MRI和MRS对前列腺疾病的鉴别诊断价值

目的探讨MRI和MRS在前列腺疾病中的鉴别诊断价值。方法回顾分析经病理证实的22例患者的临床资料及MRI和MRS所见,其中包括前列腺良性增生(BPH)16例及前列腺癌(PC)6例。MRI观察前列腺大小、病变位置、信号特点和肿瘤侵犯程度,MRS观察枸橼酸盐(Cit)、胆碱复合物(Cho)和肌酸(Cr)的化学位移及(Cho Cr)/Cit比值。结果16例BPH中,前列腺弥漫性增大,T2W均示前列腺中央叶明显增大,其中13例表现为多个大小不等类圆形高和/或低信号结节,部分低信号结节周围可见低信号假包膜,外围带受压变窄。6例PC中5例均表现为T2W外周带中见低信号区,1例表现为中央叶前部较大低信号结节;2例位于包膜内,4例突破包膜侵犯精囊腺和血管神经束,其中1例伴有盆腔淋巴结肿大和骨盆骨转移。MRS上BPH患者Cit明显升高,Cho略升高,(Cho Cr)/Cit比值不高,平均0.60。PC患者,Cit明显下降,Cho明显升高,(Cho Cr)/Cit比值升高,平均2.51。分别对PC与BPH体素的2组代谢物比值进行比较,二者之间有显著的统计学差异(t=0.353,P<0.05)。结论MRI和MRS有助于PC和BPH的鉴别诊断。

The Value of MR Imaging and MRS in Differential Diagnosis of Prostate Diseases

Objective To evaluate the diagnostic value of MRI and MRS in the prostatic diseases.Methods Clinical data together with MRI and MRS findings were reviewed retrospectively in 16 cases with benign prostate hyperplasia(BPH) and 6 cases with prostate carcinoma(PC) which were confirmed with pathology.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 BPH appeared as irregular enlargement of the whole prostate gland.On T2WI,the central zones of the gland were marked enlargement,there were many different-size similar round low-signal or high-signal intensity nodular lesions in peripheral zones in 13 cases,some low-signal nodular with low-signal false capsules were found and the peripheral zone were compressed obviously.In 6 patients with PC,5 cases localized low-signal area in the periphery and 1 case localized low-signal area in the centre,the tumors localized within the prostate capsule in 2 cases,breakthrough the prostatic capsule in 4 cases with seminal vesicle and the neurovascular bundles involved,the lymph node in pelvis and the bone of pelvis were involved in 1 case.On MRS,Cit elevated obviously,Cho elevated slightly,(Cho Cr)/Cit ratio was not high,average 0.60 in BPH.In PC,Cit dropped obviously,Cho elevated obviously,(Cho Cr)/Cit ratio elevated,average 2.51.The metabolic ratios between the BPH and PC were of remarkable statistically difference(t=0.353,P<0.05).Conclusion MRI and MRS are helpful for differentiating diagnosis of PC and BPH.