探讨超声应变力弹性成像（SUE）联合磁共振扩散加权成像（MRI-DWI）靶向引导穿刺诊断前列腺病变的价值。

前瞻性收集2019年5月至2022年5月于惠州市中心人民医院就诊的疑似前列腺占位性病变患者为研究对象，患者穿刺前均进行直肠超声、SUE、MRI-DWI检查，记录可疑区域；患者均进行直肠超声引导下经直肠前列腺系统穿刺，同时对SUE联合MRI-DWI检查的可疑病灶进行靶向穿刺。记录影像学特征；以病理结果为“金标准”，比较系统穿刺与靶向穿刺的阳性检出情况；绘制表观扩散系数（ADC）值的受试者工作特征（ROC）曲线，分析ADC值诊断前列腺病变的价值；同时比较两种穿刺活检方案的Gleason评分情况。

共105例疑似前列腺占位性病变患者纳入本次研究，其中2例因自身心理原因不配合穿刺退出研究，最终103例患者纳入本次研究。103例患者均成功穿刺并取材送检，其中病理诊断为前列腺癌66例，占64.08%（66/103），均为腺癌；良性前列腺增生为37例，占35.92%（37/103），其中2例合并上皮内瘤变。MRI-DWI联合SUE共59例患者为恶性病变，其中MRI-DWI检查为55例，而SUE检查为57例为恶性病变。在恶性病变患者中MRI-DWI检查T2WI可见病灶，出现结节状低信号，DWI图像成呈高信号，ADC图显示ADC值较小；SUE检查可发现蓝色硬度增高区。直肠超声系统穿刺的恶性病变检查率为48.54%，SUE联合MRI-DWI靶向引导穿刺为57.28%；两者比较，差异无统计学意义（P>0.05）。系统穿刺法共穿刺了1181针，其中病理诊断为恶性病变共379针，单针检出率为32.09%；SUE联合MRI-DWI靶向引导共穿刺218针，病理诊断为恶性病变共136针，单针检出率为62.38%，靶向引导穿刺的单针检出率明显高于系统穿刺（P<0.05）。恶性病变者中ADC值为（1.18±0.17）mm²/s，良性病变者中ADC值为（1.42±0.23）mm²/s，恶性病变者ADC值小于良性病变者（t=6.303，P<0.001）。ADC诊断前列腺恶性病变的曲线下面积（AUC）为0.816（95%CI：0.718~0.914），将ADC值取1.34 mm²/s作为界点评估前列腺良恶性病变的敏感度、特异度为为83.33%、67.57%。两种穿刺方案的Gleason评分情况比较，差异无统计学意义（P>0.05）。

与系统穿刺相比，SUE联合MRI-DWI靶向引导穿刺可通过较少的穿刺针数获得相似的前列腺恶性病变检出率，且穿刺的阳性率较高。

To explore the value of ultrasound strain elastography (SUE) combined with magnetic resonance diffusion-weighted imaging (MRI-DWI) guided targeted puncture in the diagnosis of prostate lesions.

Patients with suspected prostate space-occupying lesions who were treated at Huizhou Central People's Hospital from May 2019 to May 2022 were prospectively collected as the research subjects. Rectal ultrasound, SUE, and MRI-DWI were performed before puncture, and the suspicious areas were recorded. All patients underwent transrectal systematic prostate puncture under the guidance of rectal ultrasound, and targeted puncture of suspicious lesions under the guidance of SUE combined with MRI-DWI. The imaging characteristics were recorded. Taking the pathological results as the "gold standard", the positive detection rates by systematic puncture and targeted puncture were compared. The receiver operating characteristic (ROC) curve of apparent diffusion coefficient (ADC) was plotted to analyze the value of ADC in diagnosing prostate lesions. The Gleason scores of the two puncture biopsy schemes were compared.

A total of 105 patients with suspected prostate space-occupying lesions were included in this study, of which two withdrew from the study due to their own psychological reasons. Finally, 103 patients were included in this study. All 103 patients were successfully punctured and sampled for examination, among which 66 (64.08%) were pathologically diagnosed with prostate cancer (all were adenocarcinoma). There were 37 cases of benign prostatic hyperplasia, accounting for 35.92% (37/103), of which two were accompanied by intraepithelial neoplasia. A total of 59 patients were diagnosed with malignant lesions, including 55 cases by MRI-DWI and 57 cases by SUE. In patients with malignant lesions, MRI-DWI examination (T2WI) showed that the lesions had nodular low signal, DWI showed high signal, ADC map showed that the ADC value was low, and SUE examination can find a blue area with increased hardness. The malignant lesion detection rate by systematic puncture was 48.54%, and that of SUE combined with MRI-DWI targeted guided puncture was 57.28%; there was no statistical significant difference between them (P>0.05). A total of 1181 needles were used in systematic puncture, of which 379 achieved a pathological diagnosis of malignant lesions, with a single needle detection rate of 32.09%. A total of 218 needles were punctured under the guidance of SUE and MRI-DWI, and 136 needles achieved a pathological diagnosis of malignant lesions, with a single needle detection rate of 62.38%. The single needle detection rate by targeted guidance puncture was significantly higher than that by systematic puncture (P<0.05). The ADC value in malignant lesions was (1.18±0.17) mm²/s, while in benign lesions it was (1.42±0.23) mm²/s; the ADC value in malignant lesions was lower than that in benign lesions (t=6.303, P<0.001). The area under the curve (AUC) of ADC for diagnosis of benign and malignant prostatic lesions was 0.816 (95%CI: 0.718-0.914). The sensitivity and specificity of evaluating benign and malignant prostatic lesions using an ADC value of 1.34 mm²/s as the cutoff point were 83.33% and 67.57%, respectively. There was no statistical significant difference in Gleason scores between the two puncture schemes (P>0.05).

Compared with systematic puncture, SUE combined with MRI-DWI guided targeted puncture can obtain a similar detection rate of prostate malignant lesions with less puncture needles and a higher positive rate of puncture.