经直肠超声联合弹性成像与超声造影在早期前列腺癌诊断的应用价值

目的 探讨经直肠实时组织超声弹性成像及经直肠前列腺超声造影检查技术在前列腺癌早期诊断的应用价值。方法 对119例可疑前列腺癌患者行经直肠超声成像、经直肠实时组织超声弹性成像及经直肠前列腺超声造影检查，按照经直肠超声引导下穿刺活检的病理Gleason 评分结果分为低危组（≤6分，n=21）、中危组（7分，n=24）、高危组（≥8分，n=28）、良性前列腺增生组（n=46）。分析对比各项超声技术在不同Gleason评分前列腺癌的诊断价值。结果 经直肠超声成像联合经直肠实时组织超声弹性成像及经直肠超声成像联合经直肠前列腺超声造影的诊断符合率在前列腺癌低危组与前列腺增生组之间差异无统计学意义，在前列腺癌中危组、高危组与前列腺增生组组间差异有统计学意义（P<0.05），经直肠实时组织超声弹性成像联合经直肠前列腺超声造影诊断符合率在低危组、中危组、高危组与前列腺增生组组间均差异有统计学意义（P<0.05），经直肠超声成像诊断前列腺癌的敏感性、特异性、阴性预测值及阳性预测值分别为46.77%、58.18%、49.23%及55.77%，经直肠实时组织超声弹性成像的敏感性、特异性、阴性预测值及阳性预测值分别为66.13%、70.91%、65.00%及71.93%，经直肠前列腺超声造影的敏感性、特异性、阴性预测值及阳性预测值分别为80.64%、81.82%、78.95%及83.33%，经直肠前列腺超声造影联合经直肠实时组织超声弹性成像的敏感性、特异性、阴性预测值及阳性预测值分别为90.32%、85.45%、88.68%及87.50%，各检查方法比较差异均有统计学意义（P<0.05）。结论 经直肠实时组织超声弹性成像和经直肠前列腺超声造影技术均在前列腺癌早期诊断中有临床价值，二者联合在Gleason评分≤6分的前列腺癌早期诊断中亦有临床应用价值。

The clinical value of transrectal ultrasound elastography and the contrast enhanced ultrasonography in early diagnosis of prostate cancer

Objective  To evaluate the clinical value of transrectal real-time elastography（TRTE） and contrast-enhanced transrectal ultrasound（CETRUS） in early diagnosis of prostate cancer. Methods   From August 2016 to August 2017,119 patients with suspected prostate cancer were divided into low risk group (n=21) , moderate risk group (n=24) and high risk group (n=28) according to Gleason sores. The rest 46 patients were found with benign prostatic hyperplasia (BPH group) enrolled in this study. The transrectal ultrasound（TRUS），TRTE and CETRUS were performed for all patients. The accuracy rate of prostate cancer detection using TRUS，TRTE and CETRUS were compared with the pathologic results.Results   There was no statistical differences of accuracy rate between low risk group and BPH group with TRTE and CETRUS. There were statistical differences of accuracy rate between low risk group and BPH group with the combination TRTE and CETRUS. Totally 119 patients underwent TRUS, TRUS with TRTE、TRUS with CETRUS and TRTE with CETRUS. The sensitivity，specificity，positive predictive value，negative predictive value of TRUS，TRTE，CETRUS，TRTE and CETRUS in diagnosis of prostate cancer was 46.77%, 58.18% ,49.23%,55.77%，66.13％,70.91％,65.00％,71.93％，80.64% ,81.82% ,78.95%,83.33%，90.32%,85.45%,88.68%,87.50%, respectively. Conclusions  CETRUS combined With TRTE can detect early prostate cancer and contribute to differential diagnosis between benign and malignant lesions．