Contrast-enhanced Transrectal Ultrasound Research Articles

Characters of normal prostate and prostate cancer lesions by transrectal contrast enhanced ultrasonography

Objective The aim of the study was to observe the characters and differences of the inner and outer parts of prostate gland, the prostatic cancer lesions in inner and outer parts of prostate glands by transrectal contrast enhanced ultrasonography (TRCEUS) in order to provide valuable information for diagnosing of prostatic cancers.

156 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF STRESS URINARY INCONTINENCE IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY: REPORT OF INITIAL TWO CASES

You have accessJournal of UrologyStem Cell Research1 Apr 2010156 PERIURETHRAL INJECTION OF AUTOLOGOUS ADIPOSE-DERIVED STEM CELLS FOR THE TREATMENT OF STRESS URINARY INCONTINENCE IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY: REPORT OF INITIAL TWO CASES Tokunori Yamamoto, Momokazu Gotoh, Yoshihisa Matsukawa, and Ryouhei Hattori Tokunori YamamotoTokunori Yamamoto More articles by this author , Momokazu GotohMomokazu Gotoh More articles by this author , Yoshihisa MatsukawaYoshihisa Matsukawa More articles by this author , and Ryouhei HattoriRyouhei Hattori More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.209AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To report a novel cell therapy using autologous adipose tissue-derived stem cells (ADSCs) for stress urinary incontinence caused by urethral sphincteric deficiency and the outcomes in 2 initial cases undergoing periurethral injection of stem cells for the treatment of urinary incontinence after radical prostatectomy. METHODS Two patients with moderate stress incontinence following radical prostatectomy were enrolled. After liposuction of 250 ml of adipose tissue from the abdomen, we isolated ADSCs from this tissue by using the CelutionTM system. Subsequently, the isolated ADSCs and a mixture of stem cells and adipose tissue were transurethrally injected into the rhabdosphincter and submucosal space of the urethra, respectively. Unlike other cell therapy strategies, this treatment is all autologous, requires no cell culture and is performed in the context of a single surgical procedure.Outcomes during a 6-month follow-up were assessed by a 24-hours pad test, a validated patient questionnaire, urethral pressure profile, contrast-enhanced transrectal ultrasonography by intravenously injecting perflubutane, and magnetic resonance imaging. The present study was approved by the Ethics Committee of the Nagoya University Graduate School of Medicine, and written informed consent was obtained from the patients. RESULTS Urinary incontinence progressively improved after 2 weeks of injection up to 6 months, in terms of decreased leakage volume in a 24-hour pad test, decreased frequency and amount of incontinence, and improved quality of life as per the questionnaire. One patient achieved total continence 6 months after injection. In urethral pressure profile, both maximum urethral closing pressure and functional profile length increased. Ultrasonography and magnetic resonance imaging demonstrated sustained presence of the injected adipose tissue. Enhanced ultrasonography revealed a progressive increase in the blood flow to the injected area. No significant adverse events were observed peri- and postoperatively. CONCLUSIONS This preliminary study demonstrated that periurethral injection of the autologous ADSCs is a safe and feasible treatment modality for stress urinary incontinence. Nagoya, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e63 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tokunori Yamamoto More articles by this author Momokazu Gotoh More articles by this author Yoshihisa Matsukawa More articles by this author Ryouhei Hattori More articles by this author Expand All Advertisement Advertisement PDF DownloadLoading ...

1116: Pilot Study of Contrast-Enhanced Transrectal Ultrasound for Differential Diagnosis of Prostatic Nodules in the Transition and Peripheral Zones

1116: Pilot Study of Contrast-Enhanced Transrectal Ultrasound for Differential Diagnosis of Prostatic Nodules in the Transition and Peripheral Zones

Contrast-enhanced transrectal ultrasound (CE-TRUS) with cadence-contrast pulse sequence (CPS) technology for the identification of prostate cancer

Objectives Various imaging modalities, such as magnetic resonance imaging (MRI), have been assessed with regard to their value in the detection of prostate cancer (CaP). However, there is a need for less time-consuming and more cost effective procedures in urology. In order to determine the ability of contrast-enhanced transrectal ultrasound (CE-TRUS) to identify CaP, we investigated patients scheduled for radical prostatectomy for CaP and radical cystoprostatectomy for bladder cancer. Material and methods Between May and August 2008, 35 consecutive patients with CaP and muscle-invasive bladder carcinoma were prospectively enrolled in this single center study. All patients underwent B-mode TRUS and CE-TRUS (Sequoia 512 unit with an endocavity probe EV8C4, 8 MHz; Siemens, Erlangen, Germany) by one investigator blinded to any clinical data before radical surgery. Contrast-enhanced images were obtained after intravenous infusion of a bolus (2.4 ml) of the contrast agent SonoVue (Bracco, Milan, Italy). Ultrasound findings (CE-TRUS and B-mode TRUS) were correlated with step-section histology. Results On a per-patient basis, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detecting CaP with CE-TRUS were 71.0%, 50.0%, 91.7%, and 18.2%, respectively. In comparison with B-mode TRUS (sensitivity 45.2%, specificity 75.0%, PPV 93.3%, and NPV 18.0%), CE-TRUS performed significantly better ( P = 0.004, McNemar test). On a per-prostate-lobe basis sensitivity, specificity, PPV, and NPV were 69.0%, 33.3%, 83.3%, and 18.2%. Conclusion CE-TRUS detected prostate cancer with a modest sensitivity and a high PPV in a selected patient cohort. Future randomized-controlled multicenter studies are needed to further validate the value of CE-TRUS in the detection of CaP. Based on our results, CE-TRUS may not be recommended as a routine procedure in the diagnosis of CaP at present.

Experimental study of contrast enhanced transrectal ultrasound for monitoring radiofrequency ablation of prostate

Objective To determine the feasibility and safety of radiofrequeney(RF)ablation of entire prostate guided and monitored by contrast-enhanced transrectal ultrasound(CE-TRUS)in canine model.Methods Contrast ultrasound-guided RF ablation of entire prostate was preformed transrectally using Cool-tiptm electrodes in 7 normal canines under general anesthesia.The urethra/bladder and rectum were protected by infusion of cold distilled water through a Foley catheter and injection of cold distilled water into the prostate-rectum space,respectively.CE-TRUS findings were compared with TTC-stained pathologic results.Results All the 7 canines tolerated the ablation procedures.CE-TRUS clearly demonstrated hypoechoic thermal lesions as avascular/nonperfusion areas.The average number acquired for entire prostate ablation was 4.3(3 to 6).The average ablation volume achieved on pathology was 96.55%.There was no statistically significant difference when compared average ablative volumes between CE-TRUS and TTC-stained pathology[(9.16±5.20)cm3 vs(8.62±3.13)cm3,P=0.583].The coefficient correlation was 0.94(P=0.002).No thermal related injuries were found in anv of the bladder and rectum.The thermal related inj uries of the urethra were less than 1/4 quadrant.Conclusions It is feasible to ablate the entire prostate using RF thermal energy under CE-TRUS guidance.CE-TRUS plays a key role for achieving entire prostate ablation.The urethra and rectum can be protected by cooling of these structures during the procedure. Key words: EndosonograPhy; Microbubbles; Prostate; Catheter ablation

Contrast-Enhanced Transrectal Ultrasound for Assessing Vascularization of Hypoechoic BPH Nodules in the Transition and Peripheral Zones: Comparison with Pathological Examination

The purpose of this study was to investigate the vascularization of zonal location of hypoechoic benign prostatic hyperplasia (BPH) nodules and to evaluate the clinical value of contrast-enhanced transrectal ultrasound (CETRUS) for assessing vascularity of hypoechoic BPH nodules. Sixty-two patients with hypoechoic biopsy-proven BPH nodules in transition zone (TZ) (32 patients) or peripheral zone (PZ) (30 patients) of the prostate gland underwent CETRUS examination between January 2006 and September 2006. The enhancement characteristics of hypoechoic BPH nodules were observed and time to enhancement (AT), time to peak intensity (TTP) and peak intensity (PI) were measured with ACQ time-intensity curve analysis software. In addition, microvessel density (MVD) and vascular endothelial growth factor (VEGF) immunoreactivity were determined in the biopsy specimens. Microvessels were identified by immunohistochemical staining of endothelial cells for CD34. Findings were compared between hypoechoic BPH nodules located in PZ and TZ. The most common enhancement characteristic of hypoechoic BPH nodules in PZ was nonenhanced area inside (21/30), while most of hypoechoic BPH nodules in TZ appeared homogeneous enhancement (28/32). The average AT and TTP were significantly longer, the average PI was significantly lower in hypoechoic BPH nodules located in PZ than TZ ( p < 0.01). The VEGF expression and MVD were significantly higher in hypoechoic BPH nodules located in TZ than PZ ( p < 0.01). PI was found to be an important parameter strongly correlated with degree of vascularity of hypoechoic BPH nodules. Hypoechoic BPH nodules located in PZ and TZ showed significant difference in vascularization, which indirectly verified our finding that BPH nodule could occur in the peripheral zone. CETRUS could afford information on the vascularity of hypoechoic BPH nodules in a noninvasive manner and this could be used to improve selection of nodules for biopsy. (E-mail: yjc301301@163.com)

Peripheral Zone Hypoechoic Lesions of the Prostate

The purpose of this study was to evaluate the efficacy of contrast-enhanced gray scale transrectal ultrasonography (TRUS) for detection of prostate cancer in peripheral zone hypoechoic lesions of the prostate. The study involved 66 patients with peripheral zone hypoechoic lesions detected by TRUS. The lesions were evaluated with contrast-enhanced TRUS to differentiate prostate cancer from benign lesions, and the results were compared with color Doppler ultrasonographic findings. Transrectal ultrasonographically guided biopsy of the hypoechoic lesions revealed prostate cancer in 30 patients and benign prostatic diseases in 36. Flow signals within the lesions were classified as no, increased, equal, and decreased flow compared with surrounding peripheral zone tissue as follows: 1, 16, 12, and 1, respectively, in the prostate cancer group and 10, 12, 10, and 4 in the benign disease group. If we considered an increased flow signal within a peripheral hypoechoic lesion as a sign of prostate cancer, color Doppler ultrasonography had low sensitivity and specificity (55.2% and 53.8%, respectively). The enhancement intensity within the lesions was classified as no, increased, equal, and decreased enhancement compared with surrounding peripheral zone tissue as follows: 2, 20, 3, and 5 in the prostate cancer group and 14, 8, 4, and 10 in the benign disease group. The difference was statistically significant (P<.05). Thus, the peak enhancement intensity would be the optimal parameter for discriminatory performance (area under the receiver operating characteristic curve, 0.74; 95% confidence interval, 0.60-0.88). Contrast-enhanced TRUS could reveal the presence of vasculature within peripheral zone hypoechoic lesions more objectively than color Doppler ultrasonography and could be promising in guidance of prostate biopsy.

Evaluation of transrectal power-Doppler ultrasonography and effect of contrast-enhancement for detecting prostate cancer

There are many reports about the usefulness of transrectal power-Doppler ultrasonography (PDUS) for detecting prostate cancer because of the high microvessel density in cancerous tissue in the prostate. The purpose of this study was to assess the role of PDUS and contrast-enhanced transrectal power-Doppler ultrasonography (enhanced PDUS) in the identification of prostate cancer. One hundred forty-two cases (90 cases without enhancement, 52 cases with enhancement) of suspected prostate cancer found with digital rectal examination (DRE), transrectal ultrasound (TRUS) abnormal or prostate specific antigen (PSA) elevation were evaluated by PDUS and enhanced PDUS. Forty-three (30.3%) cases of cancer were detected, and there was a significant difference (p < 0.05) between PDUS group (22 cases, 24.4%) and enhanced PDUS (21 cases, 40.0%). However, there were no significant statistical results about the usefulness of enhancement to detect prostate cancer although imaging was clear with contrast agent. The results of statistical analysis of PDUS use were almost the same as for PSA of more than 10.1 ng/ml. Combination with PDUS was very helpful to detect prostate cancers. The positive predictive value of the combination with DRE, TRUS and PSA improved from 68.0% to 81.0% with the addition of PDUS. In particular, cancer was revealed frequently (65.8%) in peripheral hypoechoic lesions on gray-scale TRUS with hypervascular areas on PDUS. We conclude that enhancement with contrast agent is not especially useful in the identification of prostate cancer although imaging was clear with contrast agent. However, PDUS is useful especially for hypoechoic peripheral areas. It is suggested that we should add PDUS to DRE, TRUS and PSA examinations.