摘要
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（〉0．5μg/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（t=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。
Objective To evaluate the usefulness of magnetic resonance spectroscopic imaging in detecting local recurrence in patients with TaNoM0 prostate cancer after cryotherapy. Methods Sixty-five patients with T3 NO Mo prostate cancer underwent eryotherapy. The preoperative data of conventional MRI, MRS, transrectal ultrasound （TRUS）-guided prostate biopsy were collected. After eryotherapy, the prostatespecific 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 post- operation. The patients were divided into non-recurrence and recurrence group according to TRUS-guided biopsy. The SiN 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 11 patients with an evaluate PSA level and 4 patients with PSA unremarkable. （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 pre- operation（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.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2012年第6期529-534,共6页
Chinese Journal of Radiology
基金
国家自然科学基金资助项目（30973438）
国家青年科学基金资助项目（81001002）
天津市应用基础及前沿技术研究计划资助项目（09JCYBJC10400）
天津市卫生局科技基金资助项目（2010R271）
关键词
前列腺肿瘤
磁共振波谱学
冷冻疗法
Prostatic neoplasms
Magnetic resonance spectroscopy
Cryotherapy
