前列腺中央腺体癌的MRS和DWI定量诊断研究

目的探讨(胆碱+肌酸)/枸橼酸盐(CC/C)值和表观扩散系数(ADC)值及联合应用两者对中央腺体癌的诊断效能。方法回顾性分析经病理证实的前列腺中央腺体癌27例,良性中央腺体病变62例,比较两者的平均CC/C值和ADC值(采用3种测量方法分别获得最小ADC值、平均ADC1和平均ADC2);通过判别分析计算平均CC/C值和ADC值诊断中央腺体癌时各自所占的权重;采用受试者工作特征曲线分析计算平均CC/C值、3种ADC值及联合CC/C值和ADC值对中央腺体癌的诊断效能。结果 (1)前列腺中央腺体癌组和良性中央腺体病变的平均CC/C值、最小ADC值、平均ADC1和平均ADC2比较差异均有统计学意义(t=3.582、-9.416、-9.716、-9.889,P<0.05);(2)3种ADC值诊断中央腺体癌的权重均高于平均CC/C值;(3)3种ADC值、分别联合平均CC/C值和3种ADC值诊断中央腺体癌的曲线下面积(AUC)显著高于平均CC/C值,差异均有统计学意义(P<0.05);3种ADC值、分别联合平均CC/C值和3种ADC值诊断中央腺体癌的AUC差异均无统计学意义(P>0.05);3种ADC值诊断中央腺体癌的AUC差异无统计学意义(P>0.05)。结论 DWI对中央腺体癌的诊断效能优于MRS;不同方法所测得的ADC值对中央腺体癌的诊断效能无差异;联合DWI和MRS对中央腺体良恶性病变的鉴别优于MRS。     

MRS与DWI对前列腺中央腺体癌的诊断价值

目的探讨3D1 H MR波谱(MRS)分析和扩散加权成像(DWI)对前列腺中央腺体癌的检出价值。方法对55例前列腺中央腺体疾病的患者行MRS和扩散加权成像(DWI)扫描,经穿刺活检证实,15例为前列腺癌(PCa),40例为前列腺增生(BPH),比较两组间的(胆碱+肌酸)/枸橼酸盐(CC/C)值和表观扩散系数(ADC)值。结果 PCa组和BPH组的CC/C值分别为2.93±1.77和0.67±0.39,PCa组和BPH组的ADC值分别为(0.71±0.32)×10-3 mm2·s-1和(1.21±0.26)×10-3 mm2·s-1,PCa组和BPH组之间的CC/C值和ADC值差异均有统计学意义(P<0.05)。结论 MRS和DWI对前列腺中央腺体癌的诊断具有一定价值。     

前列腺中央腺体癌的MRS及DWI表现并误诊分析

目的探讨前列腺中央腺体癌的磁共振波谱分析(MRS)及扩散加权成像(DWI)表现,并对误诊病例进行分析。资料与方法回顾性研究术前MR诊断为前列腺中央腺体癌的患者共58例,术后确诊为癌40例、非癌18例,比较两组间的(胆碱+肌酸)/枸橼酸盐(CC/C)值和表观扩散系数(ADC)值。结果中央腺体癌组CC/C值及最小ADC值分别为2.89±1.26、(0.81±0.16)×10-3mm2/s,非癌组CC/C值及最小ADC值分别为1.28±0.59、(1.02±0.18)×10-3mm2/s,中央腺体癌组与非癌组之间的CC/C值及最小ADC值差异均有统计学意义(t值分别为5.994、-3.862,P值均<0.05)。结论 MRS和DWI对于前列腺中央腺体癌的诊断具有一定的价值。     

前列腺增生MR波谱分析与病理大切片对照研究

目的 探讨前列腺增生不同组织类型在MR波谱(MRS)检查中的代谢差异、临床应用价值及尿道周围单体MRS代谢特点.方法 对16例前列腺增生患者术前行MRS检查,并测定(胆碱+肌酸)/枸橼酸盐(cc/c)值.行耻骨上经膀胱前列腺摘除术,术后标本行病理大切片检查,采用一一对应的方法,将波谱图像cc/c值与前列腺组织病理类型(包括尿道)分别记录后,采用One-way-ANOVA检验和t检验进行不同组织类型间的比较.结果 前列腺的腺体型组织、间质型组织、混合型组织和尿道周围单体分别为233、130、165和50个,其cc/c值分别为O.59±0.29、1.23±0.38、0.80±0.27和0.68±0.33,差异有统计学意义(F=3.49,P＜0.05).其中腺体型组织与间质型、混合型组织比较,间质型组织与混合型组织、尿道周围组织比较,混合型组织与尿道周围组织比较,差异均有统计学意义(t值分别为19.60、7.09、13.22、9.42和9.42,P值均＜0.05).结论 前列腺增生不同组织类型在MRS分析检查中的cc/c值存在差异,尿道周围单体MRS代谢特点与腺体型组织相近,此方法可能对确定诊断阈值有一定意义.     

中国男性良性前列腺增生的MR波谱定量分析

目的用磁共振波谱分析方法定量评价不同类型良性前列腺增生的代谢变化。方法10例超声引导下穿刺活检证实的前列腺增生患者,都行经尿道前列腺电切术,术后对标本进行了组织学分类,分为腺体增生为主型和间质增生为主型,根据增生程度的不同在中央区设定兴趣区后利用三维磁共振波谱测定各兴趣区(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值。计算并比较各型(Cho+Cre)/Cit比值的差异。结果腺体增生为主型(Cho+Cre)/Cit比值平均为0.55±0.32,间质增生为主型(Cho+Cre)/Cit比值为0.87±0.34,两者差异有统计学意义(t=8.18,P<0.05)。结论中国男性良性前列腺增生的代谢改变可以用MRS定量评价,不同类型代谢水平不同。     

MR直肠内线圈波谱成像在前列腺癌鉴别诊断中的作用

目的:探讨磁共振波谱成像在正常前列腺、前列腺癌、前列腺增生及外周带良性结节中的诊断价值.方法:对经病理证实的前列腺癌35例、前列腺增生34例(包括7例外周带良性结节)进行MRS定量分析.选前列腺中间层或病灶最大层面作为感兴趣区,测量其(Choline Creatine)/Citrate即CC/C的比值.结果:正常前列腺外周带、前列腺癌区、外周带良性结节和前列腺增生中央带的CC/C平均比值分别为0.94±0.53、2.23±1.67、1.19±0.64和0.93±0.49.前列腺癌与前列腺外周带良性结节及前列腺增生之间的差异均有统计学意义(t值分别为2.78和4.4,P值分别为0.01和0.001).前列腺癌的CC/C值最高,CC/C＞1.5者18例(51.4%);其余各组CC/C≈1.结论:前列腺癌的CC/C值显著升高,MRS有助于前列腺癌的鉴别诊断.     

前列腺中央腺体偶发癌与中央腺体癌的MR扩散加权成像

目的:运用MR扩散加权成像对前列腺中央腺体偶发癌和中央腺体癌的表现扩散系数值(ADC值)进行定量分析.方法:回顾性分析8例前列腺中央腺体偶发癌和32例中央腺体癌患者病例资料,比较两者ADC值.结果:①中央腺体ADC值:前列腺中央腺体偶发癌组与中央腺体癌组分别为(1.48±0.18)×10-3mm2/s、(1.20±0....     

前列腺中央腺体癌3.0 T MRS的初步研究

目的 :分析前列腺中央腺体癌3.0 T MRS表现,探讨其诊断价值。方法 :回顾性分析经手术病理证实的11例前列腺中央腺体癌的3.0 T MRI及MRS表现,比较中央腺体癌区及非癌区(胆碱+肌酸)/枸橼酸盐[(Cho+Cre)/Cit]的比值。结果:MRI检查11例均表现为中央腺体增大;2例中央腺体区信号不均匀,见不规则低信号;8例中央腺体区示低、稍高混杂信号结节;1例中央腺体区弥漫性低、等混杂信号结节,侵入外周带。MRS测得中央腺体癌区(Cho+Cre)/Cit值为2.75±1.34,范围1.12~5.67;非癌区(Cho+Cre)/Cit值为0.65±0.32,范围为0.17~0.98,两者差异有统计学意义(P<0.05)。结论:前列腺中央腺体癌3.0 T MRI信号复杂多样,常规序列不易检出、定性困难;MRS能提供中央腺体癌的代谢信息,有助于提高中央腺体癌的诊断水平。     

MR Spectroscopy and Diffusion Weighted Imaging of Prostatic Central Gland Cancer and Analysis of Misdiagnosis

目的 探讨前列腺中央腺体癌的磁共振波谱分析(MRS)及扩散加权成像(DWI)表现,并对误诊病例进行分析.资料与方法 回顾性研究术前MR诊断为前列腺中央腺体癌的患者共58例,术后确诊为癌40例、非癌18例,比较两组间的(胆碱+肌酸)/枸橼酸盐( CC/C)值和表观扩散系数(ADC)值.结果 中央腺体癌组CC/C值及最小ADC值分别为2.89+1.26、(0.81 +0.16)×10-3mm2/s,非癌组CC/C值及最小ADC值分别为1.28±0.59、(1.02±0.18)×10-3mm2/s,中央腺体癌组与非癌组之间的CC/C值及最小ADC值差异均有统计学意义(t值分别为5.994、-3.862,P值均＜0.05).结论 MRS和DWI对于前列腺中央腺体癌的诊断具有一定的价值.     

良性前列腺增生的ADC值定量分析

目的运用MR扩散加权成像对不同类型良性前列腺增生的ADC值进行定量分析,并与前列腺癌ADC值进行比较。方法17例行经尿道前列腺电切术的良性前列腺增生患者,在术前3个月内均进行了前列腺DWI检查。采用单次激发EPI序列,b值为0 s/mm2和800 s/mm2,电切术后对标本进行了组织学分类,将增生组织分为腺体型增生和间质型增生,并分别测量其ADC值。另外还选取了15例穿刺活检证实的前列腺癌病人,测量其癌区的ADC值。对所得3组数值进行统计学分析。结果腺体型增生、间质型增生、前列腺癌的ADC值分别为(1.80±0.20)×10-3mm2/s、(1.56±0.18)×10-3mm2/s、(1.27±0.21)×10-3mm2/s,3组间具有统计学差异(F=47.366,P<0.01,one-way ANOVA),两两比较也具有统计学意义(P值均<0.01)。腺体增生和间质增生间有62%的ADC值重叠,腺体增生和癌之间有22%的ADC值重叠,间质增生与癌之间有57%的ADC值重叠。结论用ADC值可以定量评价不同类型的良性前列腺增生,增生与前列腺癌的ADC值有统计学差异,但存在部分重叠,以间质型增生重叠较明显。     

Temporary Health Impact of Prostate MRI and Transrectal Prostate Biopsy in Active Surveillance Prostate Cancer Patients

PurposeTo assess the temporary health impact of prostate multiparametric MRI (mpMRI) and transrectal prostate biopsy in an active surveillance prostate cancer population.MethodsA two-arm institutional review board–approved HIPAA-compliant prospective observational patient-reported outcomes study was performed from November 2017 to July 2018. Inclusion criteria were men with Gleason 6 prostate cancer in active surveillance undergoing either prostate mpMRI or transrectal prostate biopsy. A survey instrument was constructed using validated metrics in consultation with the local patient- and family-centered care organization. Study subjects were recruited at the time of diagnostic testing and completed the instrument by phone 24 to 72 hours after testing. The primary outcome measure was summary testing-related quality of life (summary utility score), derived from the testing morbidities index (TMI) (scale: 0 = death and 1 = perfect health). TMI is stratified into seven domains, with each domain scored from 1 (no health impact) to 5 (extreme health impact). Testing-related quality-of-life measures in the two cohorts were compared with Mann-Whitney U test.ResultsIn all, 122 subjects were recruited, and 90% (110 of 122 [MRI 55 of 60, biopsy 55 of 62]) successfully completed the survey instrument. The temporary quality-of-life impact of transrectal biopsy was significantly greater than that of prostate mpMRI (0.82, 95% confidence interval [CI] 0.79-0.85, versus 0.95, 95% CI 0.94-0.97; P < .001). The largest mean domain-level difference was for intraprocedural pain (transrectal biopsy 2.6, 95% CI 2.4-2.8, versus mpMRI 1.3, 95% CI 1.1-1.5; P < .001).ConclusionTransrectal prostate biopsy has greater temporary health impact (lower testing-related quality-of-life measure) than prostate mpMRI.     

Prostate cancer

Prostate cancer is the most common malignancy in American men and second only to lung cancer in deaths. The American Cancer Society estimates that there will be about 232,090 new cases of prostate cancer in the United States in 2005, and about 30,350 men will die of this disease. Over the past 15 yr, research has expanded our knowledge of this cancer, its risk factors, treatments, and the potential screening tools. Yet, there is no clear consensus of how to deal with every man who comes in for aeromedical certification, how to screen for it, and how to treat it. No man is the same when it comes to prostate cancer. It is the responsibility of the aviation medical examiner to evaluate the unique aspects of every case for aeromedical implications.     

Prostate cancer

The incidence of prostate cancer has been increasing gradually in Japan, and the optimal use of radiation therapy is important to improve therapeutic outcome and quality of life. The clinical trials conducted by RTOG and EORTC have made it clear that dose escalation results in improvement of the local control rate in early stage localized prostate cancer and androgen ablation in combination with radiation therapy improves biochemical control and the progression-free survival rate in locoregionally advanced prostate cancer. To select optimal patients for dose escalation study and to determine the optimal use of androgen ablation, it has become clear that the Gleason score and pretreatment PSA value provide valuable information in addition to clinical stage. In terms of prophylactic irradiation to pelvic lymph nodes, there has been no definitive evidence that prophylactic irradiation of clinically or pathologically uninvolved pelvic lymph nodes improves the overall survival rate. Brachytherapy including 125-I or 103-Pd permanent implants and high-dose-rate brachytherapy is now widely used in the treatment of prostate cancer, but clear indications have not yet been determined because of the lack of clinical trials. In this paper, we summarize evidence concerning the role of radiation therapy in the treatment of prostate cancer and also describe the biological basis of prostate cancer, which influences the optimal selection of treatment modalities.     

前列腺MRS诊断外周带前列腺癌的价值

目的：分析前列腺外周带的MRS特征,探讨MRS技术及其在外周带前列腺癌诊断中的价值。方法：24例临床及常规MRI检查拟诊局限性前列腺外周带前列腺癌患者均成功行前列腺MRS检查,所有患者均经病理证实为前列腺癌,其中19例行穿刺活检,5例经手术证实。回顾性分析患者的临床资料、病变部位、大小、常规MRI特征、MRS检查结果,计算（胆碱＋肌酸）/枸橼酸盐（CC/C）。采用重复测量方差分析比较正常外周带与前列腺癌组织CC/C值差异。采用操作者工作特征曲线（ROC）分析CC/C值诊断前列腺癌的价值。结果：早期外周带前列腺癌T2WI表现为在外周带高信号内有局灶性低信号区。MRS示前列腺外周带肿瘤组织枸橼酸盐（Cit）峰明显下降,胆碱（Cho）峰升高,CC/C值为1.40±0.33,正常外周带为0.51±0.12,两者差异有统计学意义（F=95.189,P〈0.001）。CC/C值的ROC曲线下面积为0.994,这一指标可用于判断前列腺癌（P=0.002）;以0.85为阈值时,诊断前列腺癌的敏感度为95%,特异度为100%。结论：前列腺MRS检查能反映早期外周带前列腺癌的代谢变化,对常规MRI无法明确诊断的前列腺癌具有重要诊断价值。     

经直肠超声引导下前列腺穿刺活检诊断前列腺癌

目的:探讨经直肠彩色多普勒超声引导下前列腺穿刺活检诊断前列腺癌的价值。材料和方法:对36例临床肛门指检、前列腺特异抗原及经直肠超声三项检查之一异常者行经直肠超声检查,并行超声引导下穿刺活检。穿刺部位选择在可疑的前列腺癌结节,再结合6点穿刺法对其它部位进行穿刺。结果:19例前列腺癌,超声发现结节11例,9例位于外腺或内外腺交界处;17例前列腺增生,超声发现结节9例,7例结节位于内腺。结论:对可疑前列腺癌病例行经直肠超声引导下穿刺活检是一种快速有效的诊断技术。