经直肠剪切波超声弹性成像模式联合弹性模量在前列腺癌诊断中的应用价值

目的 探索经直肠剪切波超声弹性成像中弹性模式与弹性模量联合应用在前列腺癌诊断方面的应用价值,建立一种新的前列腺经直肠剪切波超声弹性成像评估方法。方法 回顾性分析79例经手术或超声引导下穿刺活检病理证实的前列腺癌(n=41)及良性前列腺增生(BPH)(n=38)患者的经直肠常规超声图像特征和剪切波弹性图像特征(包括弹性成像模式特征和弹性模量值),与病理结果对照,评价上述超声特征对前列腺癌的诊断价值。结果 常规超声≥3个恶性特征(χ ²=42.5,P<0.001)和弹性图像整体不对称性(χ ²=54.2,P<0.001)在前列腺癌组和BPH组的分布差异均有统计学意义。前列腺癌组的弹性模量Emean和Emax分别为(92.8±21.5)和(114.2±29.8)kPa,均明显高于BPH组的(56.7±14.0)kPa(t=-8.8,P<0.001)和(68.4±17.2)kPa(t=-8.3,P<0.001)。Logistic回归受试者工作特征曲线结果显示,弹性模式联合弹性模量诊断前列腺癌的曲线下面积最大,诊断效能最高,联合诊断预测概率的Cutoff值为0.45,联合诊断的敏感性为95.1%、特异性为89.5%、阳性预测值为90.7%、阴性预测值为94.4%、准确性为92.4%。结论 剪切波弹性模式与弹性模量联合应用相比于单独应用弹性模量对前列腺癌具有更高的诊断价值。

Application Value of Transrectal Shear Wave Elastography Mode Combined with Elastic Modulus in the Diagnosis of Prostate Cancer

Objective To explore the value of trans-rectal shear wave elastic mode combined with elastic modulus in the diagnosis of prostate cancer and establish a new method for the evaluation of prostate with trans-rectal shear wave elastography(SWE). Methods The typical findings of trans-rectal ultrasound(US)and SWE in 79 patients with prostate cancer(n=41)and benign prostatic hyperplasia(BPH)(n=38)confirmed by surgery or US-guided biopsy were analyzed retrospectively.Their diagnostic value were evaluated with the pathological results as the golden standards. Results Three or more malignant features detected by conventional trans-rectal US(χ ²=42.5,P<0.001)and asymmetrical SWE mode(χ ²=54.2,P<0.001)showed statistically significant difference in prostate cancer and BPH groups.The elastic modulus of Emean and Emax in the prostate cancer group were(92.8±21.5)and(114.2±29.8)kPa,which were significantly higher than those in the BPH group (56.7±14.0)(t=-8.8,P<0.001)and(68.4±17.2)kPa(t=-8.3,P<0.001)].The receiver-operating characteristic(ROC)curve with Logistic regression showed that the elastic model combined elastic modulus had the largest area under ROC curve and the highest diagnosis efficiency of prostate cancer,with the cutoff value of 0.45.The diagnosis sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of the combination were 95.1%,89.5%,90.7%,94.4%,and 92.4%,respectively. Conclusion Combination of SWE mode and elastic modulus is more valuable than elastic modulus alone in the diagnosis of prostate cancer.