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目的探讨MRI、磁共振波谱(MRS)联合血清前列腺特异抗原(PSA)诊断前列腺癌(PCa)和良性前列腺增生(BPH)的价值。资料与方法经穿刺活检、手术病理或随访证实的31例PCa和41例BPH患者行常规MRI,其中26例行MRS扫描,58例获PSA数据。MRI上观察前列腺的形态、病变位置、信号特点及肿瘤侵犯范围。MRS上测量胆碱+肌酸(Cho+Cre)/枸椽酸盐(Cit)比值(CC/C)。结果31例PCa,21例位于周围带(PZ),2例位于中央腺体(CG),8例同时累及PZ和CG,T2WI表现为结节状或片状低信号;8例包膜完整,23例突破包膜。41例BPH,39例位于CG,2例位于PZ;T2WI18例表现为弥漫性混杂信号,23例表现为大小不等的圆形或结节状高信号(17例)或低信号(6例)。26例行MRS检查,12例PCa的CC/C比值为2.34±1.21,14例BPH的CC/C比值为0.79±0.25,两组间差异有统计学意义(t=4.327,P<0.001)。58例获得PSA数据,29例PCa的PSA范围为3.22～2262ng/ml,其中>10ng/ml者27例,<10ng/ml者2例;29例BPH的PSA范围为1.16～111ng/ml,其中>10ng/ml者14例,<10ng/ml者15例。MRI、MRS诊断PCa的敏感性、特异性和准确性均在70%以上,MRI、MRS二者联合其敏感性、特异性、准确性分别为83.3%、92.9%、88.5%,联合PSA后则分别达到100%、92.9%、96.2%。结论MRI、MRS和PSA3种检查方法的联合运用明显提高了鉴别PCa和BPH的诊断准确率。
Objective To investigate the diagnostic value of MRI and MRS combined with serum prostate specific antigen (PSA) in the diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH). Materials and Methods 31 cases of PCa and 41 cases of BPH confirmed by biopsy, surgical pathology or follow-up were examined by routine MRI. Among them 26 cases underwent MRS scan and 58 cases received PSA data. MRI observation of prostate morphology, location of lesions, signal characteristics and tumor invasion range. Cholesterol + creatine (Cho + Cre) / citrate (Cit) ratio (CC / C) was measured on MRS. Results 31 cases of PCa, 21 cases located in the surrounding zone (PZ), 2 cases located in the central gland (CG), 8 cases of both PZ and CG, T2WI showed nodular or flaky low signal; 8 cases of complete capsule, 23 cases of breakthrough capsule. 41 cases were BPH, 39 cases were located in CG and 2 cases were located in PZ. In T2WI, 18 cases showed diffuse mixed signals, 23 cases showed round or nodular high signal (17 cases) or low signal (6 cases) . Among the 26 patients who underwent MRS, the CC / C ratio of 12 patients with PCa was 2.34 ± 1.21 and that of 14 patients with BPH was 0.79 ± 0.25. There was significant difference between the two groups (t = 4.327, P <0.001). PSA data were obtained in 58 patients. The PSA range of 29 patients with PCa ranged from 3.22 to 2262 ng / ml, including 27 cases of> 10 ng / ml and 2 cases of <10 ng / ml. The PSA range of 29 cases of BPH was 1.16-111 ng / ml, > 10ng / ml in 14 cases, <10ng / ml in 15 cases. The sensitivity, specificity and accuracy of MRI and MRS in diagnosis of PCa were above 70%. The sensitivity, specificity and accuracy of MRI and MRS were 83.3%, 92.9% and 88.5% respectively. When combined with PSA, Respectively, reached 100%, 92.9%, 96.2%. Conclusions The combined use of MRI, MRS and PSA examination significantly improves the diagnostic accuracy of identifying PCa and BPH.