经高强度聚焦超声（HIFU）治疗前列腺后的随访，采用对比增强超声（CEUS）联合 MRI 图像融合。
Follow-up after focal therapy of the prostate with high intensity focused ultrasound (HIFU) using contrast enhanced ultrasound (CEUS) in combination with MRI image fusion.
机构信息
Department of Urology, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University Hospital Grosshadern, Ludwig-Maximilians-University Munich, Munich, Germany.
出版信息
Clin Hemorheol Microcirc. 2019;73(1):135-143. doi: 10.3233/CH-199222.
INTRODUCTION
Focal therapy (FT) of the prostate for low risk prostate cancer (PCa) is an alternative to traditional definite treatment options like external beam radiotherapy or radical prostatectomy. However, follow up after FT is still challenging and is subject to current studies. Significance of imaging after FT such as multiparametric MRI (mpMRI) is currently not well established. In this study, we aimed to evaluate the efficacy of alternative imaging during the follow up of low risk PCa treated with focal HIFU therapy using CEUS and image fusion.
MATERIALS AND METHODS
Retrospective single arm study in patients with uni- or bilateral, low or intermediate risk prostate cancer treated with HIFU at our institution between October 2016 and January 2018. CEUS in combination with image fusion using an axial T2-weighted MRI sequence was performed during follow up 3, 6, 9 and 12 months after the therapy.
RESULTS
4 consecutive patients with Gleason score (GS) 6 and 4 patients with GS 7a prostate cancer were included in the study. Hemiablation was performed in 7 patients with unilateral tumor. One patient underwent whole gland treatment due to histological proven bilateral PCa. Mean patient age at time of therapy was 70.3 (54-83) years and mean Prostate-specific antigen (PSA) level prior treatment was 7.8 ng/ml (2.1-14.4), after 3 months mean PSA level was 3.9 ng/ml (0.1-7.2), after 6 months 3.5 ng/ml (0.2-6.0), after 9 months 3.1 ng/ml (0.2-6.8) and 3.3 ng/ml (0.2-6.1) after 12 months. CEUS showed no signs of microvascularisation after 3, 6, 9 and 12 months in the ablated zone. 3 months posttreatment the necrotic tissue was still visible in the B-mode scan, although with no signs of vascularization performing CEUS. After 6 months the ablated side of the prostate was almost completely atrophic. And after 9 months the necrotic tissue was completely resolved. Between 9 and 12 months no changes in microvascularisation and perfusion could be shown.
CONCLUSIONS
MpMRI/CEUS image fusion is a cost-effective and feasible technique to monitor the perfusion of the ablation zone after focal therapy of the prostate.
介绍
对于低危前列腺癌（PCa），前列腺的局部治疗（FT）是传统确定性治疗方法（如外束放射治疗或根治性前列腺切除术）的替代方法。然而，FT 后的随访仍然具有挑战性，并且还受到当前研究的限制。FT 后成像的意义，如多参数 MRI（mpMRI），目前尚未得到充分证实。在这项研究中，我们旨在评估使用 CEUS 和图像融合对低危 PCa 进行局部 HIFU 治疗后的替代成像在随访中的疗效。
材料和方法
回顾性单臂研究，纳入 2016 年 10 月至 2018 年 1 月期间在我院接受 HIFU 治疗的单侧或双侧、低危或中危前列腺癌患者。在治疗后 3、6、9 和 12 个月进行 CEUS 检查，并结合轴向 T2 加权 MRI 序列进行图像融合。
结果
本研究纳入了 4 例 Gleason 评分（GS）为 6 分和 4 例 GS 为 7a 分的前列腺癌患者。7 例单侧肿瘤患者行半侧切除术。1 例因组织学证实双侧 PCa 而行全腺治疗。治疗时患者的平均年龄为 70.3（54-83）岁，治疗前 PSA 水平平均为 7.8ng/ml（2.1-14.4），治疗后 3 个月 PSA 水平为 3.9ng/ml（0.1-7.2），6 个月时为 3.5ng/ml（0.2-6.0），9 个月时为 3.1ng/ml（0.2-6.8），12 个月时为 3.3ng/ml（0.2-6.1）。CEUS 在治疗后 3、6、9 和 12 个月时在消融区域均未显示微血管化迹象。治疗后 3 个月，B 模式扫描仍可见坏死组织，但 CEUS 未见血管化。治疗后 6 个月，前列腺消融侧几乎完全萎缩。治疗后 9 个月，坏死组织完全消退。9 至 12 个月时，未见微血管化和灌注的变化。
结论
mpMRI/CEUS 图像融合是一种经济有效的监测前列腺局部治疗后消融区域灌注的技术。
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