经直肠超声联合超声造影在前列腺低回声病灶诊断中的应用价值

目的:探讨经直肠超声(transrectal ultrasound, TRUS)联合超声造影(contrast-enhanced ultrasound, CEUS)对前列腺低回声病灶良恶性诊断的应用价值。方法:队列研究分析131例患者共167个前列腺原发低回声病灶的TRUS及CEUS声像图特征，依据穿刺病理结果分为前列腺癌(prostate cancer, PCa)组和非PCa组。对各超声特征参数进行单因素及多因素Logistic回归分析，筛选出与低回声病灶良恶性相关的独立预测因子，建立Logistic回归预测模型，绘制受试者工作特征曲线(receiver operating characteristic curve, ROC)比较各单一超声特征参数及联合预测模型对前列腺低回声病灶的诊断效能。结果:前列腺低回声病灶分类情况、血流分级、阻力指数(resist index, RI)、造影模式、强化程度、强化均匀性在两组间差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示“污渍”样低回声、“快进快出”与“快出非快进”的造影模式、高增强是预测低回声病灶恶性诊断的独...

Application value of transrectal ultrasound combined with contrast-enhanced ultrasound in the diagnosis of prostate hypoechoic lesions

Objective:To investigate the value of transrectal ultrasound（TRUS) combined with contrast-enhanced ultrasound（CEUS) in the diagnosis of benign and malignant prostate hypoechoic lesions.Methods:A cohort study was conducted to analyze the transrectal ultrasound and contrast-enhanced ultrasound sonographic features of 167 primary prostate hypoechoic lesions in 131 patients.According to the pathological results，the patients were divided into prostate cancer（PCa) group and non-PCa group.Single and multiple Logistic regression analysis were performed on each ultrasonic characteristic parameter to screen out independent predictors related to the benign and malignant of hypoechoic lesions.Logistic regression prediction model was established，and receiver operating characteristic curve（ROC） was drawn to compare the diagnostic efficacy of each single ultrasonic characteristic parameter and combined prediction model for hypoechoic lesions of prostate.Results:There were significant differences in the classification of prostate hypoechoic lesions，blood flow classification，resist index(RI)，contrast mode，enhancement degree and enhancement uniformity between the two groups（P<0.05）.Multiple Logistic regression analysis showed that "stain" like low echo，"fast in fast out" and "fast out non-fast in" contrast mode，high enhancement were independent predictors of malignant diagnosis of low echo lesions.The area under the curve（AUC） of the three was 0.686,0.741 and 0.807，respectively（P<0.05）.The AUC of the combined prediction model was 0.922.The sensitivity was 76.83%，the specificity was 94.12%，the positive predictive value was 92.60%，and the negative predictive value was 80.80%.Compared with the single diagnosis of the first three，the diagnostic efficiency of the prediction model was the highest.Kappa consistency test results showed that the prediction model was highly consistent with postoperative pathological diagnosis（Kappa value=0.676，P<0.001）.Conclusion:TRUS combined with CEUS has a high diagnostic value in the diagnosis of benign and malignant prostate hypoechoic lesions.