MR波谱诊断T3N0M0期前列腺癌冷冻治疗后局部复发的价值
MR파보진단T3N0M0기전렬선암냉동치료후국부복발적개치
MR spectroscopy in diagnosis of local recurrence of T3N0M0 of prostate cancer after cryotherapy
  • 万方数据
    中华放射学杂志 중화방사학잡지
    Chinese Journal of Radiology
    2012年 6期 529-534 ,共6页

    刘明%郭志%司同国%王海涛%肖渤瀚

    류명%곽지%사동국%왕해도%초발한

    前列腺肿瘤%磁共振波谱学%冷冻疗法 前列腺腫瘤%磁共振波譜學%冷凍療法
    전렬선종류%자공진파보학%냉동요법
    Prostatic neoplasms%Magnetic resonance spectroscopy%Cryotherapy
    目的 探讨MRS诊断T3N0M0期前列腺癌冷冻治疗后复发的临床价值.方法 回顾性分析以行前列腺癌冷冻治疗为主的65例T3N0M0期前列腺癌患者的临床资料.患者冷冻治疗术前均行常规MRI、MRS及病理穿刺活检.术后每个月检测前列腺特异性抗原(PSA).当PSA升高(＞0.5 μg/L)时,于1周内行MRI、MRS及病理活检；如PSA小于0.5μg/L,于术后12个月时行MRI、MRS检查及超声引导下活组织穿刺病理检查.术前根据穿刺活检结果,将前列腺分为癌区和非癌区；通过MRS测量手术前、后前列腺癌癌区和非癌区的胆碱(Cho)、枸橼酸盐(Cit)的信噪比及( Cho+ Cre)/Cit[肌酸(Cre)]比值水平.术后复查根据病理活检结果分为无复发组、局部复发组.比较不同分组冷冻治疗前后癌区和非癌区Cho、Cit的信噪比及(Cho+ Cre)/Cit比值水平.数据经正态性检验证实为正态分布后,采用独立样本的t检验进行比较.结果 (1)术后12个月病理活检证实局部复发患者15例,其中11例PSA在12个月内升高、4例12个月内PSA未见升高.(2)65例患者冷冻治疗前癌区与非癌区Cho峰、Cit峰的信噪比及(Cho+ Cre)/Cit比值分别为25 +9和11±5,18±5和39±12,2.33±0.60和0.53±0.19,癌区与非癌区比较差异均有统计学意义(t值分别为11.36、9.81和13.39,P值均为0.00).(3)冷冻治疗后局部未复发的患者,癌区与非癌区的Cho峰、Cit峰的信噪比分别是4+2和3+2(t=1.024,P =0.305),2±2和4±3(t =1.147,P=0.178),癌区与非癌区比较差异无统计学意义；但癌区冷冻治疗术前、后的Cho峰(t=25.22,P=0.00)、Cit峰(=32.06,P=0.00)和非癌区冷冻治疗前、后的Cho峰(t=17.42,P =0.00)、Cit峰(t=38.60,P=0.00)的信噪比差异均有统计学意义；冷冻治疗术后癌区及非癌区可见有大量坏死区,Cho和Cit的信噪比较低,无法计算( Cho+ Cre)/Cit.(4)冷冻治疗后局部复发患者,在癌区和非癌区Cho峰信噪比分别是17±3、3±2(t =17.24,P=0.00),Cit峰的信噪比分别是9±2和3±3(t =23.66,P=0.00),癌区与非癌区比较差异有统计学意义；癌区复发区( Cho+ Cre)/Cit的比值与术前相比差异无统计学意义(t=1.214,P=0.256)；而非癌区的大量坏死区因Cho峰、Cit峰的信噪比较低,无法计算(Cho+ Cre)/Cit.结论 MRS可评估前列腺癌冷冻治疗前后治疗局部Cho、Cit的信噪比和(Cho+ Cre)/Cit比值水平,有助于判断冷冻治疗后局部复发.
    목적 탐토MRS진단T3N0M0기전렬선암냉동치료후복발적림상개치.방법 회고성분석이행전렬선암냉동치료위주적65례T3N0M0기전렬선암환자적림상자료.환자냉동치료술전균행상규MRI、MRS급병리천자활검.술후매개월검측전렬선특이성항원(PSA).당PSA승고(＞0.5 μg/L)시,우1주내행MRI、MRS급병리활검；여PSA소우0.5μg/L,우술후12개월시행MRI、MRS검사급초성인도하활조직천자병리검사.술전근거천자활검결과,장전렬선분위암구화비암구；통과MRS측량수술전、후전렬선암암구화비암구적담감(Cho)、구연산염(Cit)적신조비급( Cho+ Cre)/Cit[기산(Cre)]비치수평.술후복사근거병리활검결과분위무복발조、국부복발조.비교불동분조냉동치료전후암구화비암구Cho、Cit적신조비급(Cho+ Cre)/Cit비치수평.수거경정태성검험증실위정태분포후,채용독립양본적t검험진행비교.결과 (1)술후12개월병리활검증실국부복발환자15례,기중11례PSA재12개월내승고、4례12개월내PSA미견승고.(2)65례환자냉동치료전암구여비암구Cho봉、Cit봉적신조비급(Cho+ Cre)/Cit비치분별위25 +9화11±5,18±5화39±12,2.33±0.60화0.53±0.19,암구여비암구비교차이균유통계학의의(t치분별위11.36、9.81화13.39,P치균위0.00).(3)냉동치료후국부미복발적환자,암구여비암구적Cho봉、Cit봉적신조비분별시4+2화3+2(t=1.024,P =0.305),2±2화4±3(t =1.147,P=0.178),암구여비암구비교차이무통계학의의；단암구냉동치료술전、후적Cho봉(t=25.22,P=0.00)、Cit봉(=32.06,P=0.00)화비암구냉동치료전、후적Cho봉(t=17.42,P =0.00)、Cit봉(t=38.60,P=0.00)적신조비차이균유통계학의의；냉동치료술후암구급비암구가견유대량배사구,Cho화Cit적신조비교저,무법계산( Cho+ Cre)/Cit.(4)냉동치료후국부복발환자,재암구화비암구Cho봉신조비분별시17±3、3±2(t =17.24,P=0.00),Cit봉적신조비분별시9±2화3±3(t =23.66,P=0.00),암구여비암구비교차이유통계학의의；암구복발구( Cho+ Cre)/Cit적비치여술전상비차이무통계학의의(t=1.214,P=0.256)；이비암구적대량배사구인Cho봉、Cit봉적신조비교저,무법계산(Cho+ Cre)/Cit.결론 MRS가평고전렬선암냉동치료전후치료국부Cho、Cit적신조비화(Cho+ Cre)/Cit비치수평,유조우판단냉동치료후국부복발.
    Objective To evaluate the usefulness of magnetic resonance spectroscopic imaging in detecting local recurrence in patients with T3N0M0 prostate cancer after cryotherapy.Methods Sixty-five patients with T3N0M0 prostate cancer underwent cryotherapy.The preoperative data of conventional MRI,MRS,transrectal ultrasound (TRUS)-guided prostate biopsy were collected.After cryotherapy,the prostate specific antigen (PSA) of all patients was detected monthly.If PSA ＞5 μg/L,MRI,MRS,and TRUS-guided prostate biopsy were planned within a week.If PSA was unremarkable,MRI,MRS,and TRUS-guided prostate biopsy were planned 12 months after cryotherapy.The prostate was divided 6 regions and the cancerous and noncancerous were marked.The signal-to-noise ratio(S/N) of choline (Cho),citrate (Cit)and the ratios of Cho + creatine ( Cre)/Cit of each regions were measured in pre-operation and postoperation.The patients were divided into non-recurrence and recurrence group according to TRUS-guided biopsy.The S/N of Cho,Cit,and the ratio of Cho + Cre/Cit were compared between the groups before and after cryotherapy by using independent samples t-test.Results ( 1) Fifteen patients were confirmed local recurrence 12 months after cryotherapy,including 11patients with an evaluate PSA level and 4 patients with PSA umemarkable.(2) The S/N of Cho,Cit and the ratios of Cho + Cre/Cit in the cancerous and noncancerous regions before cryotherapy in the sixty-five patients were 25 + 9,11+ 5,and 18 + 5,and 39 ±12,2.33 +0.60,and 0.53 ± 0.19.There had significant difference between that of two groups ( t values were 11.36,9.81,and 13.39,respectively,P =0.00).(3) In the patients with non-recurrence,The S/N of Cho,Cit in the cancerous and noncancerous regions were 4 ± 2 and 3 ± 2 ( t =1.024,P =0.305 ),and 2 +2 and 4 ±3 (t =1.147,P =0.178) and no difference was found.In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.(4)In the patients with local recurrence after cryotherapy,the S/N of Cho and Cit in the cancerous and noncancerous regions were 17 ±3 and 3 ± 2 ( t =17.24,p =0.00 ),9 ± 2 and 3 ± 3 ( t =23.66,P =0.00 ) and a significant difference was found.The ratio of Cho + Cre/Cit in the recurrent area was no significant different compared with that of preoperation(t =1.214,P =0.256 ).In necrotic area,the ratios of Cho + Cre/Cit could not be calculated because of low level of the S/N of Cho and Cit.Conclusions MRS is a useful tool to evaluate the changes of the S/N of Cho and Cit,the ratios of the Cho + Cre/Cit and help diagnosis of local recurrence.
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