| 摘要: |
| 目的 验证经会阴磁共振超声三维矩阵定位靶向穿刺技术对提高前列腺穿刺活检阳性率的价值。方法 选取第二军医大学长海医院泌尿外科2015年2月至6月行经会阴磁共振超声三维定位靶向前列腺穿刺活检+系统性前列腺穿刺活检的患者共15例。15例患者既往有至少1次阴性穿刺的病史，有行再次前列腺穿刺活检的指证，且穿刺前多参数磁共振检查提示有可疑发生前列腺癌的位点，前列腺影像报告和数据系统（PI-RADS）评分4~5分，根据磁共振图像对前列腺腺体中的可疑位点进行三维定位（X、Y、Z轴3个坐标）。全麻后，在经直肠超声引导下行系统性前列腺穿刺活检，后根据三维定位的坐标在经直肠超声图像中进行定位，并根据定位的位置行超声引导下的经会阴前列腺靶向穿刺活检。结果 15例患者中有14例确诊为前列腺癌（93.3%），单纯靶向穿刺活检阳性13例（86.7%），单纯系统性穿刺活检阳性6例（40.0%），系统性穿刺活检阳性而靶向穿刺活检阴性1例（6.7%），靶向穿刺活检阳性而系统性穿刺活检阴性8例（53.3%），系统性穿刺活检和靶向穿刺活检均为阴性1例（6.7%）。两种穿刺方法阳性率差异有统计学意义（P=0.002）。结论 经会阴磁共振超声三维定位靶向前列腺穿刺技术可以准确定位并靶向穿刺磁共振显示的可疑位点，对经直肠系统性穿刺活检易漏诊的位置具有较好的诊断效能，但其确切的效果仍需大样本的病例验证。 |
| 关键词: 前列腺靶向穿刺活检 前列腺肿瘤 三维定位 磁共振成像 超声检查 |
| DOI：10.16781/j.0258-879x.2016.11.1402 |
| 投稿时间：2016-03-24修订日期：2016-05-02 |
| 基金项目:上海市卫生和计划委员会基金（201540182），第二军医大学长海医院医疗新技术基金（NT201507）. |
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| Initial application of MRI and ultrasound three-dimensional matrix positioning technique for transperineal targeted prostate biopsy in patients with previous negative prostate biopsy |
| WANG Hai-feng,GAO Xu,WANG Yan,SHI Zhen-kai,MA Chun-fei,DONG Zhen-yang,ZHU Feng,SUN Ying-hao* |
(Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author.) |
| Abstract: |
| Objective To validate the value of MRI and ultrasound three-dimensional matrix positioning technique in transperineal targeted prostate biopsy so as to improve the positive rate of prostate biopsy. Methods A total of 15 patients received transperineal targeted prostate biopsy using MRI and ultrasound three-dimensional matrix positioning technique + traditional systemic prostate biopsy from Feb. 2015 to Jun. 2015 in Changhai Hospital, Second Military Medical University. The 15 patients met the following criteria:(1) at least one negative prostate biopsy; (2) had the indications for performing re-biopsy; and (3) MRI showed suspected sites of prostate cancer (the PI-RADS scores were 4-5). Before biopsy, all the MRI images were reconstructed and the three-dimensional coordinates(X, Y, Z axis) were confirmed. After general anesthesia, systemic prostate biopsy was performed under the guidance of transrectal ultrasound. Then the transrectal ultrasound-guided biopsy was carried out according to the location in previous MRI images, which were located by the three-dimensional coordinates (X, Y, Z axis). Results Fourteen (93.3%) of the 15 patients were finally confirmed with prostate cancer, with 13 (86.7%) being positive only in targeted biopsy, and 6 (40.0%) being positive only in systemic biopsy. There was only 1 (6.7%) whose targeted biopsy result was negative and systemic biopsy result was positive, and there were 8 cases (53.3%) with positive targeted biopsy but negative systemic biopsy. Only 1 case (6.7%) was negative in both targeted biopsy and systemic prostate biopsy. There was significant difference in positive rates between the targeted biopsy and systemic biopsy (P=0.002). Conclusion Transperineal targeted prostate biopsy with MRI and ultrasound three-dimensional matrix positioning technique can accurately locate and target puncture the suspected site of prostate cancer in MRI images, and it has a higher diagnostic efficiency especially for the sites which are relatively easy to be missed by systemic prostate biopsy, but its performance still needs further large sample studies. |
| Key words: prostate targeted biopsy prostatic neoplasms three dimensional localization magnetic resonance imaging ultrasonography |
