前列腺癌的MRI和MRS诊断王宵英课件

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PekingUniversityFirstHospital前列腺癌的MRI和MRS诊断北京大学第一医院PekingU1前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH2前列腺由纤维、肌肉和腺体组织构成的腺体PekingUniversityFirstHospital前列腺由纤维、肌肉和腺体组织构成的腺体PekingUniv3前列腺的功能分泌前列腺液构成精液营养精子PekingUniversityFirstHospital前列腺的功能分泌前列腺液PekingUniversity4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。PekingUniversityFirstHospital前列腺癌来源：前列腺的外周带PekingUniversit5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PekingUniversityFirstHospital前列腺癌的临床表现大多数病人无症状PekingUniver6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PekingUniversityFirstHospital前列腺癌的分期分级A期PekingUniversityF7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PekingUniversityFirstHospital前列腺癌的治疗方法根治性切除：B期以下PekingUniv8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PekingUniversityFirstHospital手术并发症尿道狭窄PekingUniversityFir9前列腺癌诊治的核心问题早期发现根治性治疗长期随访PekingUniversityFirstHospital前列腺癌诊治的核心问题早期发现PekingUniversi10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 MRIMRS PekingUniversityFirstHospital前列腺癌的常用检查手段直肠指诊 PekingUnive11前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH12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PekingUniversityFirstHospital前列腺癌的MRI检查技术体线圈MRIPekingUnive13前列腺的解剖部位：膀胱下方包绕尿道PekingUniversityFirstHospital前列腺的解剖部位：PekingUniversityFir14前列腺的分带解剖是MRI诊断的基础PekingUniversityFirstHospital前列腺的分带解剖是MRI诊断的基础PekingUniver15正常前列腺的MRI表现

T2WI（FATSAT）T1WIPekingUniversityFirstHospital正常前列腺的MRI表现

T2WI（FATSAT）16前列腺癌病灶的MRI表现

信号改变肿瘤大小和位置PekingUniversityFirstHospital前列腺癌病灶的MRI表现

PekingUniversit17PekingUniversityFirstHospitalPekingUniversityFirstHospit18PekingUniversityFirstHospitalPekingUniversityFirstHospit19PekingUniversityFirstHospitalPekingUniversityFirstHospit20PekingUniversityFirstHospitalPekingUniversityFirstHospit21PekingUniversityFirstHospitalPekingUniversityFirstHospit22PekingUniversityFirstHospitalPekingUniversityFirstHospit23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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver24

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

PekingUniversityFirstHospital

与前列腺癌分期有关的表现

突破包膜PekingUnive25PekingUniversityFirstHospitalPekingUniversityFirstHospit26PekingUniversityFirstHospitalPekingUniversityFirstHospit27PekingUniversityFirstHospitalPekingUniversityFirstHospit28PekingUniversityFirstHospitalPekingUniversityFirstHospit29PekingUniversityFirstHospitalPekingUniversityFirstHospit30PekingUniversityFirstHospitalPekingUniversityFirstHospit31PekingUniversityFirstHospitalPekingUniversityFirstHospit32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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver33PekingUniversityFirstHospitalPekingUniversityFirstHospit34PekingUniversityFirstHospitalPekingUniversityFirstHospit35PekingUniversityFirstHospitalPekingUniversityFirstHospit36PekingUniversityFirstHospitalPekingUniversityFirstHospit37PekingUniversityFirstHospitalPekingUniversityFirstHospit38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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver39PekingUniversityFirstHospitalPekingUniversityFirstHospit40PekingUniversityFirstHospitalPekingUniversityFirstHospit41PekingUniversityFirstHospitalPekingUniversityFirstHospit42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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver43PekingUniversityFirstHospitalPekingUniversityFirstHospit44PekingUniversityFirstHospitalPekingUniversityFirstHospit45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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver46PekingUniversityFirstHospitalPekingUniversityFirstHospit47PekingUniversityFirstHospitalPekingUniversityFirstHospit48PekingUniversityFirstHospitalPekingUniversityFirstHospit49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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver50PekingUniversityFirstHospitalPekingUniversityFirstHospit51PekingUniversityFirstHospitalPekingUniversityFirstHospit52PekingUniversityFirstHospitalPekingUniversityFirstHospit53PekingUniversityFirstHospitalPekingUniversityFirstHospit54前列腺癌的分期诊断

TNM分期PekingUniversityFirstHospital前列腺癌的分期诊断

TNM分期PekingUniversi55前列腺癌的分期诊断

Jewett分期

PekingUniversityFirstHospital前列腺癌的分期诊断

Jewett分期

PekingUni56PekingUniversityFirstHospitalPekingUniversityFirstHospit57B期以下的前列腺癌

可首选根治性前列腺切除术！PekingUniversityFirstHospitalB期以下的前列腺癌

可首选根治性前列腺切除术！Peking58C期以上的前列腺癌

只适合非手术治疗！PekingUniversityFirstHospitalC期以上的前列腺癌

只适合非手术治疗！PekingUniv59鉴别诊断前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital鉴别诊断前列腺增生(BPH)PekingUniversit60PekingUniversityFirstHospitalPekingUniversityFirstHospit61PekingUniversityFirstHospitalPekingUniversityFirstHospit62鉴别诊断前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital鉴别诊断前列腺增生(BPH)PekingUniversit63PekingUniversityFirstHospitalPekingUniversityFirstHospit64PekingUniversityFirstHospitalPekingUniversityFirstHospit65前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi66PekingUniversityFirstHospitalPekingUniversityFirstHospit67PekingUniversityFirstHospitalPekingUniversityFirstHospit68PekingUniversityFirstHospitalPekingUniversityFirstHospit69前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi70PekingUniversityFirstHospitalPekingUniversityFirstHospit71PekingUniversityFirstHospitalPekingUniversityFirstHospit72前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi73PekingUniversityFirstHospitalPekingUniversityFirstHospit74前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH75MRS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。PekingUniversityFirstHospitalMRS在前列腺癌诊断中的应用

生化研究表明正常和增生的76MRS检查技术直肠内线圈序列：3D-PROSEPekingUniversityFirstHospitalMRS检查技术直肠内线圈序列：3D-PR77根据谱线可做出组织特异性诊断PekingUniversityFirstHospital根据谱线可做出组织特异性诊断PekingUniversit783DMRS可得到代谢图PekingUniversityFirstHospital3DMRS可得到代谢图PekingUniversityF79将代谢图与解剖图叠加可得到更直观的结果PekingUniversityFirstHospital将代谢图与解剖图叠加可得到更直观的结果PekingUniv80病例1：前列腺轻度增生，外周带正常。PekingUniversityFirstHospital病例1：前列腺轻度增生，外周带正常。PekingUnive81PekingUniversityFirstHospitalPekingUniversityFirstHospit82病例2：前列腺癌，位于左侧外周带，右侧正常。PekingUniversityFirstHospital病例2：前列腺癌，位于左侧外周带，右侧正常。PekingU83PekingUniversityFirstHospitalPekingUniversityFirstHospit84CitratemapCholinemapPekingUniversityFirstHospitalCitratemapCholine85病例3：前列腺穿刺活检术后。

右侧肯定癌。左侧出血，可疑癌。PekingUniversityFirstHospital病例3：前列腺穿刺活检术后。

右侧肯定癌。左侧出血，可疑癌。86PekingUniversityFirstHospitalPekingUniversityFirstHospit87CitratemapCholinemapPekingUniversityFirstHospitalCitratemapCholine88病例4：前列腺近距离放疗后，右叶残留癌，左叶代谢萎缩。PekingUniversityFirstHospital病例4：前列腺近距离放疗后，右叶残留癌，左叶代谢萎缩。Pek89PekingUniversityFirstHospitalPekingUniversityFirstHospit90CholinemapPekingUniversityFirstHospitalCholinemapPekingUniversity91病例5：前列腺根治性切除术后，前列腺癌复发。PekingUniversityFirstHospital病例5：前列腺根治性切除术后，前列腺癌复发。PekingU92PekingUniversityFirstHospitalPekingUniversityFirstHospit93总之：对于前列腺癌MRI根据病灶的信号和形态做出诊断MRS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PekingUniversityFirstHospital总之：对于前列腺癌MRI根据病灶的信号和形态做出诊断Peki94谢

谢！PekingUniversityFirstHospital谢谢！PekingUniversityFirst95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PekingUniversityFirstHospital前列腺癌的MRI和MRS诊断北京大学第一医院PekingU96前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH97前列腺由纤维、肌肉和腺体组织构成的腺体PekingUniversityFirstHospital前列腺由纤维、肌肉和腺体组织构成的腺体PekingUniv98前列腺的功能分泌前列腺液构成精液营养精子PekingUniversityFirstHospital前列腺的功能分泌前列腺液PekingUniversity99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。PekingUniversityFirstHospital前列腺癌来源：前列腺的外周带PekingUniversit100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PekingUniversityFirstHospital前列腺癌的临床表现大多数病人无症状PekingUniver101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PekingUniversityFirstHospital前列腺癌的分期分级A期PekingUniversityF102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PekingUniversityFirstHospital前列腺癌的治疗方法根治性切除：B期以下PekingUniv103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PekingUniversityFirstHospital手术并发症尿道狭窄PekingUniversityFir104前列腺癌诊治的核心问题早期发现根治性治疗长期随访PekingUniversityFirstHospital前列腺癌诊治的核心问题早期发现PekingUniversi105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 MRIMRS PekingUniversityFirstHospital前列腺癌的常用检查手段直肠指诊 PekingUnive106前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH107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PekingUniversityFirstHospital前列腺癌的MRI检查技术体线圈MRIPekingUnive108前列腺的解剖部位：膀胱下方包绕尿道PekingUniversityFirstHospital前列腺的解剖部位：PekingUniversityFir109前列腺的分带解剖是MRI诊断的基础PekingUniversityFirstHospital前列腺的分带解剖是MRI诊断的基础PekingUniver110正常前列腺的MRI表现

T2WI（FATSAT）T1WIPekingUniversityFirstHospital正常前列腺的MRI表现

T2WI（FATSAT）111前列腺癌病灶的MRI表现

信号改变肿瘤大小和位置PekingUniversityFirstHospital前列腺癌病灶的MRI表现

PekingUniversit112PekingUniversityFirstHospitalPekingUniversityFirstHospit113PekingUniversityFirstHospitalPekingUniversityFirstHospit114PekingUniversityFirstHospitalPekingUniversityFirstHospit115PekingUniversityFirstHospitalPekingUniversityFirstHospit116PekingUniversityFirstHospitalPekingUniversityFirstHospit117PekingUniversityFirstHospitalPekingUniversityFirstHospit118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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver119

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

PekingUniversityFirstHospital

与前列腺癌分期有关的表现

突破包膜PekingUnive120PekingUniversityFirstHospitalPekingUniversityFirstHospit121PekingUniversityFirstHospitalPekingUniversityFirstHospit122PekingUniversityFirstHospitalPekingUniversityFirstHospit123PekingUniversityFirstHospitalPekingUniversityFirstHospit124PekingUniversityFirstHospitalPekingUniversityFirstHospit125PekingUniversityFirstHospitalPekingUniversityFirstHospit126PekingUniversityFirstHospitalPekingUniversityFirstHospit127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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver128PekingUniversityFirstHospitalPekingUniversityFirstHospit129PekingUniversityFirstHospitalPekingUniversityFirstHospit130PekingUniversityFirstHospitalPekingUniversityFirstHospit131PekingUniversityFirstHospitalPekingUniversityFirstHospit132PekingUniversityFirstHospitalPekingUniversityFirstHospit133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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver134PekingUniversityFirstHospitalPekingUniversityFirstHospit135PekingUniversityFirstHospitalPekingUniversityFirstHospit136PekingUniversityFirstHospitalPekingUniversityFirstHospit137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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver138PekingUniversityFirstHospitalPekingUniversityFirstHospit139PekingUniversityFirstHospitalPekingUniversityFirstHospit140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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver141PekingUniversityFirstHospitalPekingUniversityFirstHospit142PekingUniversityFirstHospitalPekingUniversityFirstHospit143PekingUniversityFirstHospitalPekingUniversityFirstHospit144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PekingUniversityFirstHospital与前列腺癌分期有关的表现

突破包膜PekingUniver145PekingUniversityFirstHospitalPekingUniversityFirstHospit146PekingUniversityFirstHospitalPekingUniversityFirstHospit147PekingUniversityFirstHospitalPekingUniversityFirstHospit148PekingUniversityFirstHospitalPekingUniversityFirstHospit149前列腺癌的分期诊断

TNM分期PekingUniversityFirstHospital前列腺癌的分期诊断

TNM分期PekingUniversi150前列腺癌的分期诊断

Jewett分期

PekingUniversityFirstHospital前列腺癌的分期诊断

Jewett分期

PekingUni151PekingUniversityFirstHospitalPekingUniversityFirstHospit152B期以下的前列腺癌

可首选根治性前列腺切除术！PekingUniversityFirstHospitalB期以下的前列腺癌

可首选根治性前列腺切除术！Peking153C期以上的前列腺癌

只适合非手术治疗！PekingUniversityFirstHospitalC期以上的前列腺癌

只适合非手术治疗！PekingUniv154鉴别诊断前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital鉴别诊断前列腺增生(BPH)PekingUniversit155PekingUniversityFirstHospitalPekingUniversityFirstHospit156PekingUniversityFirstHospitalPekingUniversityFirstHospit157鉴别诊断前列腺增生(BPH)前列腺肉瘤PekingUniversityFirstHospital鉴别诊断前列腺增生(BPH)PekingUniversit158PekingUniversityFirstHospitalPekingUniversityFirstHospit159PekingUniversityFirstHospitalPekingUniversityFirstHospit160前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi161PekingUniversityFirstHospitalPekingUniversityFirstHospit162PekingUniversityFirstHospitalPekingUniversityFirstHospit163PekingUniversityFirstHospitalPekingUniversityFirstHospit164前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi165PekingUniversityFirstHospitalPekingUniversityFirstHospit166PekingUniversityFirstHospitalPekingUniversityFirstHospit167前列腺癌处理后随访

活检后改变手术后内分泌治疗后PekingUniversityFirstHospital前列腺癌处理后随访

活检后改变PekingUniversi168PekingUniversityFirstHospitalPekingUniversityFirstHospit169前列腺概述前列腺癌的MRI诊断前列腺癌的MRS诊断PekingUniversityFirstHospital前列腺概述PekingUniversityFirstH170MRS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。PekingUniversityFirstHospital