前列腺癌骨及精囊转移的MRI诊断研究
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摘要
目的:研究前列腺癌骨及精囊转移的MRI诊断价值,为临床精准诊断提供参考。方法:收集我院2015年12月~2017年12月收治的136例前列腺癌患者。穿刺活检前行MRI前列腺及周围组织、盆腔、脊柱扫描诊断,最后行前列腺系统性穿刺活检。以病理诊断为金标准,对比MRI扫描诊断前列腺癌骨及精囊转移的特异性、准确性及灵敏度。结果:136例前列腺癌患者病理诊断共发生34例(25.0%)转移,其中精囊转移16例(10.3%),骨转移20例(14.7%)。MRI诊断共发生42例(30.9%)转移,其中精囊转移20例(14.7%),骨转移22例(16.2%)。MRI诊断前列腺癌精囊及骨转移的特异度为95.7%,灵敏度为76.2%,准确度为89.7%。结论:与病理活检相比,MRI诊断前列腺癌患者精囊转移及骨转移特异度及准确度均较高,但灵敏度有所欠缺。
Objective:To study the value of MRI in the diagnosis of bone and seminal vesicle metastasis of prostate cancer,and to provide reference for clinical diagnosis.Methods:136 cases of prostate cancer treated in our hospital between December 2015 December 2017 were collected.MRI prostate and peripheral tissue,pelvic and spinal scan were performed before the puncture biopsy,and systematic biopsy of the prostate was performed at the end.The specificity,accuracy and sensitivity of MRI scan in the diagnosis of bone and seminal vesicle metastasis of prostate cancer were compared with the pathological diagnosis as gold standard.Results:the pathological diagnosis of 136 cases of prostate cancer occurred in 34 cases(25%),including 16 cases of seminal vesicle metastasis(10.3%),and 20 cases of bone metastases(14.7%).A total of 42 cases of metastasis(30.9%)were diagnosed by MRI,of which 20 cases(14.7%)were metastases of seminal vesicle and 22 cases of bone metastases(16.2%).The specificity of MRI for the diagnosis of prostate cancer seminal vesicle and bone metastases was 95.7%,the sensitivity was 76.2%,and the accuracy was 89.7%.Conclusion:compared with pathological biopsy,MRI has high specificity and accuracy in diagnosing seminal vesicle metastasis and bone metastasis in patients with prostate cancer,but the sensitivity is deficient.It is worth promoting in clinic.
Objective:To study the value of MRI in the diagnosis of bone and seminal vesicle metastasis of prostate cancer,and to provide reference for clinical diagnosis.Methods:136 cases of prostate cancer treated in our hospital between December 2015 December 2017 were collected.MRI prostate and peripheral tissue,pelvic and spinal scan were performed before the puncture biopsy,and systematic biopsy of the prostate was performed at the end.The specificity,accuracy and sensitivity of MRI scan in the diagnosis of bone and seminal vesicle metastasis of prostate cancer were compared with the pathological diagnosis as gold standard.Results:the pathological diagnosis of 136 cases of prostate cancer occurred in 34 cases(25%),including 16 cases of seminal vesicle metastasis(10.3%),and 20 cases of bone metastases(14.7%).A total of 42 cases of metastasis(30.9%)were diagnosed by MRI,of which 20 cases(14.7%)were metastases of seminal vesicle and 22 cases of bone metastases(16.2%).The specificity of MRI for the diagnosis of prostate cancer seminal vesicle and bone metastases was 95.7%,the sensitivity was 76.2%,and the accuracy was 89.7%.Conclusion:compared with pathological biopsy,MRI has high specificity and accuracy in diagnosing seminal vesicle metastasis and bone metastasis in patients with prostate cancer,but the sensitivity is deficient.It is worth promoting in clinic.
引文
1黄盛松,吴旻,赵鑫,等.前列腺癌睾丸转移二例报告[J].中华泌尿外科杂志,2014,35(8):640.
2 熊焕腾,黄海鹏.前列腺癌侵犯精囊并广泛骨转移、睾丸转移1例报告[J].中国男科学杂志,2015,29(6):64-66.
3 陆忠玉,张建年,蒲魏林,等.前列腺癌经直肠超声和CT征象的敏感性分析[J].临床超声医学杂志,2010,12(11):754-756.
4 陈正君,刘勇,揭平平,等.前列腺癌的MRI表现[J].实用医学杂志,2013,29(3):434-436.
5 李艳丽,马婷,赵惠菊,等.前列腺癌的MRI、DWI及MRS的影像分析[J].中国伤残医学,2014,(15):196-197.
6 黄业成,戴李华,农秋益,等.MRI对前列腺癌及邻近受累结构的诊断价值[J].医学影像学杂志,2013,23(12):2000-2003.
7 张洪美,王燕,曹维,等.前列腺癌骨转移误诊为原发性骨质疏松三例[J].中华老年医学杂志,2013,32(3):345-346.
8 Henninger M,Maurer T,Hacker C,Eiber M.68Ga-PSMA PET/MR showing intense PSMA uptake in nodular fasciitis mimicking prostate cancer metastasis[J].Clin Nucl Med.2016,41 (10):e443-444.
9 李飞宇,王霄英,许玉峰,等.前列腺癌内分泌治疗后复发的MRI研究[J].实用放射学杂志,2006,22(5):569-573.
10 龙小武,庄伟雄,崔凌,等.前列腺癌的MR扩散加权成像及动态增强成像的诊断价值[J].中国现代医生,2013,51(15):114-116.
11 何军.下调前列腺干细胞抗原表达对人前列腺癌细胞PC-3M生长及侵袭转移的体内研究[D].广州医科大学,2015.DOI:10.7666/d.D714944.
12 Huang S,He P,Peng X,Li J,Xu D,Tang Y.Pristimerin inhibits prostate cancer bone metastasis by targeting pc-3stem cell characteristics and vegf-induced vasculogenesis of BM-EPCs[J].Cell Physiol Biochem,2015,37(1):253-268.
13 朱家伦,邓志勇,陈富坤,等.唑来膦酸联合89SrCl2治疗前列腺癌骨转移的临床疗效分析[J].世界临床医学,2015,(10):107-108.
14 段惠新.磁共振扩散加权成像在前列腺癌及前列腺良性增生中的应用[J].中外健康文摘,2014,(12):53-54.
15 胡丹青,刘军,杨爱平,等.荧光共振能量转移体系的均相免疫分析对前列腺癌诊断运用价值初探[J].中国性科学,2016,25(1):19-21.
16 McEvoy SH,Lavelle LP,Purcell YM,Quinlan DM,Skehan SJ,Collins CD,et al.Should abdominal sequences be included in prostate cancer MR staging studies?[J]Eur J Radiol,2015,84(6):1019-1022.
17 戴金华,廖于峰,冷江涌,等.前列腺癌患者血清miR-146a与miR-152的表达水平及临床意义[J].中国性科学,2016,25(4):7-10.
18 申小章.SPECT/CT骨显像对脊柱骨转移瘤的诊断价值[D].苏州大学,2014.
2 熊焕腾,黄海鹏.前列腺癌侵犯精囊并广泛骨转移、睾丸转移1例报告[J].中国男科学杂志,2015,29(6):64-66.
3 陆忠玉,张建年,蒲魏林,等.前列腺癌经直肠超声和CT征象的敏感性分析[J].临床超声医学杂志,2010,12(11):754-756.
4 陈正君,刘勇,揭平平,等.前列腺癌的MRI表现[J].实用医学杂志,2013,29(3):434-436.
5 李艳丽,马婷,赵惠菊,等.前列腺癌的MRI、DWI及MRS的影像分析[J].中国伤残医学,2014,(15):196-197.
6 黄业成,戴李华,农秋益,等.MRI对前列腺癌及邻近受累结构的诊断价值[J].医学影像学杂志,2013,23(12):2000-2003.
7 张洪美,王燕,曹维,等.前列腺癌骨转移误诊为原发性骨质疏松三例[J].中华老年医学杂志,2013,32(3):345-346.
8 Henninger M,Maurer T,Hacker C,Eiber M.68Ga-PSMA PET/MR showing intense PSMA uptake in nodular fasciitis mimicking prostate cancer metastasis[J].Clin Nucl Med.2016,41 (10):e443-444.
9 李飞宇,王霄英,许玉峰,等.前列腺癌内分泌治疗后复发的MRI研究[J].实用放射学杂志,2006,22(5):569-573.
10 龙小武,庄伟雄,崔凌,等.前列腺癌的MR扩散加权成像及动态增强成像的诊断价值[J].中国现代医生,2013,51(15):114-116.
11 何军.下调前列腺干细胞抗原表达对人前列腺癌细胞PC-3M生长及侵袭转移的体内研究[D].广州医科大学,2015.DOI:10.7666/d.D714944.
12 Huang S,He P,Peng X,Li J,Xu D,Tang Y.Pristimerin inhibits prostate cancer bone metastasis by targeting pc-3stem cell characteristics and vegf-induced vasculogenesis of BM-EPCs[J].Cell Physiol Biochem,2015,37(1):253-268.
13 朱家伦,邓志勇,陈富坤,等.唑来膦酸联合89SrCl2治疗前列腺癌骨转移的临床疗效分析[J].世界临床医学,2015,(10):107-108.
14 段惠新.磁共振扩散加权成像在前列腺癌及前列腺良性增生中的应用[J].中外健康文摘,2014,(12):53-54.
15 胡丹青,刘军,杨爱平,等.荧光共振能量转移体系的均相免疫分析对前列腺癌诊断运用价值初探[J].中国性科学,2016,25(1):19-21.
16 McEvoy SH,Lavelle LP,Purcell YM,Quinlan DM,Skehan SJ,Collins CD,et al.Should abdominal sequences be included in prostate cancer MR staging studies?[J]Eur J Radiol,2015,84(6):1019-1022.
17 戴金华,廖于峰,冷江涌,等.前列腺癌患者血清miR-146a与miR-152的表达水平及临床意义[J].中国性科学,2016,25(4):7-10.
18 申小章.SPECT/CT骨显像对脊柱骨转移瘤的诊断价值[D].苏州大学,2014.