CAJ | 학술논문

目的：探讨经直肠实时组织弹性成像技术在鉴别诊断前列腺良、恶性病变中的应用价值。方法选择2012年5月至2013年1月南京大学医学院附属鼓楼医院经病理证实的88例前列腺病变患者95个病灶，采用经直肠实时组织弹性成像技术测量超声弹性分级和应变率比值。以病理结果作为金标准，计算弹性分级法诊断前列腺良、恶性病变的敏感度、特异度和准确性；绘制弹性分级法和应变率比值法的受试者操作特性（ROC）曲线。采用χ2检验比较弹性分级法和应变率比值法诊断前列腺良、恶性病变的准确性。结果95个前列腺病灶中病理诊断为良性47个，恶性48个。95个前列腺病灶超声弹性分级Ⅰ级26个，Ⅱ级19个，Ⅲ级16个，Ⅳ级21个，Ⅴ级13个。以超声弹性分级≤Ⅱ级诊断为良性，≥Ⅲ级诊断为恶性，超声弹性分级法诊断前列腺良、恶性病变的准确性为76.84%（73/95）、敏感度为79.17%（38/48）、特异度为74.47%（35/47）。ROC曲线显示，应变率比值法鉴别诊断前列腺良、恶性病变的最佳阈值为4.67、约登指数为0.622、敏感度为83.33%、特异度为78.72%、准确性为81.05%；弹性分级法ROC曲线下面积为0.830，应变率比值法ROC曲线下面积为0.877。应变率比值法诊断前列腺良、恶性病变的准确性略高于弹性分级法，但差异无统计学意义（χ2=0.51，P＞0.05）。结论经直肠实时组织弹性成像技术对前列腺良、恶性病变的鉴别诊断具有一定的价值，有助于前列腺癌的诊断。
목적：탐토경직장실시조직탄성성상기술재감별진단전렬선량、악성병변중적응용개치。방법선택2012년5월지2013년1월남경대학의학원부속고루의원경병리증실적88례전렬선병변환자95개병조，채용경직장실시조직탄성성상기술측량초성탄성분급화응변솔비치。이병리결과작위금표준，계산탄성분급법진단전렬선량、악성병변적민감도、특이도화준학성；회제탄성분급법화응변솔비치법적수시자조작특성（ROC）곡선。채용χ2검험비교탄성분급법화응변솔비치법진단전렬선량、악성병변적준학성。결과95개전렬선병조중병리진단위량성47개，악성48개。95개전렬선병조초성탄성분급Ⅰ급26개，Ⅱ급19개，Ⅲ급16개，Ⅳ급21개，Ⅴ급13개。이초성탄성분급≤Ⅱ급진단위량성，≥Ⅲ급진단위악성，초성탄성분급법진단전렬선량、악성병변적준학성위76.84%（73/95）、민감도위79.17%（38/48）、특이도위74.47%（35/47）。ROC곡선현시，응변솔비치법감별진단전렬선량、악성병변적최가역치위4.67、약등지수위0.622、민감도위83.33%、특이도위78.72%、준학성위81.05%；탄성분급법ROC곡선하면적위0.830，응변솔비치법ROC곡선하면적위0.877。응변솔비치법진단전렬선량、악성병변적준학성략고우탄성분급법，단차이무통계학의의（χ2=0.51，P＞0.05）。결론경직장실시조직탄성성상기술대전렬선량、악성병변적감별진단구유일정적개치，유조우전렬선암적진단。
Objective To assess the contribution of transrectal realtime tissue elastography (TRTE) on the differential diagnosis of prostatic diseases. Methods A total of 88 prostatic disease patients with 95 lesions proved by pathology from May 2012 to January 2013 in the Afifliated Drum Tower Hospital of Medical College of Nanjing University were included. The elasticity grade and strain ratio were calculated by using TRTE. According to the gold standard of pathological results, the sensitivity, speciifcity, accuracy rate were calculated to evaluate the effectiveness of elasticity grade and strain ratio in distinguishing benign and malignant prostatic diseases;and the receiver operating characteristic (ROC) curves were made respectively. The accuracy of elasticity grade and strain ratio in diagnosing prostatic diseases was also compared using chi-square test. Results Forty-seven benign lesions were found in the 95 prostatic lesions and the other 48 lesions were malignant. The elasticity grades of the 95 prostatic lesions were as follows:GradeⅠ26, GradeⅡ19, GradeⅢ16, GradeⅣ21, and GradeⅤ13. Elasticity grade ≤Ⅱwas considered to be benign, while grade ≥Ⅲwas malignant. The sensitivity, speciifcity, accuracy rate of elasticity grade in diagnosis of prostatic malignant lesions was 79.17%(38/48), 74.47%(35/47) and 76.84%(73/95), respectively. According the ROC curve analysis, the cutoff point of strain ratio was 4.67, and Youden′s index was 0.622. The sensitivity, speciifcity, accuracy rate of strain ratio was 83.33%, 78.72%and 81.05%, respectively. The area under ROC curves of strain ratio was superior to that of elasticity grade. But the diagnosis accuracy of the two approaches was almost the same in statistics (χ2=0.51, P>0.05). Conclusions TRTE is valuable in the differential diagnosis of the prostatic benign and malignant lesions. Both strain ratio and elasticity grade are useful approaches, and have similar diagnostic accuracy.