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目的探讨超声造影(CEUS)、磁共振增强(MRI增强)及其联合成像在不同前列腺特异性抗原(PSA)区间前列腺癌诊断中的临床应用价值。方法回顾性分析132例疑似前列腺癌患者,均行CEUS、MRI增强检查,并进一步经直肠前列腺穿刺活检术证实,结合病理结果比较分析2种诊断方法及其联合成像在前列腺癌诊断中的临床应用价值。结果 CEUS、MRI增强及二者联合应用对前列腺癌诊断的灵敏度分别为75.43%、80.70%、92.98%,特异度分别为77.33%、86.67%、73.33%,二者联合诊断的灵敏度高于CEUS、MRI增强诊断技术,差异均具有统计学意义(P<0.05),MRI增强诊断的特异度高于联合诊断,差异有统计学意义(P<0.05)。在4.0ng/mL≤PSA<10.0ng/mL范围内,CEUS、MRI增强及二者联合应用特异度分别为82.00%、96.00%、80.00%,MRI增强诊断特异度高于CEUS及二者联合应用,差异均有统计学意义(P<0.05)。在10.0ng/mL≤PSA<20.0ng/mL范围内,CEUS、MRI增强及二者联合应用对前列腺癌诊断的灵敏度分别为42.86%、52.38%、80.95%,特异度分别为73.68%、68.42%、63.16%,二者联合应用诊断的灵敏度高于CEUS、MRI增强诊断技术,差异均具有统计学意义(P<0.05)。在PSA≥20.0ng/mL中,3种方法均诊断正确。结论 CEUS与MRI增强对前列腺癌诊断各有优势,二者联合诊断可以提高灵敏度,优于单独一种诊断方法。同时MRI增强对前列腺癌诊断的特异度优于联合诊断方法。疑似前列腺癌患者4.0ng/mL≤PSA<10.0ng/mL,MRI增强具有较高的诊断特异性,有诊断优势;10.0ng/mL≤PSA<20.0ng/mL时,CEUS和MRI增强联合应用具有较高的灵敏度,具有诊断优势;PSA≥20.0ng/mL时,CEUS检查简便,可提高前列腺穿刺活检定位准确性,具有诊断优势。
Objective To investigate the clinical value of contrast-enhanced ultrasound (CEUS), magnetic resonance imaging (MRI) enhancement and joint imaging in the diagnosis of prostate cancer with different prostate specific antigen (PSA) intervals. Methods Retrospective analysis of 132 cases of suspected prostate cancer patients were performed CEUS, MRI enhanced examination and further confirmed by rectal prostatic biopsy, combined with pathological results of two diagnostic methods and imaging in the diagnosis of prostate cancer clinical application value. Results The sensitivities of CEUS, MRI enhancement and the combination of them were 75.43%, 80.70%, 92.98%, 77.33%, 86.67%, 73.33%, respectively. The sensitivity of combined diagnosis was higher than that of CEUS, MRI enhanced diagnostic techniques, the differences were statistically significant (P <0.05), MRI enhanced diagnostic specificity higher than the combined diagnosis, the difference was statistically significant (P <0.05). In the range of 4.0ng / mL≤PSA <10.0ng / mL, CEUS, MRI enhancement and combined specificity of the two were 82.00%, 96.00%, 80.00%, MRI enhanced diagnostic specificity higher than CEUS and the combination of the two , The differences were statistically significant (P <0.05). In the range of 10.0ng / mL≤PSA <20.0ng / mL, the sensitivities of CEUS, MRI and the combination of the two were 42.86%, 52.38% and 80.95% respectively, the specificity were 73.68% and 68.42% , 63.16% respectively. The diagnostic sensitivity of the two methods was higher than that of CEUS and MRI (P <0.05). In the PSA≥20.0ng / mL, all three methods were correctly diagnosed. Conclusions CEUS and MRI enhancement have their own advantages in the diagnosis of prostate cancer. The combination of the two can improve the sensitivity, which is superior to a single diagnosis method. At the same time MRI enhancement of the specificity of prostate cancer diagnosis is better than the combined diagnosis. In patients with suspected prostate cancer, 4.0ng / mL≤PSA <10.0ng / mL, MRI enhanced with higher diagnostic specificity, with diagnostic advantages; CEUS and MRI enhanced with 10.0ng / mL≤PSA <20.0ng / mL with Higher sensitivity, with diagnostic advantages; PSA≥20.0ng / mL, CEUS examination is simple, can improve the positioning of prostate biopsy accuracy, with the diagnosis advantage.