前列腺癌的MRI和MRS诊断.ppt

1、Peking University First Hospital,A,1,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,Peking University First Hospital 14.10.2020,A,2,前列腺概述 前列腺癌的MRI诊断 前列腺癌的MRS诊断,Peking University First Hospital 14.10.2020,A,3,前列腺,由纤维、肌肉和腺体组织构成的腺体,Peking University First Hospital 14.10.2020,A,4,前列腺的功能,分泌前列腺液 构成精液 营养精子,Peking Unive

2、rsity First Hospital 14.10.2020,A,5,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75.3/100 000 为最常见的男性恶性肿瘤 发病率第一位 中国2.41/100 000 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。,Peking University First Hospital 14.10.2020,A,6,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,Peking University First Hospital 14.

3、10.2020,A,7,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,Peking University First Hospital 14.10.2020,A,8,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,Peking University First Hospital 14.10.2020,A,9,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,Peking University First Hospital 14.10.2020,A,10,前列腺癌诊治的核心问题,

4、早期发现 根治性治疗 长期随访,Peking University First Hospital 14.10.2020,A,11,前列腺癌的常用检查手段,直肠指诊 实验室检查 TRUS CT 同位素骨扫描 MRI MRS,Peking University First Hospital 14.10.2020,A,12,前列腺概述 前列腺癌的MRI诊断 前列腺癌的MRS诊断,Peking University First Hospital 14.10.2020,A,13,前列腺癌的MRI检查技术,体线圈MRI 直肠内线圈(ERC)MRI FSE序列：T2抑脂显示病灶更敏感 与PPA联合使用：显示

5、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,Peking University First Hospital 14.10.2020,A,14,前列腺的解剖,部位： 膀胱下方 包绕尿道,Peking University First Hospital 14.10.2020,A,15,前列腺的分带解剖是MRI诊断的基础,Peking University First Hospital 14.10.2020,A,16,正常前列腺的MRI表现T2WI（FATSAT） T1WI,Peking University First Hospital 14.10.2020,A,1

6、7,前列腺癌病灶的MRI表现,信号改变 肿瘤大小和位置,Peking University First Hospital 14.10.2020,A,18,Peking University First Hospital 14.10.2020,A,19,Peking University First Hospital 14.10.2020,A,20,Peking University First Hospital 14.10.2020,A,21,Peking University First Hospital 14.10.2020,A,22,Peking University First Hos

7、pital 14.10.2020,A,23,Peking University First Hospital 14.10.2020,A,24,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,Peking University First Hospital 14.10.2020,A,25,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,Peking University First Hospital 14.10.2020,A,26,Peking Uni

8、versity First Hospital 14.10.2020,A,27,Peking University First Hospital 14.10.2020,A,28,Peking University First Hospital 14.10.2020,A,29,Peking University First Hospital 14.10.2020,A,30,Peking University First Hospital 14.10.2020,A,31,Peking University First Hospital 14.10.2020,A,32,Peking Universit

9、y First Hospital 14.10.2020,A,33,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,Peking University First Hospital 14.10.2020,A,34,Peking University First Hospital 14.10.2020,A,35,Peking University First Hospital 14.10.2020,A,36,Peking University First Hospital 14.10.2020,A,37,Peking Univers

10、ity First Hospital 14.10.2020,A,38,Peking University First Hospital 14.10.2020,A,39,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,Peking University First Hospital 14.10.2020,A,40,Peking University First Hospital 14.10.2020,A,41,Peking University First Hospital 14.10.2020,A,42,Peking Unive

11、rsity First Hospital 14.10.2020,A,43,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,Peking University First Hospital 14.10.2020,A,44,Peking University First Hospital 14.10.2020,A,45,Peking University First Hospital 14.10.2020,A,46,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,Pe

12、king University First Hospital 14.10.2020,A,47,Peking University First Hospital 14.10.2020,A,48,Peking University First Hospital 14.10.2020,A,49,Peking University First Hospital 14.10.2020,A,50,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,Peking University First Hospital 14.10.2020,A,51,

13、Peking University First Hospital 14.10.2020,A,52,Peking University First Hospital 14.10.2020,A,53,Peking University First Hospital 14.10.2020,A,54,Peking University First Hospital 14.10.2020,A,55,前列腺癌的分期诊断,TNM分期,Peking University First Hospital 14.10.2020,A,56,前列腺癌的分期诊断,Jewett分期,Peking University Fi

14、rst Hospital 14.10.2020,A,57,Peking University First Hospital 14.10.2020,A,58,B期以下的前列腺癌可首选根治性前列腺切除术！,Peking University First Hospital 14.10.2020,A,59,C期以上的前列腺癌只适合非手术治疗！,Peking University First Hospital 14.10.2020,A,60,鉴别诊断,前列腺增生(BPH) 前列腺肉瘤,Peking University First Hospital 14.10.2020,A,61,Peking Univ

15、ersity First Hospital 14.10.2020,A,62,Peking University First Hospital 14.10.2020,A,63,鉴别诊断,前列腺增生(BPH) 前列腺肉瘤,Peking University First Hospital 14.10.2020,A,64,Peking University First Hospital 14.10.2020,A,65,Peking University First Hospital 14.10.2020,A,66,前列腺癌处理后随访,活检后改变 手术后 内分泌治疗后,Peking University

16、 First Hospital 14.10.2020,A,67,Peking University First Hospital 14.10.2020,A,68,Peking University First Hospital 14.10.2020,A,69,Peking University First Hospital 14.10.2020,A,70,前列腺癌处理后随访,活检后改变 手术后 内分泌治疗后,Peking University First Hospital 14.10.2020,A,71,Peking University First Hospital 14.10.2020,A

17、,72,Peking University First Hospital 14.10.2020,A,73,前列腺癌处理后随访,活检后改变 手术后 内分泌治疗后,Peking University First Hospital 14.10.2020,A,74,Peking University First Hospital 14.10.2020,A,75,前列腺概述 前列腺癌的MRI诊断 前列腺癌的MRS诊断,Peking University First Hospital 14.10.2020,A,76,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

18、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。,Peking University First Hospital 14.10.2020,A,77,MRS检查技术,直肠内线圈 序列：3D-PROSE,Peking Universit

19、y First Hospital 14.10.2020,A,78,根据谱线可做出组织特异性诊断,Peking University First Hospital 14.10.2020,A,79,3DMRS可得到代谢图,Peking University First Hospital 14.10.2020,A,80,将代谢图与解剖图叠加可得到更直观的结果,Peking University First Hospital 14.10.2020,A,81,病例1：前列腺轻度增生，外周带正常。,Peking University First Hospital 14.10.2020,A,82,Peking University First Hospital 14.10.2020,A,83,病例2：前列腺癌，位于左侧外周带，右侧正常。,Peking University First Hospital 14.10.2020,A,84,Peking University First Hospital 14.10.2020,A,85,Citrate map Choline map,Peking Universit