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目的探讨超声造影(CEUS)在前列腺血清特异抗原(PSA)升高而常规超声检查未见可疑病灶的患者穿刺活检中的应用价值和局限性。方法对56例因PSA升高而常规超声未见可疑病灶的患者在穿刺前行经直肠前列腺CEUS检查,统计和分析穿刺点活检结果和造影剂异常分布区(CAD)之间的关系。结果 56例患者中11例(共35个穿刺点)病理诊断为前列腺癌(PCa),其中7例患者部分阳性穿刺点落在CAD区域(共20个穿刺点阳性其中15个点位于CAD区域,另外5个点不在CAD区域);有4例患者共15个阳性穿刺点均不在CAD区域。56例患者,CAD区域共有99个穿刺活检点,其中15个点穿刺病理证实为PCa,CAD区域的敏感性42.86%(15/35),特异性84.00%(441/525),阳性预测值15.15%(15/99),阴性预测值95.66%(441/461)。在所有造影的病例中CAD区域检出PCa的阳性率是非CAD区域的3.9倍(15.15%vs 3.9%,P<0.05),两者差异有统计学意义。阳性穿刺点分布与CAD分布有相关性(r=0.661)。PCa与CAD的体积有明显的相关性,与良性组相比,PCa组有更大的CAD体积(1.01±0.13mL vs 0.37±0.14mL,P<0.05)。PCa与PSA呈正相关(r=0.961),与前列腺的体积呈负相关(r=-0.842)。结论对于血清PSA升高但常规超声未发现明确的前列腺异常病灶的患者,超声造影检查有助于PCa可疑病灶的检出。但是,要完整的显示PCa的微血管特征需要更多次数的超声造影。
Objective To investigate the value and limitations of CEUS in the biopsy of patients with elevated prostate specific antigen (PSA) without any suspicious lesions in conventional ultrasonography. Methods 56 cases of patients with elevated PSA who had no suspicious lesions by conventional ultrasound were examined by transrectal CEUS before puncture. The relationship between biopsy results and abnormal distribution of contrast medium (CAD) was statistically analyzed. Results Of the 56 patients, 11 cases (35 puncture points) were diagnosed as prostate cancer (PCa), of which 7 were positive in the CAD region (a total of 20 puncture points were positive in the CAD region, The other 5 points are not in the CAD area); in 4 patients, 15 positive puncture points are not in the CAD area. Among the 56 patients, there were 99 biopsy sites in the CAD area, of which 15 were biopsied for PCa, 42.86% (15/35) for the CAD area, 84.00% (441/525) for the CAD area, and 15.15 for the CAD area % (15/99), negative predictive value 95.66% (441/461). The positive rate of PCa detected in CAD area was 3.9 times (15.15% vs 3.9%, P <0.05) in non-CAD area in all angiographic cases, the difference was statistically significant. The distribution of positive puncture points was correlated with CAD distribution (r = 0.661). There was a clear correlation between PCa and CAD volume, with a larger CAD volume in the PCa group compared with the benign group (1.01 ± 0.13 mL vs 0.37 ± 0.14 mL, P <0.05). PCa was positively correlated with PSA (r = 0.961), negatively correlated with the volume of prostate (r = -0.842). Conclusions For patients with elevated serum PSA but no definite abnormal prostate lesions found by conventional sonography, contrast-enhanced ultrasonography can be used to detect suspicious lesions in PCa. However, a complete demonstration of the microvascular characteristics of PCa requires a greater number of CEUS.