Abstract

To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. Patients with serum prostate-specific antigen (PSA) levels of ≥4.0 ng/ml were prospectively enrolled between June 2014 and December 2016. 153 prostate nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CETRUS and RTSE before a biopsy. Multivariate logistic regression models were established for CETRUS, and CETRUS combined with RTSE to diagnose prostate malignancy. The diagnostic performances of CETRUS, RTSE, and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The multivariate logistic regression for CETRUS combined with RTSE showed that enhanced strength, enhanced uniformity, and elasticity scores were the independent predictors of prostate malignancy. The area under the ROC curve of CETRUS combined with RTSE (0.921±0.023) was higher than that of CETRUS and RTSE (0.88±0.029 and 0.80±0.038, respectively; both p<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CETRUS combined with RTSE were 92.1%, 86.2%, and 84.6%, respectively. The omission diagnostic rate of CETRUS combined with RTSE (7.9%) was reduced. And the diagnostic accuracy of CETRUS combined with RTSE was significantly higher than that of CETRUS and RTSE (p<0.05). While the diagnostic accuracy of CETRUS was close to the RTSE, the difference was not statistically significant (p>0.05). The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer.

Highlights

  • To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection

  • The major goal of the current investigation was to evaluate the performance of combined RTSE and CETRUS approach for prostate cancer detection

  • CETRUS combined with RTSE; the regression equation was as follows: the regression equation is Logit (P) =4.809+2.897X1+3.401X2+1.785X5; X1, X2, X5 represent enhanced strength, enhanced uniformity, and elasticity scores, respectively

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Summary

Introduction

To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer. RTSE discriminates hard (solid tumor) from adjacent soft tissue (benign tissue), while CETRUS reveals the vascular pattern of micro-vessels Both CETRUS and RTSE allow targeted biopsy of possibly cancerous tissues, i.e. those that are harder and/or more vascularized. The major goal of the current investigation was to evaluate the performance of combined RTSE and CETRUS approach for prostate cancer detection. CETRUS enables the visualization of prostate areas with abnormal vascularity Adding this information to current gray-scale and RTSE imaging methods might improve the visualization and detection of prostate cancer. We explored whether combined RTSE and CEUS approach in a multiparametric setting would improve cancer visualization before a biopsy

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