前列腺癌的MRI和MRS诊断

PekingUniversityFirstHospital,.,前列腺癌的MRI和MRS诊断,北京大学第一医院医学影像科王霄英,PekingUniversityFirstHospital08.05.2020,.,前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断,PekingUniversityFirstHospital08.05.2020,.,前列腺,由纤维、肌肉和腺体组织构成的腺体,PekingUniversityFirstHospital08.05.2020,.,前列腺的功能,分泌前列腺液构成精液营养精子,PekingUniversityFirstHospital08.05.2020,.,前列腺癌,来源：前列腺的外周带发病率：东西方具有差异美国75.3/100000为最常见的男性恶性肿瘤发病率第一位中国2.41/100000随着人们饮食习惯的改变和医疗水平的发展，前列腺癌的临床发病率逐年增高。,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的临床表现,大多数病人无症状在体检时发现在良性前列腺增生手术标本中发现典型症状排尿困难血尿尿潴留病理骨折、骨痛,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的分期分级,A期B期C期D期分期和分级决定治疗方案和病人的预后,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的治疗方法,根治性切除：B期以下非手术治疗：C期以上内分泌治疗放疗冷冻其它,PekingUniversityFirstHospital08.05.2020,.,手术并发症,尿道狭窄尿失禁性功能障碍多器官衰竭复发、转移心、脑、肺、血管意外,PekingUniversityFirstHospital08.05.2020,.,前列腺癌诊治的核心问题,早期发现根治性治疗长期随访,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的常用检查手段,直肠指诊实验室检查TRUSCT同位素骨扫描MRIMRS,PekingUniversityFirstHospital08.05.2020,.,前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的MRI检查技术,体线圈MRI直肠内线圈(ERC)MRIFSE序列：T2抑脂显示病灶更敏感与PPA联合使用：显示范围更大造影剂增强：动态增强有意义CT-MRI图像整合：可用于放疗定位,PekingUniversityFirstHospital08.05.2020,.,前列腺的解剖,部位：膀胱下方包绕尿道,PekingUniversityFirstHospital08.05.2020,.,前列腺的分带解剖是MRI诊断的基础,PekingUniversityFirstHospital08.05.2020,.,正常前列腺的MRI表现T2WI（FATSAT）T1WI,PekingUniversityFirstHospital08.05.2020,.,前列腺癌病灶的MRI表现,信号改变肿瘤大小和位置,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移分期决定治疗,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,与前列腺癌分期有关的表现,突破包膜神经血管束侵犯精囊侵犯膀胱侵犯盆底肌侵犯直肠侵犯淋巴结转移骨转移,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的分期诊断,TNM分期,PekingUniversityFirstHospital08.05.2020,.,前列腺癌的分期诊断,Jewett分期,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,B期以下的前列腺癌可首选根治性前列腺切除术！,PekingUniversityFirstHospital08.05.2020,.,C期以上的前列腺癌只适合非手术治疗！,PekingUniversityFirstHospital08.05.2020,.,鉴别诊断,前列腺增生(BPH)前列腺肉瘤,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,鉴别诊断,前列腺增生(BPH)前列腺肉瘤,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,前列腺癌处理后随访,活检后改变手术后内分泌治疗后,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,前列腺癌处理后随访,活检后改变手术后内分泌治疗后,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,前列腺癌处理后随访,活检后改变手术后内分泌治疗后,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断,PekingUniversityFirstHospital08.05.2020,.,MRS在前列腺癌诊断中的应用,生化研究表明正常和增生的前列腺组织含有较多的枸椽酸盐，而前列腺癌组织含量很低。所以可使用枸橼酸盐的含量为标准来鉴别癌和非癌组织。由于缺乏绝对数值标准，临床上常测量枸椽酸盐、胆碱和肌酐的比率。前列腺癌、BPH和正常前列腺外周带的胆碱、肌酐和枸橼酸盐的比率已有准确的定量测定结果，且三者之间几乎没有交叉，所以根据这个比率就可鉴别不同性质的病变。另外，将MRS结果叠加在T2图像上，可以非常明确地标出病灶位置，指导活检，鉴别治疗后复发、坏死和BPH，比TRUS和常规MRI效果更好。,PekingUniversityFirstHospital08.05.2020,.,MRS检查技术,直肠内线圈序列：3D-PROSE,PekingUniversityFirstHospital08.05.2020,.,根据谱线可做出组织特异性诊断,PekingUniversityFirstHospital08.05.2020,.,3DMRS可得到代谢图,PekingUniversityFirstHospital08.05.2020,.,将代谢图与解剖图叠加可得到更直观的结果,PekingUniversityFirstHospital08.05.2020,.,病例1：前列腺轻度增生，外周带正常。,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,病例2：前列腺癌，位于左侧外周带，右侧正常。,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,CitratemapCholinemap,PekingUniversityFirstHospital08.05.2020,.,病例3：前列腺穿刺活检术后。右侧肯定癌。左侧出血，可疑癌。,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityFirstHospital08.05.2020,.,CitratemapCholinemap,PekingUniversityFirstHospital08.05.2020,.,病例4：前列腺近距离放疗后，右叶残留癌，左叶代谢萎缩。,PekingUniversityFirstHospital08.05.2020,.,PekingUniversityF