前列腺癌的MRI和MRS诊断王宵英演示课件.ppt

Peking University First HospitalPeking University First Hospital前列腺癌的前列腺癌的MRIMRI和和MRSMRS诊断诊断北京大学第一医院北京大学第一医院医学影像科医学影像科王霄英王霄英Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺概述前列腺概述前列腺癌的前列腺癌的MRIMRI诊断诊断前列腺癌的前列腺癌的MRSMRS诊断诊断Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺前列腺由纤维、肌肉和腺体组织构成的腺体Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺的功能前列腺的功能分泌前列腺液构成精液营养精子Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌前列腺癌来源：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 HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的临床表现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 HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的分期分级前列腺癌的分期分级A A期期B B期期C C期期D D期期分期和分级决定治疗方案和病人的预后分期和分级决定治疗方案和病人的预后Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的治疗方法前列腺癌的治疗方法根治性切除：根治性切除：B期以下期以下非手术治疗：非手术治疗：C期以上期以上内分泌治疗放疗冷冻其它Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital手术并发症手术并发症尿道狭窄尿道狭窄尿失禁尿失禁性功能障碍性功能障碍多器官衰竭多器官衰竭复发、转移复发、转移心、脑、肺、血管意外心、脑、肺、血管意外Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌诊治的核心问题前列腺癌诊治的核心问题早期发现早期发现根治性治疗根治性治疗长期随访长期随访Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的常用检查手段前列腺癌的常用检查手段 直肠指诊直肠指诊 实验室检查实验室检查 TRUSTRUS CT CT 同位素骨扫描同位素骨扫描 MRIMRI MRS MRSPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺概述前列腺概述前列腺癌的前列腺癌的MRIMRI诊断诊断前列腺癌的前列腺癌的MRSMRS诊断诊断Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的前列腺癌的MRIMRI检查技术检查技术体线圈体线圈MRIMRI直肠内线圈直肠内线圈(ERC)MRI(ERC)MRIFSEFSE序列：序列：T2T2抑脂显示病灶更敏感抑脂显示病灶更敏感与与PPAPPA联合使用：显示范围更大联合使用：显示范围更大造影剂增强：动态增强有意义造影剂增强：动态增强有意义CT-MRICT-MRI图像整合：可用于放疗定位图像整合：可用于放疗定位Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺的解剖前列腺的解剖部位：膀胱下方包绕尿道Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺的分带解剖是前列腺的分带解剖是MRIMRI诊断的基础诊断的基础Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital正常前列腺的正常前列腺的MRIMRI表现表现T2WIT2WI（FATSATFATSAT）T1WIT1WIPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌病灶的前列腺癌病灶的MRIMRI表现表现 信号改变信号改变肿瘤大小和位置肿瘤大小和位置Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移分期决定治疗分期决定治疗Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalTHANK YOUSUCCESS2024/5/7 2024/5/7 周二周二周二周二49可编辑Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital与前列腺癌分期有关的表现与前列腺癌分期有关的表现突破包膜突破包膜神经血管束侵犯神经血管束侵犯精囊侵犯精囊侵犯膀胱侵犯膀胱侵犯盆底肌侵犯盆底肌侵犯直肠侵犯直肠侵犯淋巴结转移淋巴结转移骨转移骨转移Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的分期诊断前列腺癌的分期诊断TNMTNM分期分期Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌的分期诊断前列腺癌的分期诊断JewettJewett分期分期Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalB B期以下的前列腺癌期以下的前列腺癌可首选根治性前列腺可首选根治性前列腺切除术！切除术！Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalC C期以上的前列腺癌期以上的前列腺癌只适合非手术治疗！只适合非手术治疗！Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital鉴别诊断鉴别诊断前列腺增生前列腺增生(BPH)(BPH)前列腺肉瘤前列腺肉瘤Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital鉴别诊断鉴别诊断前列腺增生前列腺增生(BPH)(BPH)前列腺肉瘤前列腺肉瘤Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌处理后随访前列腺癌处理后随访活检后改变活检后改变手术后手术后内分泌治疗后内分泌治疗后Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌处理后随访前列腺癌处理后随访活检后改变活检后改变手术后手术后内分泌治疗后内分泌治疗后Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺癌处理后随访前列腺癌处理后随访活检后改变活检后改变手术后手术后内分泌治疗后内分泌治疗后Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital前列腺概述前列腺概述前列腺癌的前列腺癌的MRIMRI诊断诊断前列腺癌的前列腺癌的MRSMRS诊断诊断Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital MRS MRS在前列腺癌诊断中的应用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。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalMRSMRS检查技术检查技术直肠内线圈 序列：3D-PROSEPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital根据谱线可做出组织特异性诊断根据谱线可做出组织特异性诊断Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital3DMRS3DMRS可得到代谢图可得到代谢图Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital将代谢图与解剖图叠加可得到更将代谢图与解剖图叠加可得到更直观的结果直观的结果Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital病例病例1 1：前列腺轻度增生，外周带正常。：前列腺轻度增生，外周带正常。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital病例2：前列腺癌，位于左侧外周带，右侧正常。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital Citrate map Choline mapPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital病例病例3 3：前列腺穿刺活检术后。：前列腺穿刺活检术后。右侧肯定癌。左侧出血，可疑癌。右侧肯定癌。左侧出血，可疑癌。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital Citrate map Choline mapPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital病例病例4 4：前列腺近距离放疗后，右：前列腺近距离放疗后，右叶残留癌，左叶代谢萎缩。叶残留癌，左叶代谢萎缩。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalCholine map Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital病例病例5 5：前列腺根治性切除术后，：前列腺根治性切除术后，前列腺癌复发。前列腺癌复发。Peking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First HospitalPeking University First Hospital总之：总之：对于前列腺癌对于前列腺癌MRIMRI根据病灶的信号和形态做出诊断根据病灶的信号和形态做出诊断MRSMRS根据病灶的代谢信息做出诊断根据病灶的代谢信息做出诊断将二者结合能提高诊断的准确率将二者结合能提高诊断的准确率Peking University First HospitalPeking Uni