目的 通过随访评估MRI诊断前列腺癌的准确性.方法 对因前列腺特异性抗原(PSA)异常而接受前列腺MR检查的612例患者进行随访.结果 随访对象中396例在MR检查后3个月内接受首次穿刺或手术,其中发现前列腺癌183例.MR检查结果与穿刺或手术后病理结果有显著相关性(χ2=106.04,P<0.05).MR检查诊断准确率75.25%(298/396),敏感度83.06%(152/183),特异度68.54%(146/213),阳性预测值69.41%(152/219),阴性预测值82.48%(146/177).MRI分期为B期者穿刺阳性率为52.21%(59/113),C期、D期者穿刺阳性率分别为86.17%(81/94)和100%(12/12).在213例3个月内穿刺未发现前列腺癌患者中,随访期内新发现前列腺癌12例,其中6例(6/67,8.96%)MRI曾诊断为癌,6例(6/146,4.11%)MRI曾诊断为非癌.612例患者中共发现前列腺癌195例,失访134例.结论 MRI对C期及D期的前列腺癌患者有较大诊断价值;对1次穿刺未发现肿瘤而MRI提示异常的患者需定期复查.%Objective To evaluate the diagnostic accuracy of MR in prostate cancer by using following-up. Methods Totally 612 patients with abnormal prostate specific antigen (PSA) values who had underwent MRI were followed-up. Results During first 3 months after MR examination, histopathological results were obtained in 396 patients through biopsy and transurethral resection of the prostate (TURP), among which 183 patients with tumors were detected. MR results and the results of biopsy and TURP were significantly correlated (x2= 106. 04, P＜0. 05). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI was 75.25 ％ (298/396), 83.06 ％ (152/183), 68. 54 ％ (146/213), 69.41％ (152/219) and 82.48％ (146/177), respectively. The positive biopsy rate of patients whose MRI showed stage B was 52.21％ (59/113), while of stage C and D was 86.17％ (81/94) and 100％ (12/12), respectively. Among 213 patients who had no prostate cancer during 3 months following-up, 12 patients were detected during the following-up period, including 6 (6/67, 8. 96％) diagnosed with MRI and 6 (6/146, 4.11％) misses by MRI. Among 612 patients, 195 patients were detected, while 134 patients were missed during following-up. Conclusion MRI is efficient to patients with stage C or D tumor. If MRI indicates tumor, regular examination is necessary, even though no tumor is found in the first biopsy.
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