磁共振波谱在老年前列腺疾病诊断中的价值

目的探讨磁共振波谱(MRS)对前列腺癌(PC)和良性前列腺增生(BPH)的诊断和鉴别诊断价值。方法分析经手术病理或穿刺活检证实的21例PC、28例BPH的T2WI、DWI及MRS的表现特征。MRS测量每个体素的枸橼酸盐(Cit)、胆碱(Cho)、肌酸(Cre)的相对值及(Cho+Cre)/Cit的比值。结果多体素1H-MRS显示PC(Cho+Cre)/Cit比值的平均值与BPH(Cho+Cre)/Cit比值的平均值比较有显著差异(P0.05)。结论 MRS可以很好地鉴别PC和BPH,能够应用于临床,指导临床医师穿刺检查。     

磁共振波谱成像对中央腺体前列腺癌与良性增生结节的鉴别诊断

目的 探讨磁共振波谱成像(MRS)检查中央腺体前列腺癌代谢特点,与良性增生结节的鉴别诊断价值. 方法 应用3.0T MR成像仪对38例前列腺疾病患者进行前列腺MRI成像,中央腺体前列腺癌11例,良性前列腺增生27例.在MRI常规成像基础上行MRS检查,分析良性前列腺增生(BPH)和前列腺癌的MRS表现,11例前列腺癌中3例局限于中央腺体,8例肿块较大同时累及外周带,测量中央腺体内前列腺癌及BPH的胆碱(Cho)+肌酐(Cr)/枸橼酸盐(Cit)比值,并对前列腺癌与BPH体素的代谢物比值进行比较. 结果 中央腺体内前列腺癌波谱主要表现为Cit峰明显下降1,Cho+Cr峰显著升高,(Cho+Cr)/Cit的均值为1.94±1.43;BPH主要表现为Cit峰高耸,Cho+Cr峰低,(Cho+Cr)/Cit的均值为0.83±0.28(P＜0.01). 结论 联合应用MRI和MRS,有利于中央腺体内前列腺癌和BPH的鉴别,可提高前列腺癌诊断的准确性.     

发生于移行带的前列腺癌1例

患者72岁,因前列腺特异性抗原(PSA)增高半年于2003年2月入院。血总PSA23．44ng／ml,游离PSA2．08ng／ml,二者比值0．09。MRI示T2WI像右侧移行带低信号,向右侵及周围带,包膜清亮。磁共振频谱(MRS)示右侧移行带内多个体素显示异常代谢,表现为胆碱升高和枸橼酸盐降低,胆碱与枸橼酸的比值(cc／c)为2～3,周围带5～9点处也可见多个体素显示cc／c在0．5～1。     

3D-H~1磁共振波谱及表观扩散系数在老年前列腺良恶性病变中的价值

目的探讨3D-H1磁共振波谱(MRS)及表观扩散系数(ADC)值在老年前列腺良恶性病变中的价值。方法选择老年前列腺癌、前列腺增生、前列腺炎及健康志愿者各43例,均接受MRS及扩散加权成像(DWI)检查。比较各组病变组织3D-H1MRS特征、(Cho+Cr)/Cit及ADC值的差异。结果前列腺癌病变区(Cho+Cr)/Cit均值(2.861±0.872)显著高于其他各组(P<0.05)。前列腺癌病变区ADC均值(0.892±0.091)显著低于其他各组(P<0.05)。前列腺癌病变区胆碱(Cho)峰值+肌酸(Cr)峰值/枸橼酸盐(Cit)峰值与Gleason评分呈正相关(r=0.241,P=0.032),ADC值与Gleason评分呈负相关(r=-0.226,P=0.041)。结论 3D-H1MRS及ADC值可以为老年前列腺良恶性病变的鉴别诊断提供有价值的信息。     

核磁共振波谱成像在老年前列腺癌与良性前列腺增生鉴别诊断中的价值

目的探讨利用核磁共振波谱(1H-MRS)成像对老年前列腺癌(PC)和良性前列腺增生(BPH)之间的鉴别诊断价值。方法选取老年患者中经病理证实的PC患者30例,BPH患者20例,通过1H-MRS对图像进行分析,得到枸橼酸盐(Cit)、肌酸(Cr)、胆碱复合物(Cho)峰值,并计算(Cho+Cr)/Cit、Cho/Cit比值。结果 PC与BPH相应区域比较Cit峰值、(Cho+Cr)/Cit、Cho/Cit比值明显降低,Cho明显升高(P0.05)。结论1H-MRS成像可以在分子水平上对PC与BPH进行鉴别,并与病理结果具有较好一致性。     

磁共振氢质波谱成像评估高强度聚焦超声治疗原发性肝癌疗效的可行性及其价值

目的 通过比较原发性肝癌高强度聚焦超声(HIFU)治疗前后胆碱峰、脂质峰下积分面积及胆碱/脂质峰下积分面积比值的变化,探讨磁共振氢质波谱成像(1H-MRS)在HIFU治疗原发性肝癌疗效评估中的价值及可行性.方法 24例原发性肝癌患者于HIFU治疗前及治疗后2周内行常规磁共振平扫及动态增强扫描.以呼吸触发的横轴位T2WI...     

高b值扩散加权成像对前列腺癌的诊断价值

目的探讨高b值扩散加权成像对前列腺癌的诊断价值。方法经穿刺活检、手术病理证实的38例前列腺癌患者,回顾性分析其磁共振成像(MRI)特点并进行诊断。结果b=1000 s/mm2时检出ADC图对前列腺癌的敏感性为72%,特异性为89%,阳性预测值(PPV)为87%,阴性预测值(NPV)为67%;b=2000 s/mm2时分别为87%、92%、95%和75%。不同b值时磁共振扩散加权成像(DWI)对前列腺癌诊断的敏感性、PPV具有显著性差异。b=1000、2000 s/mm2时肿瘤组织的平均ADC值分别为1.17±0.38和0.75±0.19,与非肿瘤前列腺组织比较具有显著性差异(P<0.05)。结论常规MRI T2WI结合高b值DWI可显著提高前列腺癌的诊断准确性。     

大鼠慢性胰腺炎离体组织块高分辨氢质子磁共振波谱分析

目的 对CP大鼠离体胰腺组织块进行高分辨磁共振波谱分析,探索其代谢变化特征.方法 SD大鼠30只,数字随机法分为实验组(20只)与对照组(10只).实验组经尾静脉注射二丁基二氯化物8 mg/kg体重,对照组注射等量溶剂.胰腺组织行病理检查及胶原纤维染色.运用高分辨魔角旋转磁共振波谱技术对离体大鼠CP组织样品代谢物进行分析.结果 造模60 d后,11只大鼠胰腺小叶结构破坏,腺泡消失,炎症细胞广泛浸润,纤维组织大量增生,广泛间质纤维化,呈典型CP表现.波谱分析显示CP组织的磷酸胆碱(PC)和甘油磷酸胆碱(GPC)、牛黄酸(Tan)及乳酸(Lac)峰强度增加;甜菜碱(Bet)、谷氨酸(Glu)、丙氨酸(Ala)、异亮氨酸(Ile)、亮氨酸(Leu)、缬氨酸(Val)峰降低;而乙酸(Ace)、胆碱(Cho)峰强度则无明显差异.结论 离体大鼠CP组织具有显著的代谢特征,为人CP波谱分析研究奠定了实验基础.     

1HMRS在脑肿瘤鉴别诊断及胶质瘤分级中的应用研究

应用Philips Marconi Eclipse 1.5T超导型磁共振机,对60例经病理证实的脑肿瘤患者行单体素波谱(SVS)采集NAA、Cho、Cr、Lac、Lip和Ala峰,计算NAA/Cho、NAA/Cr和Cho/Cr比值.结果 显示,与正常侧相比,脑肿瘤均有NAA下降,Cho升高(P<0.05).不同肿瘤间Cho/Cr无明显差异,NAA/Cr和NAA/Cho具有统计学差异(P<0.05).各级别胶质瘤间NAA/Cr无明显差异,Cho/Cr和NAA/Cho具有高度统计学差异(P<0.01).Lip仅出现于高级别胶质瘤及转移瘤中.认为氢质子磁共振波谱(1HMRS)可以为脑肿瘤诊断与鉴别诊断、胶质瘤的组织学分级提供可靠信息.     

高场强MR对老年人前列腺癌分期预测的临床价值

目的 探讨高场强MR预测前列腺癌病理分期的临床价值.方法 48例手术病理证实的局限性前列腺癌患者,术前分别进行高场强MR检查,应用美国GE公司1.5T(GE Excite HD Twinspeed 1.5T)超导磁共振成像系统,扫描序列包括轴位快速自旋回波T1加权像、快速自旋回波T2加权像、T2脂肪抑制轴位和冠状位像及轴位弥散加权像.应用Whitmore-Jewett方法对前列腺癌进行分期. 结果 48例局限性前列腺癌患者,32例术前MR诊断B期,16例为C1期.术前MR诊断为B期者,43.8%(14/32)术后病理分期为C1期,其中1例为C2期;术前MR诊断C期者,术后病理12.5%(2/16)为B2期.MR对前列腺癌的分期与术后病理结果有显著相关性(r=0.451,P＜0.001),能够较准确地预测病理结果(x2=10.628,P＜0.01).MR分期对局限于前列腺内肿瘤的预测为56.3%(18/32),对浸润包膜及包膜外肿瘤的预测为87.5%(14/16);MR对局限性前列腺癌分期的敏感性为90.0%,特异性50.0%,准确性66.7%.结论 高场强MR对局限性前列腺癌能够预测前列腺癌的病理分期,能够更准确地预测肿瘤对包膜及包膜外的浸润情况.     

磁共振扩散加权成像在前列腺癌诊断和鉴别诊断中的价值

目的 探讨磁共振扩散加权成像(DWI)和表观弥散系数(ADC)值在前列腺癌诊断与鉴别诊断中的应用价值.方法 46例经手术病理或穿刺活检证实的前列腺疾病患者行DWI检查,其中前列腺增生(BPH)21例,慢性前列腺炎9例,前列腺癌16例,扩散敏感分数值800 s/mm2.依病理结果,将前列腺外周带六分区归类为正常区、增生区,炎症区、癌区,测量每个分区的ADC值,癌与非癌组之间进行受试者操作特征曲线(ROC)分析.结果 各组ADC值分别为,BPH外周带(2.20±0.29)×10-3mm2/s,中央带(1.66±0.14)×10-3 mm2/s,炎症区(1.95±0.34)×10-3 mm2/s,癌区(1.24±0.32)×10-3 mm2/s,组间ADC值两两比较,差异均有统计学意义(均P＜0.01);ROC曲线上临界点取1.49×10-3 mm2/s,诊断的敏感性达86.8%,特异性为94.0%,ROC曲线下面积0.945±0.010.结论 前列腺DWI及ADC值可用于前列腺肿瘤的诊断和鉴别诊断,具有很高的临床应用价值.

Abstract：

Objective To explore the application of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) value in the diagnosis and differential diagnosis of prostatic cancer. Methods Diffusion-weighted echo-planar imaging (EPI) sequences were performed in 46 patients, including 21 cases of benign prostatic hyperplasia (BPH), 9 cases of chronic prostatitis and 16 cases of prostate cancer. DWI were obtained with a b-factor of 800 s/mm2. According to the pathological results obtained by ultrasound guided biopsy, the peripheral zone of prostate was divided into six parts by orientations and they were divided into noncancerous, hyperplasia, prostatitis and cancerous groups. The ADC value of each region was measured and analyzed with one-way ANOVA and ROC analysis. Results Acceptable images for ADC measurement were obtained in all cases.The mean ADC values of prostatic peripheral zone, prostatic central gland, inflammatory area and cancerous area were (2.20±0. 29)×10-3 mm2/s, (1.66±0.14)×10-3 mm2/s, (1.95±0.34)×10-3 mm2/s and ( 1.24 ± 0.32) × 10-3 mm2/s, respectively. There were statistically significant differences in ADC values between the inter-groups (P＜0. 01 ). With ROC cut point setting to 1.49 ×10-3 mm2/s, the diagnostic sensitivity and specificity for prostate cancer were 86. 8% and 94. 0%, the area under the ROC curve (AUC) was 0. 945±0. 010. Conclusions ADC value might be useful to evaluate prostate cancer. DWI has an important clinical application value in the diagnosis and differentiation of prostate cancer.     

A decade in prostate cancer: from NMR to metabolomics

Over the past 30 years, continuous progress in the application of nuclear magnetic resonance (NMR) spectroscopy and magnetic resonance spectroscopic imaging (MRSI) to the detection, diagnosis and characterization of human prostate cancer has turned what began as scientific curiosity into a useful clinical option. In vivo MRSI technology has been integrated into the daily care of prostate cancer patients, and innovations in ex vivo methods have helped to establish NMR-based prostate cancer metabolomics. Metabolomic and multimodality imaging could be the future of the prostate cancer clinic--particularly given the rationale that more accurate interrogation of a disease as complex as human prostate cancer is most likely to be achieved through paradigms involving multiple, instead of single and isolated, parameters. The research and clinical results achieved through in vivo MRSI and ex vivo NMR investigations during the first 11 years of the 21st century illustrate areas where these technologies can be best translated into clinical practice.     

Prostate histopathology of NIH category IV prostatitis detected by sextant prostate needle biopsy from the patients with high prostatic specific antigen

Asymptomatic prostatitis is classified as category IV in NIH classification of prostatitis syndrome (1999). No report concerning this category has been present. We investigated this category histopathologically and clinically, in order to clarify the histopathological distribution and its correlation to the clinical features, in this study. Among 785 patients who were suspected prostate cancer because of their high prostatic specific antigen (PSA) values and to have a sextant prostate needle biopsy was performed between January, 1996 and December, 2000, 88 patients (11.2%) were diagnosed as NIH category IV prostatitis (asymptomatic prostatitis). We observed all pathological specimens stained with Hematoxylin-Eosine, and classified them into subtypes according to the classification criteria for prostatitis defined by True et al. (1999). We also investigated the relationship between histopathological distribution and clinical features such as PSA values, PSA density, the incidence of pyuria or bacteriuria. In the histopathological study, grade distributions were 12.5% (11/88) in mild, 71.6% (63/88) in moderate, and 15.9% (14/88) in severe. Location distributions were 2.3% (2/88) in glandular, 68.2% (60/88) in periglandular, and 29.5% (26/88) in stromal. No relationship between these subtypes and clinical features was recognized statistically. However, 7 patients (7.95%) were diagnosed as prostate cancers, later. Pyuria was found in 29.1% (23/79). Bacteriuria was present in 14.3% (11/77). Isolated bacteria were 4 strains of Enterococcus faccalis, 2 strains of each of Pseudomonas aeruginosa and Staphylococcus aureus, and one strain of each of Escherichia coli, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter aerogenes, Staphylococcus haemolyticus, and Staphylococcus epidermidis. Gram positive rod, and Candida sp. No relationship between these subtypes and bacterial species was recognized. These results indicated that the incidence of NIII category IV prostatits was not low without correlation to any clinical features. However, we should pay attention to the presence of prostate cancer, because a small number of the patients were diagnosed as prostate cancer, later.     

Prostate cancer and chronic prostatitis

Prostate cancer and chronic prostatitis are prevalent disorders in men. The cause of prostate cancer and chronic prostatitis is multifocal and diverse. Both disorders exhibit characteristic elevation of serum prostate-specific antigen, currently the primary screening test for prostate cancer. Prostate inflammation, regardless of cause, is the histopathologic hallmark of chronic prostatitis. In general, inflammation is associated with multiple cancers, and prostate inflammation, in particular, is a suggested factor in the development and progression of prostate cancer. This review addresses the link between chronic prostatitis and prostate cancer, especially as it relates to clinical practice.     

不同认知水平的广泛性脑萎缩患者磁共振波谱分析

目的 观察不同认知水平的广泛性脑萎缩患者脑内生化物质含量的差异. 方法 按照美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)和认知功能障碍的诊断标准将33名广泛性脑萎缩患者分为阿尔茨海默病(AD)组14例、遗忘型轻度认知功能损害(aMCI)组9例和认知功能正常组10例.所有研究对象接受神经心理量表检测,然后采用1.5-T MR系统对左侧额叶皮质和左侧海马进行氢质子磁共振波谱(1H-MRS)检测分析. 结果 广泛性脑萎缩AD组的左侧海马和左侧额叶皮层的N-乙酰天门冬氨酸(NAA)/肌酸(Cr)值较认知正常组分别降低10.2%和5.3%.胆碱复合物(Cho)/Cr值分别升高17.5%和16.7%,肌醇(MI)/Cr值分别升高39.5%和19.2%.与aMCI组比较,广泛性脑萎缩AD组的左侧海马NAA/Cr值降低6.4%,左侧海马和左侧额叶皮层的Cho/Cr值分别升高9.3%和12.3%,左侧海马和左侧额叶皮层的MI/Cr值分别升高30%和17%,而左侧额叶皮层的NAA/Cr值在两者间差异无统计学意义.广泛性脑萎缩aMCI组的左侧海马NAA/Cr值比正常组降低4.1%、Cho/Cr值比认知正常组升高7.5%,但是左侧额叶皮层的生化改变在两组间差异均无统计学意义. 结论 不同认知水平的广泛性脑萎缩患者存在脑内神经生化物质的变化.左侧海马NAA/Cr值的降低、左侧海马和左侧额叶皮质Cho/Cr和MI/Cr值的升高有助于预测aMCI进展为AD;左侧海马NAA/Cr降低和Cho/Cr升高有助于鉴别广泛性脑萎缩伴aMCI患者与广泛性脑萎缩认知功能正常的患者.     

The role of serum testosterone to prostate-specific antigen ratio as a predictor of prostate cancer risk

We analyzed the ratio of serum total testosterone (sTT) to prostate-specific antigen (PSA) as a predictor of prostate cancer risk. One-hundred-four consecutive men with a normal digital rectal examination and a serum PSA level of 2.5–10 ng/ml underwent transrectal ultrasonography-guided biopsy using a 10-core scheme. The sTT level was determined before the procedure using a chemiluminescent assay, and the ratio of sTT to PSA (sTT/PSA) was calculated after transforming sTT measurements from ng/dL to ng/mL. The overall cancer detection rate was 17.3%. The median sTT level was 332 ng/dl in men with cancer and 413 ng/dL in those without (p = 0.032). The median sTT/PSA ratio in these groups was 0.55 and 0.74, respectively (p = 0.035). The receiver operator characteristic (ROC) method was used to evaluate the properties of the sTT/PSA ratio, with testosterone and PSA as predictors of prostate cancer risk. The accuracy of the sTT/PSA ratio in prostate cancer diagnosis, represented by the area under the curve (AUC), was 0.739 (95% CI 0.640–0.823, p < 0.05). Optimizing the sensitivity and specificity of the sTT/PSA ratio using the ROC provided a cutoff point of 0.60, which corresponded to 82% sensitivity and 62% specificity. When the patients were divided into normal- and low-sTT level groups according to testosterone value (300 ng/dl), the probability of detecting prostate cancer was 3.3-fold higher in hypogonadal men as compared with eugonadal men. These results support the use of the sTT-to-PSA ratio for predicting the risk of prostate cancer and increasing the specificity of PSA measurement.     

核磁共振动态增强扫描在前列腺癌诊断及鉴别诊断中的应用价值

目的 通过绘制时间信号强度曲线，探讨磁共振成像(MRI)快速序列动态增强在前列腺癌诊断及鉴别诊断中的价值。方法 对6例无泌尿系症状健康对照者、13例经病理证实的前列腺癌及32例前列腺增生患者行MR动态增强及延迟扫描，测量并计算病灶和正常组织的相对信号强度值，并绘制正常周围带、前列腺癌及增生的时间信号强度曲线。结果 正常周围带轻度强化，并缓慢上升至晚期(300s)达峰值(信号强度0．94～1．02)；32例前列腺增生患者于60s明显强化(信号强度1．11～1．29)并逐渐上升至240s时达峰值(信号强度1．50～1．68)后缓慢下降；13例前列腺癌患者中9例于60s时明显强化(信号强度1．30～1．j1)，并快速下降，4例T2WI影像上弥漫性病灶240～300s时明显强化。结论 正常周围带、前列腺癌及前列腺增生的动态强化方式明显不同，应用MR动态增强扫描对前列腺癌的诊断与鉴别诊断有较大的价值。     

Impacts of antibiotic and anti-inflammatory therapy on serum prostate specific antigen in asymptomatic men: our experience

Introduction. The management of "grey zone" elevated Prostate Specific Antigen (PSA) is uncertain. After prostate cancer, benign prostatic hyperplasia and prostatitis may induce PSA increase. PSA reduction, after medical therapy, might identify those patients in whom biopsy can be avoided. The aim of this study was to determine if antibiotic and anti-inflammatory allow avoiding prostate biopsies in patients showing PSA decrease or normalization after medical therapy. Materials and Methods. Between January 2009 and May 2011, a total of 31 men with total PSA between 4 and 10 ng/ml were enrolled in this study. Patients with pathological digital rectal examination and clinical symptoms of prostatitis or lower urinary tract infection were excluded from the study. Total PSA, free PSA and free/total PSA were evaluated for all of them. Patients received 1000 mg ciprofloxacin daily for 15 days in combination with 100 mg ketoprofen administered rectally. PSA determinations were repeated two weeks after treatment. SPSS for Windows (version 10.0.7) computer package was used for statistical analysis of the data; a p value <0.05 was considered as level of statistical significance. Results. 19 patients (61%) showed a reduction of PSA level after therapy. Initial total PSA and free-PSA levels were 7.41 and 1.24 ng/ml, respectively. After medical therapy total and free PSA decreased to 5.72 and 1.19 ng/ml. Free/total PSA changed from 15.2% to 14.3%. PSA reached a normal range value in 5 patients (16%), while in 26 patients it was persistently >4 ng/ml, it decreased in 14 patients (45%), and increased in 12 (39%). Patients with PSA up to 4 ng/ml reported a prostatic cancer in 28.5% and 41.6% of cases if PSA was respectively decreased or increased from the initial value. Conclusions. A combination of antibiotic and anti-inflammatory therapy seems to be a useful way to avoid unnecessary biopsies in patients with PSA range from 4 to 10 ng/ml.