Application of ultrasound strain elastography combined with MRI-DWI guided targeted puncture in diagnosis of prostate lesions
Objective:To explore the value of ultrasound strain elastography (SUE) combined with magnetic resonance diffusion-weighted imaging (MRI-DWI) guided targeted puncture in the diagnosis of prostate lesions.Methods:Patients with suspected prostate space-occupying lesions who were treated at Huizhou Central People's Hospital from May 2019 to May 2022 were prospectively collected as the research subjects. Rectal ultrasound, SUE, and MRI-DWI were performed before puncture, and the suspicious areas were recorded. All patients underwent transrectal systematic prostate puncture under the guidance of rectal ultrasound, and targeted puncture of suspicious lesions under the guidance of SUE combined with MRI-DWI. The imaging characteristics were recorded. Taking the pathological results as the "gold standard", the positive detection rates by systematic puncture and targeted puncture were compared. The receiver operating characteristic (ROC) curve of apparent diffusion coefficient (ADC) was plotted to analyze the value of ADC in diagnosing prostate lesions. The Gleason scores of the two puncture biopsy schemes were compared.Results:A total of 105 patients with suspected prostate space-occupying lesions were included in this study, of which two withdrew from the study due to their own psychological reasons. Finally, 103 patients were included in this study. All 103 patients were successfully punctured and sampled for examination, among which 66 (64.08%) were pathologically diagnosed with prostate cancer (all were adenocarcinoma). There were 37 cases of benign prostatic hyperplasia, accounting for 35.92% (37/103), of which two were accompanied by intraepithelial neoplasia. A total of 59 patients were diagnosed with malignant lesions, including 55 cases by MRI-DWI and 57 cases by SUE. In patients with malignant lesions, MRI-DWI examination (T2WI) showed that the lesions had nodular low signal, DWI showed high signal, ADC map showed that the ADC value was low, and SUE examination can find a blue area with increased hardness. The malignant lesion detection rate by systematic puncture was 48.54%, and that of SUE combined with MRI-DWI targeted guided puncture was 57.28%; there was no statistical significant difference between them (P>0.05). A total of 1181 needles were used in systematic puncture, of which 379 achieved a pathological diagnosis of malignant lesions, with a single needle detection rate of 32.09%. A total of 218 needles were punctured under the guidance of SUE and MRI-DWI, and 136 needles achieved a pathological diagnosis of malignant lesions, with a single needle detection rate of 62.38%. The single needle detection rate by targeted guidance puncture was significantly higher than that by systematic puncture (P<0.05). The ADC value in malignant lesions was (1.18±0.17) mm2/s, while in benign lesions it was (1.42±0.23) mm2/s; the ADC value in malignant lesions was lower than that in benign lesions (t=6.303, P<0.001). The area under the curve (AUC) of ADC for diagnosis of benign and malignant prostatic lesions was 0.816 (95%CI: 0.718-0.914). The sensitivity and specificity of evaluating benign and malignant prostatic lesions using an ADC value of 1.34 mm2/s as the cutoff point were 83.33% and 67.57%, respectively. There was no statistical significant difference in Gleason scores between the two puncture schemes (P>0.05).Conclusion:Compared with systematic puncture, SUE combined with MRI-DWI guided targeted puncture can obtain a similar detection rate of prostate malignant lesions with less puncture needles and a higher positive rate of puncture.
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