经直肠实时组织弹性成像联合MRI在前列腺良恶性病变诊断中的应用及影像学特点

doi:10.3969/j.issn.1006-5725.2026.06.021

Abstract

Abstract:

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.

Key words: prostate lesions, transrectal real-time tissue elastography, magnetic resonance imaging, imaging characteristics, diagnose

CLC Number:

R445

Kai LI,Xing WANG,Zhijun ZENG,Xu CHENG,Bo SHI. Application and imaging characteristics of transrectal real-time tissue elastography combined with MRI in the diagnosis of benign and malignant prostate lesions[J]. The Journal of Practical Medicine, 2026, 42(6): 1070-1077.

Figures/Tables 9

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References 27

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病理诊断	TRTE影像学特点	例数	MRI影像学特点	例数
恶性（n = 79）	病灶区全蓝色或大部分为蓝色	57	T2WI病灶区低信号	67
	病灶区见局部蓝色区域	7	T1WI病灶区周边脂肪不对称或者消失	24
	病灶区夹杂少许蓝色	13	DWI高信号、ADC低信号	67
	病灶区无蓝色	2	增强早期强化明显	62
			T2WI等信号、DWI低信号	12
良性（n = 75）	病灶区大部分为绿色	60	T2WI呈现均匀高信号	62
	病灶区夹杂少许蓝色	6	T2WI低信号	13
	病灶区见局部蓝色区域	9	增强扫描未见明显强化	75

项目	例数	年龄（x ± s）/岁	平均穿刺针数（x ± s）/针	tPSA/（ng/mL）	PSAD	弹性评分/分	PI-RADS V2.1/分
恶性	79	71.76 ± 6.49	13.40 ± 0.60	41.58（8.36，231.88）	0.62（0.13，3.68）	4（2，4）	4（2，4）
良性	75	68.47 ± 5.83	12.50 ± 0.80	12.42（4.62，32.14）	0.17（0.06，0.40）	1（1，2）	2（1，2）
t/Z值		3.303	7.924	7.628	5.494	5.832	6.927
P值		0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001

方法	敏感度	特异度	准确率	阳性预测值	阴性预测值
TRTE	81.01（64/79）	88.00（66/75）	84.42（130/154）	87.67（64/73）	81.48（66/81）
MRI	84.81（67/79）	82.67（62/75）	83.77（129/154）	83.75（67/80）	83.78（62/74）

变量	β	SE	Wald	P值	OR	95%CI
年龄	0.072	0.038	3.590	0.059	1.078	0.998 ~ 1.158
PSAD	0.087	0.029	9.000	0.003	1.091	1.031 ~ 1.155
弹性评分	0.181	0.065	7.754	0.006	1.198	1.055 ~ 1.361
PI-RADS V2.1	0.358	0.126	8.073	0.005	1.430	1.117 ~ 0.831
常数项	-0.421	0.107	15.481	< 0.001

方法	AUC	标准误	95%CI
TRTE	0.845	0.0292	0.778 ~ 0.898
MRI	0.837	0.0299	0.769 ~ 0.892
TRTE联合MRI模型	0.933	0.0200	0.881 ~ 0.967

Application and imaging characteristics of transrectal real-time tissue elastography combined with MRI in the diagnosis of benign and malignant prostate lesions

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检查方式		临床病理		合计
检查方式		恶性	良性	合计
合计		79	75	154
TRTE	恶性	64	9	73
	良性	15	66	81
MRI	恶性	67	13	80
	良性	12	62	74

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