联合全腺体CEUS与固定平面FRI提升前列腺癌诊断效能
本研究纳入163例PSA 4.00-20.00 ng/mL拟行活检患者，比较常规TRUS、常规TRUS联合全腺体CETRUS、及再加FRI三种策略。结果显示三联组合检出率61.35%、AUC 0.747，显著优于常规TRUS（AUC 0.669）及联合全腺体CETRUS（AUC 0.703），仅遗漏5例临床 insignificant 癌。
要点
- PSA 4.00-20.00 ng/mL患者，三联组合（常规TRUS+全腺体CETRUS+FRI）前列腺癌检出率最高（61.35%）。
- 三联组合AUC 0.747，显著优于常规TRUS（AUC 0.669，p=.018）和常规TRUS+全腺体CETRUS（AUC 0.703，p=.026）。
- 联合方法通过整合全腺体CETRUS（快速/高增强及弥漫异常高PPV）与FRI（不对称/局灶增强高PPV）的互补优势，检出更多阳性活检核心（p-Bonf<.001）。
关键影像表现/征象
- 全腺体CETRUS对快速/高增强及弥漫异常具有高阳性预测值。
- FRI对不对称/局灶增强具有高阳性预测值。
- 三联组合遗漏的临床 insignificant 癌仅5例。
诊断标准与关键数值
- 常规TRUS检出率43.56%，常规TRUS联合全腺体CETRUS检出率57.06%，三联组合检出率61.35%。
- 常规TRUS的AUC为0.669，常规TRUS联合全腺体CETRUS的AUC为0.703，三联组合的AUC为0.747。
- 三联组合AUC显著高于常规TRUS（p=.018）及常规TRUS联合全腺体CETRUS（p=.026）。
- 联合方法检出更多阳性活检核心（p-Bonf<.001）。
临床应用与阅片要点
- 对PSA 4.00-20.00 ng/mL且MRI禁忌或不可用的患者，可考虑常规TRUS联合全腺体CETRUS及FRI以提高检出。
- 阅片时注意全腺体CETRUS的快速/高增强及弥漫异常，以及FRI的不对称/局灶增强，二者互补可提高阳性预测。
- 联合策略遗漏临床 insignificant 癌仅5例，提示对临床显著癌检出较好。
局限性
- 单中心研究，样本量163例，结论外推需谨慎。
- 仅纳入PSA 4.00-20.00 ng/mL患者，不适用于其他PSA区间。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVES: To evaluate whether the addition of whole-gland contrast-enhanced transrectal ultrasound (CETRUS) and fixed-plane flash-replenishment imaging (FRI) to conventional transrectal ultrasound (TRUS) improves the diagnostic efficacy of prostate cancer (PCa) in patients with prostate-specific antigen (PSA) levels of 4.00-20.00 ng/mL.
METHODS: A total of 163 patients scheduled for TRUS-guided biopsy due to elevated PSA (4.00-20.00 ng/mL) were enrolled. Each patient underwent conventional TRUS, whole-gland CETRUS, and FRI before biopsy. Detection rates and diagnostic efficacy for PCa were compared among 3 imaging strategies: conventional TRUS alone, the combination of conventional TRUS with whole-gland CETRUS, and the triple combination.
RESULTS: PCa was diagnosed in 62 of 163 (38.04%), including 29 (46.77%) clinically significant cases. The detection rates were 43.56% for conventional TRUS, 57.06% for conventional TRUS combined with whole-gland CETRUS, and 61.35% for the triple combination. Only 5 clinically insignificant cases were missed by the combined approach. The triple combination demonstrated the highest area under the ROC curve (AUC = 0.747), significantly outperforming conventional TRUS (AUC = 0.669, p = .018) and TRUS with whole-gland CETRUS (AUC = 0.703, p = .026). The combined method also identified significantly more positive biopsy cores (p-Bonf < .001) by integrating the complementary diagnostic strengths of whole-gland CETRUS (high positive predictive value (PPV) for rapid/hyperenhancement and diffuse abnormalities) and FRI (high PPV for asymmetric/focal enhancement).
CONCLUSION: The triple-modality combination significantly improves PCa detection rate and diagnostic efficacy in patients with PSA levels of 4.00-20.00 ng/mL, offering a valuable alternative when magnetic resonance imaging is contraindicated or unavailable.
引用
- Jiang X, Zhao Z, Li Y, et al. Sweep and Scrutinize: Improving Prostate Cancer Diagnostic Efficacy by Combining Whole-Gland Contrast-Enhanced Transrectal Ultrasound With Fixed-Plane Flash-Replenishment Imaging. J Ultrasound Med. 2026. PMID: 41983683. doi:10.1002/jum.70264
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。