前列腺癌和前列腺增生3DMRS的对比研究

目的：分析前列腺癌（PCa）的磁共振波谱成像（MR spectroscopy，MRS）代谢特征，探讨MRS在PCa诊断中的价值。材料与方法：分析经手术或穿刺活检证实的28例PCa和36例前列腺增生（BPH）患者的临床资料及MRI、MRS所见。MRI分析前列腺的大小、形态、病变位置、信号特点和肿瘤侵犯程度等。MRS测量枸橼酸盐（Cit）、胆碱（Cho）、肌酸（Cr）的峰值、（胆碱＋肌酸）／63橼酸盐（Cho＋Cr）／Cit]的比值。结果：PCa中有22例在BWI像上有明显的PCa征象，其中18例侵犯精囊，14例侵犯膀胱，13例侵犯盆腔周围骨组织，5例侵犯直肠，5例盆腔内见多个肿大淋巴结并部分相互融合成团；余6例未见明显的PCa征象。MRS上将前列腺分成6个区，在MRS代谢图上标记出癌点归入相应分区。每例取4个体素（癌点或MRI上疑点），64例中一共取256个体素进行测量，PCaCit峰值均明显下降，Cho峰值均升高，标记出手术或穿刺活检取材癌区的（Cho＋Cr）／Cit平均值为2．3612±1．91178，增生的波谱形态和癌相反，（Cho＋Cr）／Cit平均值为0．6290±0．59067，两组间差异有统计学意义（t=-4．626，P=0．000〈0．05）。结论：MRI能对PCa定位，了解侵犯部位及转移情况。MRS能根据MRI提示的病变及可疑部位进行定量分析、显示其代谢情况。MRS在MRI形态的基础上能提高对肿瘤的定性诊断，具有重要的诊断价值。

Study of 3D-magnetic resonance spectroscopy imaging in prostate cancer and benign prostate hyperplasia

Objective： To describe MR spectroscopy （MRS） of prostate cancer （PCa）, to evaluate MRS in the diagnosis of PCa. Materials and Methods： Clinical data together with MRI and MRS findings were reviewed in 28 cases with pathologically confirmed PCa and 36 cases of benign prostate hyperplasia. MRI observation was focused on the size of the gland, the location of the lesion, the signal features and the extent of the tumor. MRS observation included the chemical shift of citrate （Cit）, choline（Cho） and creatine（Cr） spectra, and the ratio of （Cho＋Cr）/Cit. Results： On MRI, 22 cases have apparent sign of PCa, in these the affected structures included seminal vesicle （n=18）, bladder （n=14）, bone of pelvis （n=13）, rectum （n=5）and pelvic lymph nodes fused into a mass （n=5）. While apparent sign of PCa was not found in 6 cases. On MRS, prostate was di- vided into six regions and marked the cancer focus into the relative region point on MRS. Six cancer points abstracted from every case, in all of the 64 cases 256 points were selected, Cit peak was obviously declined and Cho peak was high in PCa. The average ratio of （Cho＋Cr）/Cit for PCa was 2.3612±1.91178, for benign prostate hyperplasia was 0.6290±0.59067. Condusion： MRI can display localization of tumor and the detection of extracapsular spread of the disease. MRS can provide the metabolic information the area of PCa and the suspected prostate parenchyma.