老年前列腺疾病的CT诊断

为了估价ＣＴ对前列腺疾病诊断的价值，笔者对１２０例全部经ＣＴ检查的病例作了研究。有关前列腺大小与年龄的关系，在１２０例中其大小心稼随年龄增长而有所增长的趋势，但均未超过正常数值范围。１２０例中３６例为前列腺癌，８４例前列腺肥大，ＣＴ表现为密度不均，结节，精囊角变钝或消失。此见于前列腺癌，亦见于前列腺肥大，然而ＣＴ复合征象主要见于前列腺癌，只是阳性率相对较少，重要的是ＣＴ对前列腺的良，恶性鉴别是困难     

前列腺部的CT诊断与鉴别诊断

目的 研讨前列腺癌的ＣＴ表现,及时作出诊断与鉴别诊断。方法 经手术或穿刺病理证实前列腺癌２８例（其中４例为术后复发）,采用盆腔、前列腺范围ＣＴ平扫与增强扫描,层厚、层距各５ｍｍ。结果 ２４例中ＣＴ确诊２１例（占８７．５％）,其ＣＴ表现：（１）癌灶：平扫示前列腺不匀称肥大１８例,肿物密度比正常略低１７例,等密度１１例,肿物内钙化２例。增强后呈结节状中等强化但仍比正常低２２例,６例呈等密度;（２）转移     

前列腺增生与前列腺癌CT及病理分析：（附32例报告）

随着我国人口结构老龄化，前列腺增生目前已成为老年患者最常见的疾病，而前列腺癌的发病率也正在逐年增高。在临床工作中，有时两者之间鉴别有一定困难。为此，收集了１９９５年至１９９６年度经手术病理证实的病例３２例，其中前列腺增生１９例，前列腺癌１３例，探讨ＣＴ的诊断价值。     

前列腺疾病的影象诊断

目的：评价老年前列腺疾病的Ｘ－ＣＴ,超声的价值。材料与方法：回顾性分析了４３例经手术病理证帝的前列腺肥大和前列腺癌的超声波,Ｘ线,ＣＴ的表现。结果：良性增生ＣＴ表现为结节性增生,密度不均匀,精囊角变钝。超声表现为增大变形,结节性增生,内外腺比例失常以及向膀胱内凸出等。癌肿表现：ＣＴ除可以良性增生联合征象外,尚有膀胱浸润,精直肠,淋巴结和骨骼转移称以及侵犯邻近组织,也有仅以前列腺内出现强光斑和低回声     

前列腺癌的CT评价

前列腺癌的ＣＴ评价王东磁，李洪波，王学飞磁共振科主题词前列腺肿瘤，Ｘ线计算机体层摄影术作者回顾性分析了２７例经病理证实的前列腺癌的ＣＴ表现，旨在评价ＣＴ扫描对前列腺癌的诊断价值及其在术前分期和治疗后随访中的作用。１材料与方法经ＣＴ检查并经病理证实的前...     

前列腺穿刺活检联合血清前列腺特异抗原在前列腺癌诊断中的意义

目的探讨经直肠前列腺穿刺活检与血清前列腺特异抗原联合检测在前列腺癌诊断中的价值。方法对61例经直肠指检阳性，和（或）总前列腺特异抗原≥10ug／L，和（或）游离前列腺特异抗原/总前列腺特异抗原〈0．25的可疑前列腺癌患者，在超声引导下经直肠前列腺多点穿刺活检。结果61例中，前列腺活检病理检查诊断为前列腺癌25例（40．98％），良性前列腺增生36例（59．02％）。其中，游离前列腺特异抗原／总前列腺特异抗原〈0．20的患者中前列腺癌检出8例（8／13，占61．54％）。结论总前列腺特异抗原≥10ug／L，特别是游离前列腺特异抗原／总前列腺特异抗原〈0．20对前列腺癌的诊断比前列腺穿刺活检更为敏感，两者联合检测对临床诊治具有更重要的价值和意义。     

前列腺肥大宜早防

正常人的前列腺如栗子大小,重约 20～ 30克。随着年龄的增长和性生活的增多,前列腺会逐渐肥大,增至 40～ 80克。如超过 80克,就会压迫尿道口,造成排尿困难。前列腺体积增至鸽蛋大,医生称为 1度肥大;增至鸡蛋大,称为 2度肥大;增至鸭蛋大,称为 3度肥大;增至鹅蛋大,称为 4度肥大。 　　为什么人到老年前列腺会肥大呢？医学界对其病因说法不一。尽管有人认为与种族和遗传因素有关,但多数人认为性生活过度是前列腺肥大的主要原因。过多的性生活使前列腺经常处于充血状态,久之逐渐形成肥大。年轻时由于代谢旺盛,机体活力强,恢复快…     

前列腺肉瘤的MRI特征及临床表现:与前列腺癌的比较

目的总结前列腺肉瘤的MRI特征和临床表现,并与前列腺癌比较.方法搜集经病理证实的6例前列腺肉瘤,并选择同期15例前列腺癌作对照,分析临床资料、实验室结果及影像表现,分析两者间差异的特征性.结果(1)病理结果前列腺肉瘤中横纹肌肉瘤3例,平滑肌肉瘤1例,间质来源无法分类的肉瘤1例,间质来源未分类的肉瘤1例;前列腺腺癌15例.(2)临床结果前列腺肉瘤年龄中位数为36.5(范围为15～71)岁;病史1个月至5年;症状主要为进行性排尿困难;肛门指诊前列腺显著增大,表面不光滑,有结节或有囊性感,有压痛;前列腺特异性抗原(PSA)在正常范围[(0.20～4.00)×10-3 ng/L],中位数为0.56×10-3 ng/L.前列腺癌年龄中位数为72(范围为50～78)岁;病史5个月到17年;症状主要为尿急、尿频、排尿困难;肛门指诊前列腺呈轻、中度增大,表面光滑,质硬,无压痛;PSA值升高,中位数为27.80×10-3 ng/L,范围为(1.55～352.00)×10-3 ng/L.2种疾病的发病年龄和血清PSA值比较差异均有显著性意义(P<0.05).(3)MRI表现前列腺肉瘤表现为前列腺体积明显增大,中位数为217.46 cm3,范围为64.35～859.04 cm3,占据盆腔的大部,呈分叶状;正常结构消失,中央带、外周带界限不清;T1WI可见内部斑片状低信号,T2WI呈明显中、高混杂信号;包膜外侵犯5例,淋巴结和骨转移3例.前列腺癌表现为前列腺呈轻、中度增大,中位数为41.57 cm3,范围为17.16～179.44 cm3,外形规则或变形,结构基本存在;T2WI显示病变外周带内呈局限性低信号11例,包膜外侵犯10例、骨转移7例.2种疾病的前列腺体积比较差异有显著性意义P<0.05).结论前列腺肉瘤和前列腺癌的发病年龄、病史、前列腺体积、外形、质地、PSA 值及MRI表现都有明显的不同.     

前列腺特异性抗原密度在前列腺癌诊断中的价值

目的探讨前列腺特异性抗原密度(PSAD)对良性前列腺增生与前列腺癌的鉴别诊断价值。方法采集80名健康人、160例良性前列腺增生患者和60例前列腺癌患者的血清,用化学发光免疫法测定前列腺特异性抗原(PSA),腹部前列腺B超检查计算前列腺体积,计算前列腺特异性抗原密度。结果前列腺癌患者PSA和PSAD水平分别为(82.66±20.62)μg/L和(0.68±0.2),前列腺癌患者中PSA和PSAD水平明显高于前列腺增生患者。160例良性前列腺增生患者血清PSA水平为4~10μg/L,明显高于正常对照组,前列腺癌组中PSA>10μg/L和PSAD>0.2明显高于前列腺增生患者。血清PSA>10μg/L诊断前列腺癌的敏感性和特异性分别为50.0%和91.3%,PSAD诊断前列腺癌的敏感性和特异性为96.7%和85.0%。结论 PSAD是诊断前列腺癌更敏感、更有效的指标,在前列腺癌和良性前列腺增生中有鉴别意义。     

CT在前列腺癌诊断中的评价

评价ＣＴ在前列腺癌诊断２中的作用和限度。回顾性分析经病理证实的２６例前列腺癌ＣＴ表现，与３０例前列腺增生作比较分析，对前列腺癌的主要ＣＴ表现和肿瘤分期评价。前列腺边缘结节状隆起在前列腺癌和前列腺增生之间存在显著性差异，Ｐ〈０．０１；前列腺局部密度减低或不均，在两者之间无显著性差异．     

前列腺癌的CT诊断及评价

目的 评价CT在前列腺癌诊断及分期中的价值。材料与方法 回顾性分析经病理证实的30例前列腺癌CT表面及其中6例治疗后的CT表现,28例行平扫和增强,2例行平扫,扫描层厚和间距均为5mm。由两位高龄CT医师分析其CT表现,并进行CT分期。结果 30例前列腺癌中,前列腺边缘隆起乾占83．33％,局限性前列腺密度减低或不均匀者占90％,治疗前CT分明的准确率为80％,Ⅲ期以上的准确率为92％。6例去势治疗后,5例肿瘤明显缩小。结论 前列腺边缘结节状隆起和边缘毛糙,前列腺局限性密度减低是CT诊断前列腺癌的主要征象,CT对肿瘤的临床分期及治疗后疗效的评价具有较大的价值。     

前列腺癌螺旋CT早期增强的初步研究

目的 初步探讨螺旋CT早期增强对前列腺癌的诊断价值。材料与方法 对11例活检或临床证实的前列腺癌行螺旋CT动态增强扫描。团注非离子型对比剂90－100ml,3ml/s,延时30s螺旋扫描,层厚5mm,Pitch1：1。结果 11例中4例显示早期较明显强化灶位于周围带,7例未见早期强化。前列腺分区显示较好有助于观察结节增生等情况。结论 螺旋CT团注动脉增强能够显示部分前列腺癌的早期强化,可提高检出率及分辨率。     

Computed tomography in the evaluation of the suspected carcinomatous prostate.

Twenty-six patients with physical findings suspicious for prostatic cancer were examined by contrast-enhanced computed tomography (CT) of the prostate region prior to prostatic biopsy of resection. Twelve had benign hypertrophy and/or prostatitis and fourteen had adenocarcinoma. Prostatic contour, density, seminal vesicle "angle," extraprostatic soft tissue "mass," and the pelvic fat planes were evaluated. A nodular prostatic contour was found only in patients with adenocarcinoma of the prostate, indicating a role for CT in the diagnosis of this disease. Two patients with benign prostatic disease had extraprostatic soft tissue "masses" identical to those seen in six patients with adenocarcinoma of the prostate, suggesting limited usefulness of CT in staging patients with known tumor.     

MR depiction of zonal anatomy of the prostate at 1.5 T

Previous reports of magnetic resonance imaging of the prostate have described a homogeneous appearance to the normal prostate gland. The T2-weighted images of the normal prostate obtained at higher field strength (1.5 T) reveal an inhomogeneous appearance of the normal gland, with apparent differentiation of normal prostatic zones having differing histology. The anterior fibromuscular tissue of the normal prostate, the glandular tissue comprising the central zone of the prostate, and the glandular tissue of the peripheral zone of the prostate can be differentiated by differences in intensity in the T2-weighted images. The ability to differentiate histologically distinct regions of the normal prostate may be important since clinically important prostatic diseases (benign prostatic hypertrophy and carcinoma) arise in different prostatic zones.     

Computed tomography in the evaluation of the suspected carcinomatous prostate

Twenty-six patients with physical findings suspicious for prostatic cancer were examined by contrast-enhanced computed tomography (CT) of the prostate region prior to prostatic biopsy or resection. Twelve had benign hypertrophy and/or prostatis and fourteen had adenocarcinoma. Prostatic contour, density, seminal vesicle “angle,” extraprostatic soft tissue “mass,” and the pelvic fat planes were evaluated. A nodular prostatic contour was found only in patients with adenocarcinoma of the prostate, indicating a role for CT in the diagnosis of this disease. Two patients with benign prostatic disease had extraprostatic soft tissue “masses” identical to those seen in six patients with adenocarcinoma of the prostate, suggesting limited usefulness of CT in staging patients with known tumor.     

前列腺上皮内瘤CT灌注成像表现初探

目的 了解前列腺增生(BPH)中前列腺上皮内瘤(PIN)的CT灌注成像表现,并初步探讨PIN与前列腺癌(PCa)及良性BPH的灌注成像表现的关系.资料与方法 BPH25例,其中PIN样变9例,良性BPH 16例.PCa 34例,行前列腺病变中心层面灌注扫描,得到各组灌注图(PF)、强化峰值图(PEI)、达峰时间图(TTP)、血容量(BV)值和时间密度曲线(TDC),并对各组灌注值进行对比分析.结果 PIN的PF值大于良性BPH,TTP值小于良性BPH,差异有统计学意义.PIN的TTP值大于PCa组,PF值小于PCa组,差异有统计学意义. 结论 PIN的CT灌注成像表现提示,PIN的PF值和邢值与PCa和良性BPH不同,介于两者间.这种灌注特征可能为早期发现PCa提供一定帮助.     

Magnetic resonance imaging of the prostate

Twenty-two normal volunteers and 32 patients with either benign prostatic hypertrophy or prostatic carcinoma were examined by magnetic resonance imaging (MRI). The images were of high quality and clearly demonstrated the prostate gland and the surrounding anatomy but were of limited value in differentiating between benign and malignant prostatic disease. Using a specific pulse sequence, the authors were able to visualize what they believed to be the periprostatic venous plexus and suggest that the demonstration of this venous plexus may be of value in showing extraglandular spread of carcinoma of the prostate.     

低场磁共振T1 FLAIR在前列腺检查中的应用(与SE序列比较)

目的：评估低场磁共振T1 FLAIR对前列腺检查的价值。方法：分析50例志愿者的前列腺MRI正常解剖;评估42例前列腺癌,76例前列腺增生,48例前列腺炎的磁共振诊断价值。结果：T1 FLAIR在显示前列腺内部结构、包膜和神经血管束方面与SE T1 WI(T1—SE)在统计学上差异有显著性意义;T1 FLAIR对疾病诊断价值的评分明显高于T1-SE。结论：T1 FLAIR在前列腺检查中有较高的使用价值。     

Magnetic resonance imaging (MRI) anatomy of the prostate and application of MRI in radiotherapy planning

Radiotherapy planning for prostate carcinoma has traditionally been performed on computed tomography (CT)-images, on which both the high dose areas (prostate with or without seminal vesicles) as well as the low dose areas (surrounding structures, such as the rectum and bladder) are anatomically delineated. However, magnetic resonance imaging (MRI) provides much more information than CT; it can superbly demonstrate the internal prostatic anatomy, prostatic margins and the extent of prostatic tumours. Hence, MRI becomes a powerful tool to improve the accuracy of planning delineations in radiotherapy for prostate carcinoma and is rapidly gaining popularity in the radiotherapy community. The present paper reviews some important anatomical landmarks and acquisition protocols relevant to radiotherapy planning and explains the rationale and importance of close collaboration between radiotherapists and radiologists in optimizing radiotherapy for patients with prostate carcinoma.