目的 探究经直肠实时组织弹性成像（TRTE）联合磁共振成像（MRI）在前列腺良恶性病变诊断中的应用及影像学特点。 方法 收集疑似前列腺癌患者154例，均接受TRTE和MRI检查，分析影像学特征，并以穿刺活检病理结果为金标准，评价TRTE和MRI检查对前列腺良恶性病变的诊断价值。 结果 154例患者，经穿刺活检病理诊断为恶性79例（前列腺癌），占比51.30%；诊断良性75例（前列腺增生），占比48.70%。前列腺恶性病变在TRTE图像中主要表现为病灶主体为蓝色区域（高硬度、低应变），边缘或呈绿色过度（中应变、中硬度）；在MRI图像中主要表现为T2WI中病灶整体呈低信号，DWI呈高信号，相应区域ADC呈低信号，DCE出现早期明显强化灶；与良性病变患者相比，恶性病变患者年龄、平均穿刺次数、总前列腺特异性抗原（tPSA）、前列腺特异性抗原密度（PSAD）水平以及SR评分、PI-RADS评分均更高（P < 0.05）；对照临床病理诊断结果（金标准），基于二分法的TRTE、MRI在前列腺良恶性病变诊断效能比较，差异无统计学意义（P > 0.05）；多因素logistic回归分析结果显示，校正年龄、PSAD后，TRTE弹性评分、MRI PI-RADS评分是前列腺恶性病变的预测因素（P < 0.05）由此构建前列腺恶性病变危险模型为：logit（P） = -0.421 + 0.072 × 年龄 + 0.087 × PSAD + 0.181 × 弹性评分 + 0.358 × PIRADS V2.1评分；以病理诊断结果为金标准，TRTE、MRI分别诊断以及TRTE联合MRI构建的logistic回归模型诊断前列腺病变良恶性质的敏感度为81.01%、84.81%和94.94%，特异度为88.00%、82.67%和85.33%，其中TRTE联合MRI构建的logistic回归模型诊断效能最优［曲线下面积（AUC）为0.933］。 结论 病灶主体为蓝色区域的TRTE征象以及T2WI低信号、DWI高信号，ADC低信号，DCE“快进快出”强化的MRI征象有助于前列腺病变良恶性质的诊断，TRTE联合MRI有助于提高诊断效能。

Objective To explore the application and imaging characteristics of transrectal real-time tissue elastography （TRTE） combined with magnetic resonance imaging （MRI） in the diagnosis of benign and malignant prostate lesions. Methods A total of 154 patients with suspected prostate cancer were collected and received TRTE and MRI. The imaging characteristics were analyzed， and the diagnostic value of TRTE and MRI on benign and malignant prostate lesions was evaluated with the pathological result of needle biopsy as the gold standard. Results Among the 154 patients， 79 malignant cases （prostate cancer， 51.30%） and 75 benign cases （benign prostatic hyperplasia， 48.70%） were pathologically diagnosed by needle biopsy. The malignant prostate lesions in the TRTE image were mainly manifested as lesions with a predominantly blue core （high stiffness， low strain）， often with green margins or transitions （moderate strain， moderate stiffness）. In MRI images， the lesions primarily exhibited low signal intensity on T2WI， high signal intensity on DWI， and low signal intensity on ADC， and early and obvious enhancement on DCE. Compared with patients with benign lesions， those with malignant lesions exhibited significantly older age and higher mean biopsy frequency， total prostate specific antigen （tPSA）， prostate-specific antigen density （PSAD）， SR scores and PI-RADS score （P < 0.05）. Compared with clinicopathological diagnosis （gold standard）， the diagnostic efficiency of TRTE and MRI based on binary classification showed no statistically significant difference in distinguishing benign from malignant prostate lesions （P > 0.05）. Multivariate logistic regression analysis revealed that after adjusting for age and PSAD， TRTE elasticity score and MRI PI-RADS score were predictive factors for prostate malignancy （P < 0.05）. Consequently， a prostate malignancy risk model was constructed as logit（P） = -0.421 + 0.072 × age + 0.087 × PSAD + 0.181 × elasticity score + 0.358 × PI-RADS V2.1 score. Taking the pathological diagnosis result as the gold standard， the sensitivities of TRTE， MRI and logistic regression model constructed by TRTE combined with MRI in the diagnosis of benign and malignant prostate lesions were 81.01%， 84.81% and 94.94%， and the specificities were 88.00%， 82.67% and 85.33%. The logistic regression model constructed by TRTE combined with MRI had the best diagnostic efficiency （area under the curve of 0，933）. Conclusions The TRTE signs of lesions with a predominantly blue core and the MRI signs of T2WI low signal， DWI high signal， ADC low signal， DCE “fast in and fast out” enhancement are helpful to the diagnosis of benign and malignant prostate lesions. TRTE combined with MRI is helpful to enhance the diagnostic efficiency.