不同血清前列腺特异抗原水平前列腺癌超声造影微血管成像与常规超声靶向引导穿刺活检的对比

目的 比较不同血清前列腺特异抗原(PSA)水平下超声造影微血管成像(MFI)与常规超声靶向引导前列腺癌穿刺活检的价值.方法 对65例血清PSA升高(≥4 ng/ml)的患者行经直肠前列腺穿刺活检,分为A(4 ng/ml≤PSA＜10 ng/ml)、B(10 ng/ml≤PSA＜20 ng/ml)、C(PSA≥20 ng/ml)三组,活检前行经直肠灰阶、彩色多普勒能量图(CDE)及MFI检查.在超声引导下对每例患者行底、中、尖三切面12点穿刺.以病理结果为金标准,比较不同PSA水平组中MFI与常规超声靶向引导前列腺癌穿刺活检的价值.结果 65例患者有230针穿刺活检病理诊断为前列腺癌.A组、B组中MFI检出恶性病灶的敏感度均高于灰阶及CDE(P＜0.01),C组中MFI的敏感度、准确率及阴性预测值均高于灰阶及CDE(P＜0.01).三组间MFI靶向引导前列腺活检的敏感度和准确率差异无统计学意义(P＞0.05).结论 对不同PSA水平前列腺癌,MFI均较常规超声靶向引导穿刺活检的敏感性高.     

经直肠超声引导前列腺穿刺活检术168例分析

目的:探讨经直肠超声引导前列腺穿刺活检术诊断前列腺癌的临床价值。方法:对168例直肠指征阳性或PSA>4 ng/ml及前列腺癌术后直肠指诊异常伴PSA升高病例在行前列腺标准六点穿刺活检术同时对可疑回声区随机增加穿刺点。对Ⅱ度以上前列腺两侧各增加2个穿刺点。结果:共检出前列腺癌47例,标准六点未检出.随机增加穿刺活检检出8例。结论:前列腺穿刺活检为前列腺癌诊断重要手段。超声引导定位准确.可随机增加穿刺点,提高前列腺癌检出率。     

经直肠超声引导前列腺穿刺活检对前列腺特异抗原小于4 ng/ml前列腺癌的诊断

目的探讨经直肠超声引导下前列腺穿刺活检对前列腺特异抗原(PSA)<4ng/ml前列腺癌诊断的临床价值。方法59例PSA<4ng/ml疑为前列腺癌的患者行经直肠超声引导下前列腺多点穿刺活检,观察前列腺内结节声像图特点,并病理分级,对照分析活检术式的检出情况。结果59例患者中经病理证实前列腺癌16例,检出率为27%,其中12例声像图显示前列腺结节性病变,均分布于外腺,且血流增加较良性病变及癌前病变高。结节区域定点穿刺的检出率较六点系统穿刺活检术高(P<0.05);活检阳性点数占所有活检点数比率为51.2%,病理分级中分化程度占56.25%,低分化程度占31.25%。结论结合经直肠超声声像图和前列腺多点穿刺活检可提高PSA<4ng/ml的前列腺癌检出率,对前列腺癌的早期诊断非常必要。     

超声造影导向活检在常规超声检查阴性前列腺癌的应用价值

目的 评价超声造影匹配成像(CnTI)技术在靶向引导常规超声无可疑前列腺癌病灶前列腺穿刺活检中的临床应用价值。方法 对56例因血清前列腺特异性抗原(PSA)升高(≥4.00 ng/ml)而常规超声未发现明确病灶的患者在穿刺前行经直肠前列腺CnTI实时扫查。在超声引导下对患者行底、中、尖三切面10点穿刺,如相应穿刺点有可疑病灶,则直接对病灶进行活检。统计分析CnTI实时扫查图像结果与病理结果。结果 56例患者共穿刺560针,穿刺病理诊断为前列腺癌11例(11/56,19.64%)共39针(39/560,6.96%),CnTI实时扫查检出7例(7/11,63.64%)共22针(22/39,56.41%)。在4例CnTI实时扫查假阴性病例中,2例仅有1针穿刺点阳性,1例2针穿刺点阳性,1例3针穿刺点阳性,其Gleason分值均为6分。CnTI实时扫查真阳性与假阴性前列腺癌穿刺点Gleason分值差异无统计学意义(6.9 vs 6.6, P=0.134)。结论 对血清PSA升高但常规超声未发现明确前列腺癌病灶的患者,经直肠前列腺CnTI实时扫查有助于检出前列腺癌可疑病灶并指导前列腺穿刺活检。     

经直肠超声造影指导前列腺穿刺活检的临床价值

目的对比超声造影与常规超声引导穿刺活检结果,探讨经直肠超声造影对引导前列腺穿刺活检的优势。方法 195例可疑前列腺癌患者行前列腺穿刺活检,随机分为造影组60例,经直肠超声造影指导前列腺穿刺;对照组135例,经直肠超声引导前列腺穿刺。对比两组前列腺癌检出率、穿刺针数及单针阳性率。结果造影组60例患者,恶性42例,良性18例,前列腺癌诊断率为70.0%,共接受穿刺716针,平均12针;阳性针数352针,阳性率为49.2%。对照组135例患者,恶性95例,良性40例,前列腺癌诊断率为70.4%,共接受穿刺1431针,平均11针,阳性针数466针,阳性率为32.6%;两组前列腺癌诊断率和平均穿刺针数,差异无统计学意义(P0.05),造影组针数阳性率高于对照组(P0.01)。结论应用超声造影引导对前列腺可疑部位进行经直肠穿刺活检,能明显提高诊断前列腺癌的敏感性和穿刺的单针诊断率。     

经直肠超声引导移行区穿刺在前列腺癌检测中的作用

目的：探讨经直肠超声引导移行区穿刺在诊断前列腺癌中的作用。方法：对469例因前列腺血清特异抗原（PSA）升高或直肠指检异常来我科行前列腺穿刺活检术的患者,采用经直肠超声引导的六点系统穿刺法加移行区穿刺的方案,根据PSA、直肠指检、经直肠超声、前列腺体积及前列腺血清特异抗原密度（PSAD）检查结果进行分组,比较分析增加移行区穿刺对提高各组患者前列腺癌检出率的作用。结果：469例患者经穿刺病理诊断为前列腺癌187例（39.9％）,经直肠超声引导的六点系统穿刺法加移行区穿刺比单独采用六点系统穿刺法多发现前列腺癌24例（5.1%）,两种穿刺方案的前列腺癌检出率无统计学差异（P=0.105）。但在257例经直肠超声检查阴性患者中,经穿刺病理诊断为前列腺癌66例,其中移行区穿刺阳性患者20例,增加移行区穿刺可提高7.8%的前列腺癌检出率（Ｐ＝0.033）。结论：对经直肠超声检查阴性患者应采用移行区穿刺以提高前列腺癌的检出率。     

经直肠实时超声弹性成像在前列腺活检中的应用价值

目的 探讨经直肠实时超声弹性成像(TRTE)在前列腺活检中的应用价值.方法 应用经直肠超声(TRUS)和TRTE检查68例疑诊前列腺癌患者,寻找病灶行目标活检,并行系统活检.比较前列腺癌检出率;比较系统活检和目标活检前列腺癌检出率.结果 TRUS检出可疑病灶36个,其中16例19个癌结节,检出率52.8％;TRTE检出可疑病灶30个,其中21例26个癌结节,检出率86.7％,TRTE和TRUS的前列腺癌检出率有明显差异(P＜0.01);24例30个病灶行目标活检,活检点数71个,检出前列腺癌21例,检出率29.6％;68例系统活检点数472个,检出前列腺癌20例,检出率4.3％,两种活检方案的前列腺癌检出率有明显差异(P＜0.01).结论 TRTE可提高前列腺癌病灶的检出率,有助于引导目标活检,提高超声引导前列腺穿刺的活检效能.     

经直肠能量多普勒超声在前列腺穿刺活检中的临床价值

目的：探讨经直肠能量多普勒超声（PDU）在前列腺穿刺活检中的临床应用价值,提高前列腺癌的诊断率。方法：对临床高度怀疑前列腺癌的54例病人在穿刺前完成经直肠二维灰阶超声的常规检查、PDU检查,根据检查结果选择经直肠二维灰阶超声、PDU及两者联合使用靶向穿刺结合6点前列腺系统穿刺活检方案。对比分析直肠二维灰阶超声、PDU靶向穿刺活检诊断前列腺癌的敏感性、特异性、阳性预测值、阴性预测值。结果：经直肠PDU检查发现异常血流增多37例,其中前列腺癌23例（包括2例为灰阶超声无异常发现的位于外腺的前列腺癌）,前列腺增生症11例,前列腺癌不能除外1例, 前列腺占位1例（未定）,转移性前列腺癌1例（膀胱癌）。结论：经直肠PDU能提高前列腺癌检测的敏感性与定位适合穿刺点,经直肠PDU靶向穿刺活检病理Gleason评分更高。     

经直肠超声引导前列腺穿刺活检在前列腺癌诊断中的应用

【目的】探讨经直肠超声前列腺标准6点系统穿刺结合靶向引导穿刺活检方案在前列腺癌诊断中的应用价值。【方法】对直肠指诊阳性、血清前列腺特异性抗原（PSA）〉10mg／L、超声检查前列腺声像图异常159例患者进行经直肠超声前列腺标准6点系统穿刺结合靶向引导穿刺活检。【结果】前列腺癌检出率为32．1％（51／159）,其中1例前列腺癌合并膀胱癌患者;前列腺增生70例,占44．0％;非典型增生32例,占20．1％;膀胱癌3例,占0．19％;前列腺肉芽肿、膀胱血管肉瘤及直肠癌各1例,占0．19％;所有患者均未出现严重并发症。【结论】对于PSA〉10．0ng／mL患者行经直肠超声前列腺标准6点系统穿刺结合靶向引导穿刺活检法是一种合理有效穿刺活检方案,操作简单、安全且准确性高、并发症极少,在前列腺癌诊断及鉴别诊断具有重要价值。     

超声引导下经会阴部前列腺穿刺活组织检查术在前列腺癌诊断中的意义

目的研究超声引导下经会阴部前列腺穿刺活组织检查术运用于前列腺癌诊断中的价值。方法选取36例前列腺癌患者,观察所有患者穿刺诊断结果。所有患者利用超声下经会阴前列腺穿刺活检。结果前列腺癌检出率为41.67%(15/36);不同年龄前列腺癌的检出率有差异(P<0.05)。所有患者经过前列腺特异性抗原(PSA)水平检测,前列腺癌检出率为33.33%(12/36);不同PSA水平检出率有差异(P<0.05)。所有患者经过直肠超声或MRI检查检测前列腺体积,前列腺癌检出率为36.11%(13/36);不同前列腺体积检出率有差异(P<0.05)。结论超声下经会阴前列腺穿刺活检在前列腺癌诊断中具有重要意义,可提高疾病检出率,为治疗及预后提供参考依据。     

Color Doppler imaging of the prostate: important adjunct to endorectal ultrasound of the prostate in the diagnosis of prostate cancer

The purpose of this article is to evaluate color Doppler imaging (CDI) as an adjunctive tool to gray-scale ultrasound (US) in the diagnosis of prostate cancer and to correlate CDI-positive lesions to cancer grade. We retrospectively analyzed 619 consecutive patients who underwent prostate US, CDI, and biopsy because of abnormal digital rectal examination results or prostate-specific antigen levels. All had directed (into a specific lesion) biopsies or directed biopsies along with systematic four-quadrant or sextant biopsies, or systematic biopsy alone. Color Doppler imaging was compared with gray-scale findings and histologic results. There were 222 (35.9%) biopsy-proven cancers (n = 197) or prostatic intraepithelial neoplasia (n = 25). Of these, 106 (47.7%) had color-flow abnormalities. Of these 106 patients, 26 (24.5%), or 11.7% of all cancer patients, had relatively normal gray-scale US findings but had focal CDI abnormalities as the method of identification. Overall, 76.9% of these were moderate to high Gleason grades and were considered clinically significant lesions. Color Doppler imaging can identify a large number (11.7%) of clinically significant prostate cancers that are poorly seen by gray-scale US. Positive lesions on CDI are of clinical importance because 76.9% are histologically, moderately, or poorly differentiated. We recommend that CDI be used in all diagnostic and biopsy-guided US examinations of the prostate.     

Diffuse prostatic lesions: role of color Doppler and power Doppler ultrasonography.

The purpose of this study was to assess the role of color Doppler ultrasonography and power Doppler ultrasonography in the identification of diffuse prostatic lesions. Forty male patients underwent gray scale transrectal ultrasonography, color and power Doppler sonography, and transrectal ultrasonographically guided biopsy. Transrectal ultrasonographically guided biopsy revealed cancer in 23 patients and benign lesions in 17 patients. Among the prostatic cancers 82.6% (19 of 23) showed increased flow signals, whereas 23.5% (four of 17) of benign lesions showed increased flow signals on color or power Doppler ultrasonography. If we consider increased flow signal on color or power Doppler sonography as a sign of a prostate cancer in diffuse prostatic lesions, these modalities have a sensitivity of 82.6%, specificity of 76.5%, and positive predictive value of 82.6%. On the basis of our study, we may conclude that color and power Doppler ultrasonography are useful in the identification of diffuse prostatic lesions.     

经直肠彩色多普勒超声鉴别前列腺周缘区低回声性质的价值

目的 探讨经直肠彩色多普勒超声对前列腺周缘区低回声结节良恶性诊断的价值。方法 对77例前列腺周缘区低回声结节行经直肠彩色多普勒超声探测，利用彩色直方图软件计算结节内彩色血流面积与选定结节面积比值(black and white color ratio，BCR)和整个前列腺血流BCR并比较二者的BCR，如结节内BCR高于整个前列腺内5％则为血流增多。结果 77例前列腺周缘区低回声结节穿刺活检证实前列腺癌51例，前列腺增生症26例。周缘区低回声内血流增多共50例，其中前列腺癌41例。经直肠彩色多普勒超声检查结节内血流增加对诊断前列腺癌的敏感性、特异性、阳性预测值分别为80．4％，65．4％，82．0％。结论 经直肠彩色多普勒超声检查前列腺周缘区低回声结节内血流并用BCR解释其丰富程度对结节良恶性的鉴别诊断有一定帮助。     

CPS及CCI灰阶超声造影成像技术诊断肝脏局灶性病变应用价值

目的探讨灰阶超声造影成像(CE-GUS)诊断肝占位性病变的应用价值.方法应用CPS及AD-CCI成像技术检查39个肝脏局灶性病变,32个病灶同期检查基波彩色多普勒增强超声(CE-CDFI). 结果 CE-GUS病灶内部血流信号显示率97.44%,高于CE-CDFI(P<0.05).CE-GUS诊断符合率为92.3%(36/39),明显高于常规超声检查(23.1%)及CE-CDFI(50%),P<0.05.结论 CPS及CCI灰阶超声造影成像技术能清楚显示肝脏及肝肿瘤血液灌注,对肝脏局灶性病变的鉴别诊断有实用价值.     

Power Doppler Ultrasonography of the Feeding Arteries of the Prostate Gland

OBJECTIVE: The purpose of this study was to assess the role of spectral Doppler ultrasonographic parameters of the feeding arteries of the prostate for the detection of prostate cancer. METHODS: A total of 55 patients referred for prostate biopsy with a mean age of 66.4 years (range, 46-82 years) were included. In each patient, Doppler indices from bilateral capsular and urethral arteries were obtained. The indices were compared with regard to malignant (group A) and benign (group B) subgroups of histopathologic outcomes of transrectal ultrasonographically guided prostate biopsy for each side (n = 19 and n = 91 for groups A and B, respectively) and to assess whether the indices were significantly altered on the side with cancer compared with the contralateral side. RESULTS: The mean pulsatility index value for the capsular artery of group A (1.49 +/- 0.57) was significantly lower than that of group B (1.71 +/- 0.52; P = .048). The mean resistive index and systolic/diastolic ratio for the capsular artery of group A (0.78 +/- 0.10 and 5.40 +/- 2.74, respectively) were lower than those of group B (0.82 +/- 0.08 and 7.40 +/- 4.91) despite being statistically insignificant (P = .075 and .119, respectively). CONCLUSIONS: Spectral waveform measurements by power Doppler transrectal ultrasonography may be useful in differentiating prostate cancer from benign hypertrophy. Further research is needed to elucidate the potential of spectral Doppler indices of the capsular and urethral arteries.     

Peripheral zone hypoechoic lesions of the prostate: evaluation with contrast-enhanced gray scale transrectal ultrasonography.

OBJECTIVE: The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. METHODS: The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. RESULTS: Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). CONCLUSIONS: Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.     

磁共振—经直肠超声认知融合引导下前列腺靶向穿刺联合系统穿刺对血清前列腺特异性抗原水平4~20 ng/mL患者的前列腺癌诊断有效性

  目的  评价磁共振—经直肠超声认知融合引导下前列腺靶向穿刺（CFTB）联合经直肠超声引导下系统穿刺（SB）与单纯经直肠超声引导下SB对前列腺特异性抗原（PSA）在4~20 ng/mL水平患者的前列腺癌诊断的有效价值。  方法  选取我院接收的血清PSA水平4~20 ng/mL且首次经历经直肠超声引导下前列腺穿刺活检的337例患者,按穿刺活检前是否行MRI检查,将患者分为CFTB+SB组（n=177）和单纯行SB组（n=160）。比较两组患者穿刺阳性率、单针阳性率、临床显著性前列腺癌（CSPCa）及临床非显著性前列腺癌的检出率。  结果  CFTB+SB组患者穿刺阳性率、单针阳性率和CSPCa检出率均高于单纯行SB的患者（40.1% vs 26.3%;17.5% vs 10.3%;38.4% vs 20.6%,P < 0.05）,而临床非显著性前列腺癌检出率低于SB组患者（1.7% vs 5.6%,P < 0.05）;对CFTB+SB组内CFTB+SB与仅行CFTB的CSPCa检出率一致性比较显示:CFTB+SB与仅行CFTB对CSPCa检出有较高的一致性（Kappa=0.860）,CFTB+SB的CSPCa检出率高于仅行CFTB（40.1% vs 36.1%,P < 0.05）。  结论  磁共振—经直肠超声认知融合引导下前列腺靶向穿刺联合系统穿刺法对血清PSA在4~20 ng/mL水平的临床可疑前列腺癌患者有较高的临床诊断价值。      

经会阴途径穿刺确诊的前列腺癌大体病灶空间分布

  目的  探讨经会阴途径穿刺确诊的前列腺癌大体病理的病灶空间分布特点。  方法  北京协和医院2013年11月至2015年3月经会阴前列腺穿刺阳性且阳性区数≤ 6区的前列腺癌根治术后标本61例, 根据大体病理分为前、后半区为主肿瘤并比较肿瘤阳性率和肿瘤特点。进一步以尖部、中部和基底部为分区, 比较各部分的肿瘤分布情况。  结果  61个主要肿瘤中, 前半区为主肿瘤有32个(52.5%), 后半区为主肿瘤有29个(47.5%), 两者比较差异无统计学意义(χ²=0.295, P=0.587)。对于切缘阳性率和Gleason评分, 前半区为主肿瘤与后半区为主肿瘤相比较差异均无统计学意义。中部、尖部和基底部的肿瘤阳性率分别为96.7%、80.3%和29.5%, 平均单位体积肿瘤负荷分别为105.17、130.62和69.81 μl/ml。其中, 尖部与基底部相比有更高的肿瘤阳性率(χ²=31.816, P < 0.001)和单位体积肿瘤负荷(P=0.028)。  结论  经会阴前列腺穿刺阳性的前列腺癌大体病理前、后半区的肿瘤阳性率一致, 肿瘤特点相同。前列腺尖部比基底部有更高的肿瘤阳性率和单位体积肿瘤负荷。     

Analysis of three-dimensional Doppler ultrasonographic quantitative measures for the discrimination of prostate cancer.

OBJECTIVE: The purpose of this study was to determine whether several quantitative ultrasonographic measures have potential to discriminate prostate cancer from normal prostate and to determine the best combination of these measures. The true spatial distributions of cancer within the prostates studied were obtained histologically after radical prostatectomy. The relationship between Doppler ultrasonography and microvessel count was also investigated. METHODS: Three-dimensional Doppler ultrasonographic data were acquired from 39 patients before radical prostatectomy. The removed prostate was sectioned, and whole-mount hematoxylineosin-stained slides were used to identify all regions of cancer within each prostate. These histologic and ultrasonographic data were spatially registered. Doppler ultrasonographic measures were calculated within uniformly sized three-dimensional regions that were either entirely cancerous or noncancerous, and receiver operating characteristic analysis was performed on the results. Microvessel counts were made within each contiguous cancerous region and correlated with ultrasonographic measures. RESULTS: Color pixel density was the best simple measure for discriminating prostate cancer (accuracy, 80%). The mean power mode value (normalized mean power in color pixels) was inversely related to cancer with an accuracy of 1--normalized mean power in color pixels = 65% (low mean power is more cancerous). When color pixel density was combined with the normalized mean power in color pixels, its accuracy improved slightly to 84%. The peak microvessel count had a negative correlation with color pixel density as well as with cancer stage. CONCLUSION: Doppler ultrasonography does provide discriminatory information for prostate cancer, with color pixel density being the most promising measure.