前列腺癌的磁共振DWI诊断价值

目的：分析前列腺癌（PCa）和良性前列腺增生（BPH）的MR扩散加权成像（DWI）和表观扩散系数（ADC）图的表现及其ADC值的差异,探讨DWI在PCa诊断中的价值。方法：对27例PCa,38例BPH进行MR扩散加权成像,分析DWI和ADC图表现,测量PCa区域、BPH的中央腺体区增生结节及外周带的ADC值。结果：PCa在DWI图上表现为高信号,ADC图上表现为低信号;BPH在DWI和ADC图上外周带信号较均匀,中央腺体信号欠均匀。前列腺癌Ca灶及中央腺体非癌灶区平均ADC值分别为（1.091±0.214）×10-3mm2/s和（1.497±0.318）×10-3mm2/s;前列腺增生外周带及中央腺体区增生结节的平均ADC值分别为（1.839±0.190）×10-3mm2/s和（1.509±0.225）×10-3mm2/s。PCa灶的ADC值明显低于BPH外周带及中央腺体区增生结节（P〈0.05）,其间ADC值差异具有显著性意义。结论：MR扩散加权成像对PCa有重要的诊断价值,在常规MRI形态学的基础上,结合DWI图上病变的信号特点及ADC值提供的病理变化信息,能提高对PCa的定性诊断,提高诊断准确率。     

MR扩散加权成像在前列腺病变中的诊断价值

目的：探讨DWI在前列腺病变诊断中的价值。方法：分别对30例前列腺癌（PCa）、30例良性前列腺增生（BPH）患者和30名健康志愿者进行前列腺DWI扫描,分析三者的DWI图、ADC图的信号表现,以及癌灶、增生结节灶、正常前列腺的ADC值,以及前两者病灶ADC值与其周围正常外周带ADC值的相对比值变化规律。所有BPH和PCa病例均经手术或穿刺活检病理证实。结果：①PCa、BPH患者和健康志愿者（各30例）DWI表现：PCa表现为高信号影为主;增生结节呈稍高信号为主,强度低于外周带,并且信号不均匀;健康志愿者外周带呈稍高信号为主,中央带呈等信号为主,外周带信号高于中央带,二者分界清晰;②PCa癌灶平均ADC值（0.878±0.056）×10^-3mm^2/s;BPH增生结节灶平均ADC值（1.379±0.201）×10^-3mm^2/s;健康者前列腺中央带平均ADC值（1.287±0.041）×10^-3mm^2/s;健康者前列腺外周带平均ADC值（1.636±0.064）×10^-3mm^2/s;③PCa癌灶、BPH增生结节灶（各30例）的平均ADC值与其周围正常外周带ADC值的相对比值平均分别为0.54±0.05,0.85±0.06。结论：正常前列腺外周带、BPH、正常前列腺中央带、PCa在DWI图像上信号有较大差别,PCa癌灶信号最高。正常前列腺外周带、BPH、正常前列腺中央带、PCa癌灶的ADC值依次下降。BPH、PCa癌灶ADC值与其周围正常外周带组织ADC值的相对比值有明显差别。ADC值≤0.97×10^-3mm^2/s,特别是同时ADC相对比值≤0.62,是PCa DWI诊断的可靠依据,有临床诊断意义。     

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。     

体素内不相干运动对前列腺癌和前列腺增生结节的鉴别诊断

目的:分析前列腺癌(PCa)和前列腺增生(BPH)的体素内不相干运动(IVIM)参数,旨在评价IVIM对PCa和BPH的鉴别诊断价值.方法:回顾性分析72例经病理证实PCa(n=32)和BPH(n=40)患者的3.0T MR图像,扫描序列包括常规T2 WI、DWI、LAVA平扫及动态增强和IVIM.IVIM成像,扫描采用EPI-STIR序列,b值=0、20、50、100、200、400、600、800、1000和1200 s/mm2.利用GE Functool 4.5工作站的MADC软件,测量PCa和BPH组的标准ADC、慢ADC、快ADC和快ADC分数值,PCa和BPH组的各参数比较采用独立样本t检验.采用受试者工作曲线(ROC)分析标准ADC值、慢ADC值对PCa和BPH的鉴别效能,获得相应曲线下面积(AUC)、诊断PCa的阈值以及相应灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)和准确度.结果:PCa的标准ADC值和慢ADC值分别为(6.21±2.35)×10-4和(7.11±2.49)×10-4 mm2/s,BPH的标准ADC值和慢ADC值分别为(11.11±2.62)×10-4和(12.65±1.81)×10-4mm2/s,PCa者明显低于BPH者,二者之间的差异具有统计学意义.PCa和BPH的快ADC值和快ADC值分数之间的差异无统计学意义.标准ADC值、慢ADC值AUC分别为0.912和0.947.以8.325×10-4mm2/s作为标准ADC值的阈值,其诊断PCa的敏感度为78.13％,特异度为97.50％,PPV为96.15％oo,NPV为84.78％,准确率为88.89％.以10.03×10-4mm2/s作为慢ADC值的阈值,其诊断PCa的敏感度为87.50％,特异度为95.00％,PPV为93.33％,NPV为90.48％,准确率为91.67％.结论:IVIM的定量参数标准ADC和慢ADC值对PCa和BPH鉴别诊断效能好,可作为前列腺增生基础上PCa检出良好的指标.     

前列腺癌的MR扩散成像初步研究

目的初步评价MR扩散成像(DWI)对前列腺癌的诊断可行性。方法28例前列腺癌患者及20例前列腺正常的对照组受试者行MR DWI检查,使用回波平面扩散张量成像序列,b值为1000s/mm2。测量正常前列腺外周带及前列腺癌区域的表观扩散系数(ADC)值。同时测量每位受检者膀胱区域的ADC值。结果48例中44例(91.7%)获得前列腺外周带和膀胱的ADC值。24例前列腺癌灶的ADC值为(0.35±0.06)×10-3mm2/s,20例正常前列腺外周带的ADC值为(1·35±0.30)×10-3mm2/s,前列腺癌灶较正常前列腺外周带ADC值低(t=11.99,P=0.00)。前列腺癌患者膀胱的ADC值为(1.27±0.21)×10-3mm2/s,对照组膀胱ADC值为(1.29±0.30)×10-3mm2/s,2组之间差异无统计学意义(t=1.15,P=0.48)。结论MR DWI可用于前列腺的检查。前列腺癌灶与正常前列腺外周带ADC值的差别有可能用于前列腺癌的鉴别诊断。     

DWI在散发性脑炎与急性脑梗死鉴别诊断价值

目的　探讨磁共振弥散加权成像在散发性脑炎与急性脑梗死的鉴别诊断中的应用价值。方法　回顾性分析 23例经临床诊断的散发性脑炎,包括 14例病毒性脑炎和 9例脱髓鞘性脑炎的磁共振弥散加权表现,并与 30例急性脑梗死进行比较。结果　病毒性脑炎和脱髓鞘性脑炎病灶表现局灶性或大片异常信号,T1WI呈稍低信号,T2WI及FLAIR呈高信号。除 1例超急性脑梗死未能显示梗死灶外, 29例脑梗死病灶T1WI呈稍低信号,T2WI及FLAIR呈高信号。脑炎与梗死病灶在DWI均呈稍高或高信号。ADC值测量, 30例梗死灶ADC值为(0. 46±0. 13)×10-3 mm2 /s。7例病毒性脑炎和 9例脱髓鞘性脑炎ADC值分别为(0. 98±0. 18)×10-3 mm2 /s和(0. 89±0. 07)×10-3 mm2 /s,病毒性脑炎与脱髓鞘性脑炎病灶ADC值差异无统计学意义 (Ρ>0. 05),但明显高于脑梗死(Ρ<0. 01)和镜面对侧正常区(Ρ<0. 05)。有 4例病毒性脑炎病灶在不同区域弥散增加和受限并存,ADC值表现高低不一,最高者达 0. 96×10-3 mm2 /s,最低者达 0. 31×10-3 mm2 /s;另有 3例全部病灶ADC值表现降低,分别为 0. 44×10-3 mm2 /s、0. 51×10-3 mm2 /s和 0. 58×10-3 mm2 /s。结论　磁共振弥散加权成像对脑炎与急性脑梗死鉴别诊断具有重要临床价值。     

颅内表皮样囊肿ADC值的测量

目的分析颅内表皮样囊肿(ECs)的DWI特征,评价“T2shine-through”效应。方法手术病理证实15例ECs,其中3例术后复查残留。测量ECs、深部脑白质、脑脊液(CSF)的表观弥散系数(ADC)值;比较DWI与FLAIR对病灶的显示。结果(1)15例病灶DWI均呈高信号,ADC值(0.80~1.23)×10-3mm2/s,平均(1.05±0.14)×10-3mm2/s;深部脑白质ADC值(0.74~1.09)×10-3mm2/s,平均(0.88±0.09)×10-3mm2/s;CSF的ADC值(2.98~3.78)×10-3mm2/s,平均(3.31±0.21)×10-3mm2/s;ECs的ADC值低于CSF(P<0.001),高于脑白质(P=0.005),与脑灰质近似。(2)15例病人中,在FLAIR上6例病灶轮廓清楚,DWI上12例病灶轮廓清楚,对病灶轮廓勾画存在显著性差异,P=0.025(χ2值5.00)。(3)5例复查病人中,2例DWI上没有显示高信号病灶,3例病变区小的高信号病灶。结论颅内表皮样囊肿ADC值降低不明显,与DWI高信号不匹配,是由于增强T2效应。DWI能最好的显示病灶,对小病灶检测、术后评估优于其它成像序列。     

ADC联合DWI鉴别中枢神经细胞瘤与室管膜瘤的诊断价值

【摘要】目的：利用磁共振成像ADC值的测定,联合DWI磁共振成像探讨中枢神经细胞瘤与室管膜瘤的鉴别诊断。方法：回顾性分析本院经手术及病理检查证实的发生于侧脑室内,15例中枢神经细胞瘤和15例室管膜瘤患者常规MRI平扫、增强、DWI信号强度,并测量肿瘤实质病变的平均ADC值,观察比较两组肿瘤的DWI信号强度和ADC值,运用ROC曲线评价ADC值的诊断价值,统计学分析采用两样本t检验。结果：15例中枢神经细胞瘤DWI上均呈高或稍高信号,ADC 均值( 0．69±0.11)×10-3mm2/s;15例室管膜瘤DWI上12例呈等或稍高信号,3例呈低信号,ADC均值(1.10±0.24)×10-3mm2/s,两组肿瘤的平均ADC值比较具有统计学意义(P＜0.01)。ADC值诊断中枢神经细胞瘤的灵敏度为100%,特异度为92.9%。结论：磁共振成像ADC值的测定辅助DWI信号强度有利于提高中枢神经细胞瘤和室管膜瘤的术前诊断及鉴别诊断。     

前列腺良恶性疾病MR表观扩散系数与细胞增殖的相关性研究

目的 通过表观扩散系数(ADC)与细胞密度、增殖细胞核抗原(PCNA)表达相关性分析,探讨扩散加权成像(DWI)评价良性前列腺增生(benign prostate hyperplasia,BPH)、前列腺癌(prostate cancer,PCa)细胞增殖状态的价值. 资料与方法 71例行DWI检查的前列腺疾病患者,其中PCa 38例,BPH 33例.根据常规HE染色和免疫组织化学记录PCa细胞密度及PCNA表达情况.对ADC值与细胞密度及PCNA表达水平进行相关性分析. 结果 PCa、BPH和正常外周带的平均ADC值分别为(49.32±12.68)×10-5 mm2/s、(86.73±26.75)×10-5 mm2/s和(126.25±27.21)×10-5 mm2/s,差异有统计学意义(P＜0.05).PCa的细胞密度及PCNA表达平均值分别为12.9%和72.1%,高于BPH的细胞密度(8.6%)及PCNA表达(55.7%)(P＜0.05).PCa的ADC值与细胞密度及PCNA表达存在负相关性(r=-0.646、-0.446,P＜0.05). 结论 细胞密度是影响ADC值的重要因素,ADC值能对PCa细胞增殖状态进行评估.     

DTI在鉴别前列腺癌与前列腺增生中的价值

目的探讨扩散张量成像(DTI)在鉴别前列腺癌(PCa)与前列腺增生(BPH)中的价值。方法对疑似PCa或BPH的患者行常规磁共振检查及DTI检查,测量感兴趣区部分各向异性值(FA)及平均表观弥散系数值(ADC)并绘制DTI参数图及纤维示踪图。比较PCa与BPH组间FA值与ADC值的差别,并绘制ROC曲线,确定FA值及ADC值曲线下面积。结果 PCa与BPH的FA值分别为(0.36±0.05,0.28±0.06),两者差异有统计学意义(P<0.05),受试者工作特征曲线(ROC)下面积为0.82。PCa与BPH的ADC值分别为(1.10±0.27)×10-3 mm2/s,(1.55±0.32)×10-3mm2/s,两者差异有统计学意义(P<0.05),ROC曲线下面积为0.85。结论 DTI能够反映PCa与BPH微观结构的不同,对鉴别PCa与BPH有一定的价值。     

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