前列腺癌的MRI和MRS診斷

前列腺癌的MRI和MRS診斷北京大學(xué)第一醫(yī)院醫(yī)學(xué)影像科王霄英PekingUniversityFirstHospital前列腺癌的MRI和MRS診斷前列腺概述前列腺癌的MRI診斷前列腺癌的MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺由纖維、肌肉和腺體組織構(gòu)成的腺體PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺的功能分泌前列腺液構(gòu)成精液營養(yǎng)精子PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌來源：前列腺的外周帶發(fā)病率：東西方具有差異美國—75.3/100000為最常見的男性惡性腫瘤發(fā)病率第一位中國—2.41/100000隨著人們飲食習(xí)慣的改變和醫(yī)療水平的發(fā)展，前列腺癌的臨床發(fā)病率逐年增高。PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的臨床表現(xiàn)大多數(shù)病人無癥狀在體檢時發(fā)現(xiàn)在良性前列腺增生手術(shù)標(biāo)本中發(fā)現(xiàn)典型癥狀排尿困難血尿尿潴留病理骨折、骨痛PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的分期分級A期B期C期D期分期和分級決定治療方案和病人的預(yù)后PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的治療方法根治性切除：B期以下非手術(shù)治療：C期以上內(nèi)分泌治療放療冷凍其它PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷手術(shù)并發(fā)癥尿道狹窄尿失禁性功能障礙多器官衰竭復(fù)發(fā)、轉(zhuǎn)移心、腦、肺、血管意外PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌診治的核心問題早期發(fā)現(xiàn)根治性治療長期隨訪PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的常用檢查手段

直腸指診 實驗室檢查

TRUS CT

同位素骨掃描

MRIMRS PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺概述前列腺癌的MRI診斷前列腺癌的MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的MRI檢查技術(shù)體線圈MRI直腸內(nèi)線圈(ERC)MRIFSE序列：T2抑脂顯示病灶更敏感與PPA聯(lián)合使用：顯示范圍更大造影劑增強：動態(tài)增強有意義CT-MRI圖像整合：可用于放療定位PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺的解剖部位：膀胱下方包繞尿道PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺的分帶解剖是MRI診斷的基礎(chǔ)PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷正常前列腺的MRI表現(xiàn)

T2WI（FATSAT）T1WIPekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌病灶的MRI表現(xiàn)

信號改變腫瘤大小和位置PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移分期決定治療PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷

與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移

PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷與前列腺癌分期有關(guān)的表現(xiàn)

突破包膜神經(jīng)血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直腸侵犯淋巴結(jié)轉(zhuǎn)移骨轉(zhuǎn)移PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的分期診斷

TNM分期PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌的分期診斷

Jewett分期

PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷B期以下的前列腺癌

可首選根治性前列腺切除術(shù)！PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷C期以上的前列腺癌

只適合非手術(shù)治療！PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷鑒別診斷前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷鑒別診斷前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌處理后隨訪

活檢后改變手術(shù)后內(nèi)分泌治療后PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌處理后隨訪

活檢后改變手術(shù)后內(nèi)分泌治療后PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺癌處理后隨訪

活檢后改變手術(shù)后內(nèi)分泌治療后PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷前列腺概述前列腺癌的MRI診斷前列腺癌的MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷MRS在前列腺癌診斷中的應(yīng)用

生化研究表明正常和增生的前列腺組織含有較多的枸椽酸鹽，而前列腺癌組織含量很低。所以可使用枸櫞酸鹽的含量為標(biāo)準(zhǔn)來鑒別癌和非癌組織。由于缺乏絕對數(shù)值標(biāo)準(zhǔn)，臨床上常測量枸椽酸鹽、膽堿和肌酐的比率。前列腺癌、BPH和正常前列腺外周帶的膽堿、肌酐和枸櫞酸鹽的比率已有準(zhǔn)確的定量測定結(jié)果，且三者之間幾乎沒有交叉，所以根據(jù)這個比率就可鑒別不同性質(zhì)的病變。另外，將MRS結(jié)果疊加在T2圖像上，可以非常明確地標(biāo)出病灶位置，指導(dǎo)活檢，鑒別治療后復(fù)發(fā)、壞死和BPH，比TRUS和常規(guī)MRI效果更好。PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷MRS檢查技術(shù)直腸內(nèi)線圈序列：3D-PROSEPekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷根據(jù)譜線可做出組織特異性診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷3DMRS可得到代謝圖PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷將代謝圖與解剖圖疊加可得到更直觀的結(jié)果PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷病例1：前列腺輕度增生，外周帶正常。PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷病例2：前列腺癌，位于左側(cè)外周帶，右側(cè)正常。PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷PekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷CitratemapCholinemapPekingUniversityFirstHospital2022/1/12前列腺癌的MRI和MRS診斷病例3：前列腺穿刺活檢術(shù)后。

右側(cè)肯定癌。左側(cè)出血，可疑癌。PekingUnivers