[Cho+肌酸(Cr)]／Cit比值,并经方差分析比较不同组织和病灶间差异。结果经DCE-MRI检查,22例前列腺癌患者中18例病灶区呈早期明显强化,并快速下降;40例前列腺增生患者中38例呈早期明显强化并逐渐上升至中晚期达峰值后缓慢下降,除0及120 s两时间段前列腺癌与前列腺增生组织两者之间差异无统计学意义(P>0．05)外,正常周围带、增生与癌三者的相对信号强度在其余每个时段均差异有统计学意义(P<0．05)。经DWI检查前列腺癌患者26例于ADC图上病灶呈明显低信号,ADC值为(104．23±26．15)×10-5mm2／s,43例前列腺增生患者病灶区平均ADC值为(175．21±64．86)×10-5mm2／s,除正常前列腺周围带与前列腺增生之间ADC值差异无统计学意义(P>0．05)外,前列腺癌、前列腺增生和正常前列腺中央腺区之间差异均有统计学意义(P<0．05)。MRS检查前列腺癌17例,其病灶区Cho／Cit比值为2．26±0．91,(Cho+Cr)／Cit比值为2．85±1．01,35例前列腺增生患者病灶区平均Cho／Cit比值为0．46±0．23,(Cho+Cr)／Cit比值为0．57±0．20。除正常前列腺周围带与正常前列腺中央腺区之间差异无统计学意义(P>0．05)外,前列腺癌、前列腺增生和正常前列腺组织其余各组间差异均有统计学意义(P<0．05)。DCE-MRI、DWI和MRS 3种检查方法在前列腺癌诊断敏感度、特异度和准确度均达70％以上,而通过3种检查方法的联合应用,其敏感度、特异度和准确度分别达87．50％、94．74％、92．59％。结论DCE-MRI、DWI和MRS 3种检查方法在前列腺癌诊断中具有特征性表现,而3种检查方法的联合应用又将极大地提高MRI诊断前列腺癌的正确诊断率。     

化学发光法检测f-PSA/t-PSA比值在前列腺癌诊断中的意义

目的探讨化学发光法检测血清中总前列腺特异性抗原(t-PSA)、游离PSA(f-PSA)及f/t PSA比值在前列腺癌诊断中的意义。方法采用化学发光免疫分析技术检测90例正常健康男性、72例前列腺增生(BPH)患者和60例前列腺癌(PCa)患者血清的t-PSA和f-PSA,并求出f/t PSA比值,然后进行统计学分析。结果正常对照组、BPH组、PCa组t-PSA分别为1.67±1.22、8.37±5.47和26.46±28.20,f-PSA分别为0.59±0.55、3.07±3.62和2.60±3.07,f/t PSA比值分别为0.36±0.14、0.32±0.14和0.11±0.04,上述各组三项指标两两之间比较差异均有统计学意义(P<0.01)。将PCa组t-PSA分为<4.0μg/L、4.0~10.0μg/L、10.0~20μg/L、>20μg/L四个组,显示t-PSA和f-PSA组间两两比较差异均有统计学意义(P<0.01),但f/t PSA比值相比较差异无统计学意义(P>0.05)。将f/t PSA比值分为<0.10、<0.15、<0.20、<0.25四个截点,显示在0.15截点以内PCa患者占有率为93.30%,特异性为88.89%。结论化学发光免疫分析f/t PSA比值<0.15时对PCa的诊断具有良好的应用价值,适用于t-PSA处于各种范围的PCa患者。     

Granulomatous prostatitis: a pitfall in MR imaging of prostatic carcinoma

Granulomatous prostatitis is an uncommon disease that can prostatic carcinoma on both digital rectal examination and transrectal ultrasound. Four patients who underwent magnetic resonance imaging of the prostate had a histological diagnosis of graanulomatous prostatitis; three of them had recent urinary tract infections. The other patient had an associated midline prostatic cyst and a focus of malignancy. T1-and T2-weighted spin-echo images were obtained in all cases. Peripheral zone lesions of decreased signal intensity, suggestive of carcinoma,were found in all four patients on T2-weighted images. Granulomatous prostatitis should be considered in the differential diagnosis of low signal intensity areas with prostatic magnetic resonance imaging. Correspondence to; P.A. Gevenois     

Prospective Analysis on the Relation between Pain and Prostate Volume during Transrectal Prostate Biopsy

Objective

We wanted to assess the relationship between pain and the prostate volume during transrectal ultrasound (TRUS) guided biopsy.

Materials and Methods

Between July and September 2006, 71 patients scheduled for TRUS biopsy of the prostate were considered for inclusion to this study. These patients underwent periprostatic neurovascular bundle block with lidocaine prior to biopsy. Pain was assessed using a Visual Analogue Scale (VAS) during periprostatic neurovascular bundle block (VAS 1), during biopsy (VAS 2), and 20 minutes after biopsy (VAS 3). The mean pain scores were analyzed in the large prostate group (prostate volume > 40 cc) and the small prostate group (prostate volume ≤ 40 cc). P values < 0.05 were considered significant.

Results

The mean prostate volume was 42.2 cc (standard deviation: 8.6). The mean pain scores of VAS 1, 2 and 3 were 4.70 ± 1.61, 3.15 ± 2.44 and 1.05 ± 1.51, respectively. In the large prostate group, the mean pains scores of VAS 1, 2 and 3 were 4.75 ± 1.76, 3.51 ± 2.76 and 1.29 ± 1.70, respectively, whereas in the small prostate group, the means pain scores were 4.66 ± 1.46, 2.77 ± 2.0, and 0.80 ± 1.26, respectively. Although there were no statistical differences of VAS 1, the larger prostate group revealed higher pain scores of VAS 2 and 3 compared with the small prostate group (p < 0.05).

Conclusion

Patients with larger prostate volumes tend to feel more pain during and after TRUS guided prostate biopsy. Our findings suggest that additional analgesic strategies may be necessary when the patients with larger prostate undergo TRUS guided prostate biopsy.     

Hypoechoic Rim of Chronically Inflamed Prostate, as Seen at TRUS: Histopathologic Findings

Objective

The purpose of this study is to correlate the findings of peripheral hypoechoic rim, seen at transrectal ultrasonography (TRUS) in chronic prostatitis patients, with the histopthologic findings.

Materials and Methods

Seven patients with pathologically proven chronic prostatitis were involved in this study. The conspicuity of the peripheral hypoechoic prostatic rim, seen at TRUS, was prominent and subtle, and to determine its histopathologic nature, the microscopic findings were reviewed.

Results

In five of seven cases (71%), TRUS demonstrated a prominent peripheral hypoechoic rim. Microscopic examination revealed that inflammatory cell infiltration of prostatic glandular tissue was severe in three cases (42.9%), moderate in two (28.6%), and minimal in two (28.6%). In all seven cases, the common histopathologic findings of peripheral hypoechoic rim on TRUS were loose stromal tissues, few prostatic glands, and sparse infiltration by inflammatory cells.

Conclusion

The peripheral hypoechoic rim accompanying prostatic inflammation and revealed by TRUS reflects a sparsity of prostate glandular tissue and is thought to be an area in which inflammatory cell infiltration is minimal.     

Primary staging of prostate cancer

Staging prostate cancer is a systematic classification of the extent of disease based on clinical and pathological criteria. Despite general acceptance of the TNM staging system, a lot of controversy and uncertainty with respect to staging still exists. This paper gives an overview of different staging modalities and emphasizes the need for incorporation of prognostic factors, such as tumour grade and volume, in the staging system. Correspondence to: G. J. Jager     

超声技术在前列腺癌诊治中的应用与进展

前列腺癌（prostate cancer,PCa）是欧美国家男性发病率最高的恶性肿瘤,其病死率仅次于肺癌[1];近年来,随着人口老龄化比例的上升和饮食结构的改变,我国前列腺癌的发病率呈现出了明显的上升趋势[2].超声技术应用于前列腺显像经过了几十年的演进,其在前列腺癌的诊治中作用已经得到了广泛的认可和重视.特别是近些年如超声造影、弹性成像、3D-TRUS、HistoScanning等新的超声影像技术以及介入性超声（Interventional Ultrasonic）的问世及其发展和应用,为前列腺癌的诊断和治疗提供了新的技术支持和期待.本综述对超声技术在前列腺癌诊治的历史进行回顾,并且对当前及潜在的超声应用技术进行梳理和总结.     

Photodynamic therapy for prostate cancer: One urologist's perspective

Photodynamic therapy (PDT) has slowly found its place in the treatment of human disease. Currently, photodynamic therapy is being explored as a treatment option for localized prostate cancer. PDT for the treatment of prostate cancer will require ablation of both malignant and non-malignant glandular epithelium. Ablation of both malignant and normal epithelium adds a new treatment dimension since traditionally PDT has not targeted normal epithelial tissue. PDT for prostate cancer as currently envisioned will present challenges in terms of in situ monitoring of light, drug concentration, p_O2 levels and biologic endpoints. The introduction of vascular-targeted photosensitizers fundamentally alters the traditional axioms for successful PDT treatment by obviating the need for “selective” tumor localization. Should clinical trials demonstrate the utility of this approach, patients with organ-confined disease will benefit.     

Transrectal ultrasound-guided prostate biopsy: is antibiotic prophylaxis necessary?

The aim of this study was to assess infectious complications in transrectal ultrasound-guided prostate biopsy (TRUSPB), comparing two groups of patients: one group with antibiotic prophylaxis and the other without prophylaxis. A total of 1,018 TRUSPBs were performed from April 1996 to July 2003. No antibiotic prophylaxis was given in the first 614; the remaining 404 procedures were performed under antibiotic prophylaxis. Biopsy complications were assessed at outpatient urologist visits after the procedure in the 212 first biopsies and by telephone interview in the remaining 806. A total of 78 infectious complications were found. Major infectious complications (n=41) were septic shock (n=3), sepsis (n=3), Fournier gangrene (n=1), urinary tract infection (n=2), and fever requiring hospital admission (n=32). Minor infectious complications were fever that did not require admission (n=29), prostatitis (n=6), and epididymitis (n=2). Infectious complications occurred in 63 of 614 (10.3%) procedures without antibiotic prophylaxis and in 15 of 404 (3.7%) of those with antibiotic prophylaxis (P=0.0001). Of the 41 major infectious complications, 31 (75.6%) occurred in procedures without antibiotic prophylaxis (n=583) versus ten (24.4%) in those with prophylaxis (n=394) (P=0.0410). In conclusion, transrectal ultrasound-guided biopsy of the prostate has a statistically significant higher risk of infectious complications when performed without antibiotic prophylaxis.     

Endorectal magnetic resonance imaging of prostatic cancer: comparison between fat-suppressed T2-weighted fast spin echo and three-dimensional dual-echo, steady-state sequences

The aim of this study was to develop an endorectal MRI strategy for prostatic cancer. We evaluated the MR images from 44 consecutive prostatic cancer patients treated by radical prostatectomy. Each sequence from every examination was assessed separately with a specific tumor map drawn. Tumor localization, capsular penetration, and seminal vesicle invasion were marked on maps on the basis of T2 and DESS (dual-echo steady-state) sequences. Thirty patients also had T1-weighted images, and these were assessed with regard to possible tumor outgrowth. The maps were compared with histopathological findings from radical prostatectomy specimens. According to our study, DESS equaled T2 in every respect. No statistically significant differences between the sequences were found with respect to detecting either tumor localization, outgrowth, or seminal vesicle invasion. DESS is a potential new sequence in prostatic MRI as it has been proven to parallel the routinely used T2-weighted imaging. Received: 2 December 1999/Revised: 3 July 2000/Accepted: 4 July 2000