Contrast-enhanced Transrectal Ultrasound Research Articles

The correlation between time-intensity curve parameters of transrectal contrast-enhanced ultrasound and pathological prognostic factors in rectal adenocarcinoma.

To investigate the correlation between time-intensity curve (TIC) parameters obtained from transrectal contrast-enhancedultrasound (TR-CEUS) and important pathological prognostic factors in rectal adenocarcinoma. We retrospectively included 477 patients with pathologically confirmed rectal adenocarcinoma. TIC parameters werederived from preoperative dynamic TR-CEUS images. These parameters included peak intensity (PI), time to peak (TTP),mean transit time (MTT), slope (S), and area under the curve (AREA). Pathological prognostic factors included TN stage,tumor diameter, lymphovascular invasion (LVI), perineural invasion, and tumor differentiation. Spearman's correlation analysisand binary logistic regression were used to analyze the association between TIC parameters and pathological prognosticfactors. pT1-2 stages rectal carcinomas exhibited higher PI-max, PI-min, S-max, S-min, AREA-max, and AREA-minthan pT3-4 stages (all p<0.05). pN0 stage rectal adenocarcinomas displayed higher PI-max, S-max, AREA-max, PI-ratio, Sratio,and AREA-ratio than pN1-2 stage (all p<0.05). PI-ratio and S-ratio were higher in the LVI-negative and tumor diameter≥4cm group compared to the LVI-positive and tumor diameter <4cm group, respectively (p<0.05). Well-differentiated rectaladenocarcinomas displayed higher PI-max, AREA-max, PI-ratio, S-ratio, and AREA-ratio than the moderate-poor differentiatedgroup (all p<0.05). PI-max, S-max, AREA-max, PI-ratio, S-ratio, and AREA-ratio were negatively correlated with pNstage (all p<0.05). PI-ratio and S-ratio were independent predictive factors for the pN stage (OR=0.774, OR=1.048). S-ratioand AREA-ratio were independent predictive factors for tumor differentiation (OR=1.071, OR=0.911). TIC parametersderived from TR-CEUS exhibit correlations with specific pathological prognostic factors in rectal adenocarcinomas.This non-invasive method may hold promise for preoperatively assessing the prognosis of rectal adenocarcinoma patients.

Contrast-Enhanced Ultrasonography for Transabdominal and Transrectal Ultrasound in Staging Cervical Cancer: A Reliability Study.

This retrospective study aimed to evaluate the consistency of transrectal contrast-enhanced ultrasonography (TR-CEUS) with post-operative pathology and the value of contrast-enhanced ultrasonography (CEUS) in staging surgically treated cervical cancer when combined with conventional ultrasonography (US). From October 2020 to March 2023, hospitalized patients with stage IB and II cervical cancer confirmed by total hysterectomy were consecutively enrolled. The standard images of US and CEUS by transabdominal (TA-US/CEUS) and transrectal (TR-US/CEUS) approaches and magnetic resonance imaging (MRI) were acquired, on which the size and stage of the tumors were evaluated, and the consistency of results with the pathological specimen was analyzed. Thirty-nine patients with cervical cancer were finally enrolled in this study. The results showed that CEUS significantly improved the reliability of TA-US in evaluating tumor diameter; the intraclass correlation coefficient (ICC) was from 0.672 to 0.735. TR-US indicated good reliability with or without the addition of CEUS (ICC=0.796 and 0.780). In terms of tumor staging, CEUS improved the consistency of transabdominal (weighted κ values from 0.689 to 0.731) and transrectal staging of tumors (κ from 0.758 to 0.785), and the staging of TR-US combined with TR-CEUS had the highest consistency with post-operative results, similar to MRI (κ, respectively 0.785 and 0.789). CEUS can reflect the heterogeneity of the tumor. Heterogeneous enhancement and perfusion defects were more common in >2 cm cervical cancer (50%, 20/40 and 52.5%, 21/40), respectively, and perfusion defects were more common in moderately to poorly differentiated tumors (66.67%, 20/30). For stage IB and IIA cervical cancer, CEUS can aid in assessing the International Federation for Gynecology and Obstetrics staging of tumors alongside TA-US and TR-US. The combination of TR-US and TR-CEUS has shown good consistency with pathology in the staging of cervical cancer, comparable to that of MRI.

Correlation between microvessel maturity and ISUP grades assessed using contrast-enhanced transrectal ultrasonography in prostate cancer.

This study aimed to assess the correlation among the peak intensity (PI) values of quantitative parameters, microvessel density (MVD), microvessel maturity, and International Society of Urological Pathology (ISUP) grades in biopsy specimens from prostate cancer (PCa) patients. The study population included PCa patients who underwent targeted and systematic biopsy, without radiation or chemohormonal therapy before biopsy. Contrast-enhanced transrectal ultrasonography (CE-TRUS) was performed in all patients before biopsy. Contrast-enhancement patterns and PI values of quantitative parameters were observed. Tumor tissue samples were immunostained for CD31 expression. MVD, microvessel maturity, and ISUP grades were determined in prostate biopsy specimens. Based on the contrast enhancement patterns of prostate lesions, 16 patients were assigned to a low-enhancement group and 45 to a high-enhancement group. The number of mature vessels, MVD, mature vessel index, and ISUP grades were all higher in the high-enhancement group than in the low-enhancement group (all P < 0.05). The immature vessel index was lower in the high-enhancement group than in the low-enhancement group (P < 0.05). The PI value was positively correlated with the number of mature vessels (r = 0.372). In conclusion, enhancement patterns on CE-TRUS can reflect microvessel maturity in PCa. The PI value was positively correlated with the number of mature vessels.

Value of transrectal ultrasound-guided biopsy in endoscopy negative biopsy patients with rectal lesions

ObjectiveTo evaluate the value of transrectal ultrasound (TRUS) guided biopsy in endoscopy negative biopsy patients with rectal lesions.Methods150 endoscopy negative biopsy result rectal lesions adopted the transrectal ultrasound-guided biopsy. Based on whether the patients received contrast-enhanced ultrasound examination or not before the biopsies, all enrolled cases were divided into TRUS guided group and contrast-enhanced TRUS (CE-TRUS) guided group, and the safety and diagnostic performances were analyzed retrospectively.ResultsWe obtained adequate specimens in the majority of cases (98.7%,148/150); There were no complications identified in our study. 126 patients received contrast-enhanced TRUS examination before biopsy to evaluate vascular perfusion and necrosis. The sensitivity, specificity, PPV, NPV, and overall accuracy of all biopsies were 89.1%, 100%,100%, 70.4%, and 91.3% respectively; The sensitivity, specificity, PPV, NPV, and accuracy for TRUS-guided biopsy and CE-TRUS guided biopsy were 73.7%, 100%,100%, 50%,79.2% and 92.1%,100%,100%,75%,93.6% separately; The increase in correct diagnoses was significant (p < 0.05) between TRUS guided biopsy and CE-TRUS guided biopsy.ConclusionTRUS-guided biopsy is a reliable procedure that can be augmented by endoscopic biopsy techniques if the biopsy yields negative results. CE-TRUS might assist in the location of the biopsy and decrease sampling errors.

Enhanced Transrectal Ultrasound, Real-Time Sonoelastography, and Contrast-Enhanced Transrectal Ultrasound in Heavily Prescreened Chinese Men With Naive and Repetitive Biopsy: A Comparison of Detection Rate of Prostate Cancer Per Man and Per Lesion.

Multiparametric magnetic resonance imaging and targeted biopsy have been widely accepted as the most accurate technique to detect localize prostate cancer. It is a time-consuming and expensive option and may not be widely available in China, making ultrasound the first choice for the detection of prostate cancer. In this current retrospective study, the diagnostic values of enhanced transrectal ultrasound, contrast-enhanced transrectal ultrasound, and real-time sonoelastography were evaluated. Symptomatic 315 men older than 40 years with prostate-specific antigen level greater than 4.0 ng/mL, with abnormal digital rectal examinations, and with suspicious lesions for prostate cancer under enhanced transrectal ultrasound included in the study. Enhanced transrectal ultrasound was suspicious in all 315 men, with 189 of 315 men with prostate cancer according to the prostate biopsy report. Sonoelastography was suspicious in 294 of 315 men, with 166 of 315 men with prostate cancer according to the prostate biopsy report. Contrast-enhanced transrectal ultrasound was suspicious in 221 of 315 men, with 159 of 315 men with prostate cancer according to the prostate biopsy report. Real-time sonoelastography alone and contrast-enhanced transrectal ultrasound alone were missed in 27 (11%) and 39 (15%) lesions to report cancer through biopsies. Working area for enhanced transrectal ultrasound, real-time sonoelastography, and contrast-enhanced transrectal ultrasound for detection of prostate cancer were 0 to 1 diagnostic confidence, 0.11 to 0.895 diagnostic confidence, and 0.39 to 0.63 diagnostic confidence respectively. Real-time sonoelastography and contrast-enhanced transrectal ultrasound may improve the detection of prostate cancer in men with suspicious prostate lesions under enhanced transrectal ultrasound (Level of Evidence: III; Technical Efficacy Stage: 2).

Contrast-enhanced transrectal ultrasound can reduce collection of unnecessary biopsies when diagnosing prostate cancer and is predictive of biochemical recurrence following a radical prostatectomy in patients with localized prostate cancer

BackgroundTo investigate the value of using contrast-enhanced transrectal ultrasound (CETRUS) to reduce unnecessary collection of biopsies during prostate cancer diagnosis and its utility in predicting biochemical recurrence in patients with localized prostate cancer.MethodsThis was a prospective study of suspected prostate cancer patients who were evaluated with CETRUS followed by a prostate biopsy. Prostate blood flow via CETRUS was graded using a 5-point scale. The relationship between CETRUS score and biopsy outcome was then analyzed for all patients; univariate and multi-variate analyses were used to determine the probable prognostic factors for biochemical recurrence in patients with localized prostate cancer that underwent a radical prostatectomy.ResultsA total of 347 patients were enrolled in the study. Prostate cancer was found in 164 patients. A significant positive correlation (r = 0.69, p < 0.001) was found between CETRUS scores and prostate cancer incidence. Using CETRUS scores ≥2 as the threshold for when to biopsy could have safely reduced the number of biopsies taken overall by 12.1% (42/347) and spared 23.0% (42/183) of patients from undergoing an unnecessary biopsy. 77 patients with localized prostate cancer underwent a radical prostatectomy. The median follow-up time was 30 months (range: 8–56 months) and 17 of these 77 patients exhibited biochemical recurrence during the follow-up period. 3-year biochemical recurrence-free survival rates were 86% for patients with low CETRUS scores (≤ 3) and 59% for patients with high scores (> 3; p = 0.015). Multivariate Cox regression analysis indicated that CETRUS score was an independent predictor of biochemical recurrence (HR: 7.02; 95% CI: 2.00–24.69; p = 0.002).ConclusionsCETRUS scores may be a useful tool for reducing the collection unnecessary biopsy samples during prostate cancer diagnosis and are predictive of biochemical recurrence in patients with localized prostate cancer following a radical prostatectomy.

Contrast-enhanced ultrasound evaluation of the prostate before transrectal ultrasound-guided biopsy can improve diagnostic sensitivity: A STARD-compliant article.

To conduct a STARD-compliant validity that the contrast-enhanced ultrasound (CEUS) evaluation of prostate for the improvement of positive rate of biopsy and diagnostic efficiency of prostate carcinoma (PCa).Data of 137 patients with suspected PCa who underwent relevant examinations and treatment were reviewed, and 82 of 137 patients were finally included. The patients consisted of Group 1 (26 patients) and Group 2 (42 patients) according to which they underwent transrectal ultrasound (TRUS) biopsy selected from CEUS evaluation of the prostate and who underwent TRUS-guided biopsy directly. A systematic 12-core biopsy was performed at first, and additional 1 to 2 cores biopsy was made in the suspected target area where CEUS had showed abnormal enhancement. The assumed diagnoses were compared with pathological findings.There were 37 patients with PCa and 31 patients with benign lesions; and 14 patients without biopsy after CEUS did not find PCa emerging in follow-up (18–47 months). The positive rates of biopsy-malignant lesions were 73.1% and 42.8% in Group 1 and Group 2, respectively. The positive rate of biopsy in Group 1 was significantly higher than that in Group 2 (P = .024). The sensitivity and accuracy of TRUS biopsy and a combination of TRUS biopsy after transrectal CEUS for the evaluation of prostate benign and malignant lesion were 60% and 66.7% (P=0.0139), and 94.4% and 88.5% (P=0.0453), respectively.CEUS evaluation of the prostate of PSA-elevated patient before biopsy can help select target patient with high risk of PCa, reduce unnecessary biopsy, increase detection rate of PCa, and improve diagnostic sensitivity and accuracy.

A pilot study of the shapes of ablation lesions in the canine prostate by laser, radiofrequency and microwave and their clinical significance.

To explore the shape characteristics of ablation lesions created via laser ablation (LA), radiofrequency ablation (RFA) and microwave ablation (MWA) in canine prostates and the clinical significance of these characteristics, six adult male beagles were randomly assigned to the LA, RFA, and MWA groups. These ablations were performed with common parameters applied in clinical practice (LA, 3 W/1200 J; RFA and MWA, 30 W/120 s). One ablation lesion was created in each lobe of the prostate via the ablation technique, resulting in a total of twelve ablation lesions. Transrectal ultrasound (TRUS) was used as guidance during puncture and to monitor changes in the ablation lesions. Finally, the ablation efficacy was assessed using transrectal contrast-enhanced ultrasonography (CEUS), and the transverse diameter (TRD), anteroposterior diameter (APD) and longitudinal diameter (LD) of each ablation lesion were measured. The volume (V) and the ratio (R) value were calculated. R reflects the shape characteristic of the ablation lesion (the R value close to 1.0 indicates a more spherical shape). The R values of the ablation lesions were 0.89 ± 0.02, 0.72 ± 0.01, and 0.65 ± 0.03 for RFA, MWA and LA, respectively, and they were significantly different (P = 0.027). The volumes of the ablation lesions were 2.17 ± 0.10 ml, 1.51 ± 0.20 ml, and 0.79 ± 0.07 ml for MWA, LA and RFA, respectively, and they were also significantly different (P = 0.001). The three abovementioned thermal ablation techniques with common parameters in clinical practice can be used for ablation in the prostate. The shapes and volumes of the ablation lesions of the three techniques were varied: The RFA-created lesions had the lowest volumes and were more spherical in shape, demonstrating that RFA could be used for the treatment of relatively small lesions or tumours adjacent to vital organs. The MWA lesions had the largest size with a spherical shape, which could be advantageous for the ablation of tumours with relatively large sizes. The sizes of the ablation lesions created via LA were between those of RFA and MWA but presented more oval in shape, suggesting that this method is highly appropriate for the ablation of benign prostatic hyperplasia (BPH).

V14-06 CETRUS; CONTRAST-ENHANCED TRANS-RECTAL ULTRASOUND TO MONITOR POST-TREATMENT RECURRENCE AFTER FOCAL HIFU OF PROSTATE

You have accessJournal of UrologyProstate Cancer (V14)1 Apr 2020V14-06 CETRUS; CONTRAST-ENHANCED TRANS-RECTAL ULTRASOUND TO MONITOR POST-TREATMENT RECURRENCE AFTER FOCAL HIFU OF PROSTATE Aliasger Shakir*, Atsuko Fujihara, Tsuyoshi Iwata, Alessandro Tafuri, Cacciamani Giovanni, Suzanne Palmer, Inderbir Gill, and Andre Luis Abreu Aliasger Shakir*Aliasger Shakir* More articles by this author , Atsuko FujiharaAtsuko Fujihara More articles by this author , Tsuyoshi IwataTsuyoshi Iwata More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Cacciamani GiovanniCacciamani Giovanni More articles by this author , Suzanne PalmerSuzanne Palmer More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Andre Luis AbreuAndre Luis Abreu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000982.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess the role of contrast enhanced trans-rectal ultrasound (CeTRUS) in the follow-up evaluation of patients who underwent focal High Intensity Focused Ultrasound (HIFU) for prostate cancer (PCa). METHODS: From our IRB-approved database (HS-17-00749), we identified 22 patients who underwent focal hemi-gland HIFU ablation of the prostate and had follow-up CeTRUS, mutiparametric MRI (mpMRI) and prostate biopsy (PBx) between 6 months to 1 year after HIFU. Salvage or whole-gland HIFU patients were excluded. CeTRUS was performed following a 2.5cc intravenous bolus of ultrasound contrast agent (LUMASON). Two-minute cine images of the regions of interest were recorded. CeTRUS findings were compared with mpMRI and the results of PBx. CeTRUS images were evaluated qualitatively. A PIRADS v2 score of 3 or higher was considered positive. Clinically significant PCa (csPCa) is defined as ISUP Grade Group (GG) ≥ 2 and non-csPCa is defined as ISUP Grade Group (GG) < 2. RESULTS: At baseline, median age and PSA was 65 year old and 5.1ng/ml. Six (26%) patients had low-risk, 13 (57%) had intermediate-risk and 3 (13%) had high-risk PCa. Post HIFU, median PSA nadir, and reduction in PSA were 1.0 ng/mL and 72%, respectively. On follow-up PBx with a median follow of 16M, 12 (55%) patients had cancer, 6 (27%) patients had csPCa, 3 (14%) patients had in-field recurrences, 9 (40%) patients had out-field recurrences, and 10 (45%) patients had a negative biopsy. Among them, three (14%) patients had in-field csPCa, 3 (14%) had out-field csPCa, 0 (0%) had in-field ncsPCa, and 6 (27%) had out-field ncsPCa. In the 3 patients with in-field csPCa (Table), MRI detected 2 (66%) lesions and CeTRUS detected 2 (66%) lesions. However, the patients with lesions detected by MRI and CeTRUS were not the same. One patient had a lesion detected by both MRI and CeTRUS, one patient had a lesion detected by MRI only and one patient had a lesion detected by CeTRUS only. Overall, among the 3 patients with in-field csPCa, 3 (100%) had lesions detected by either imaging modality. CONCLUSIONS: CeTRUS enhancement pattern showed high correlation with in-field csPCa on follow up PBx. CeTRUS and MRI were able to identify more csPCa compared to MRI alone. The addition of CeTRUS to MRI can be helpful in the follow up after focal HIFU and aid detection, and localization of csPCa. Source of Funding: This study was funded in part by the R01 grant CA205058-01 from the National Institutes of Health/ National Cancer Institute (M.C.S, I.S.G. and A.L.A.). © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1307-e1308 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aliasger Shakir* More articles by this author Atsuko Fujihara More articles by this author Tsuyoshi Iwata More articles by this author Alessandro Tafuri More articles by this author Cacciamani Giovanni More articles by this author Suzanne Palmer More articles by this author Inderbir Gill More articles by this author Andre Luis Abreu More articles by this author Expand All Advertisement PDF downloadLoading ...

Dynamic prostatic and laser-ablated lesion volume change after transperineal laser ablation in canine: preliminary observation and its clinical significance

Aim The purpose of this study is to observe the volume change of prostate and laser-ablated lesions in the canine and to explore the mechanism and clinical significance through histopathology. Materials and methods Transperineal laser ablation (TPLA) was performed under the guidance of transrectal ultrasound (TRUS) in eight canines. Two canines were sacrificed 1 day and 1 week after TPLA, respectively. The remaining six canines were sacrificed after finishing transrectal contrast-enhanced ultrasound (TR-CEUS) at three phases. Results The prostatic volumes immediately following TPLA and 1 week later were larger than before TPLA (20.1 ± 3.9 vs 17.1 ± 3.8 ml; 21.7 ± 3.6 vs 17.1 ± 3.8 ml, p < 0.05), but 1 month later, returned to the preoperative level (17.4 ± 3.2 ml). At three time points, the mean volumes of laser-ablated lesions at 3 W/600 J were 0.6 ± 0.2, 1.1 ± 0.4, and 1.7 ± 0.5 ml, respectively, while those of laser-ablated lesions at 3 W/1200 J were 1.2 ± 0.2, 1.6 ± 0.3, and 2.2 ± 0.5 ml, respectively. The mean volumes of laser-ablated lesions increased significantly over time after TPLA (p < 0.050). Conclusion The prostate volume transient enlarges after TPLA, which prompts for clinical application that it should prolong appropriately the duration of urinary catheterization to avoid acute urinary retention. Many inflammatory cells were observed in the laser-ablated lesions and adjacent normal prostate parenchyma through histopathology. It is speculated that the inflammatory response is involved in the progression of tissue damage.

Prostate Contrast Enhanced Transrectal Ultrasound Evaluation of the Prostate With Whole-Mount Prostatectomy Correlation

ObjectiveTo investigate the diagnostic accuracy of contrast enhanced transrectal ultrasound (CE-TRUS) in comparison with whole-mount radical prostatectomy specimens. Method and MaterialsFifty-eight subjects who underwent CE-TRUS and subsequent radical prostatectomy with whole-mount pathology were included in the study. Each patient underwent evaluation with baseline TRUS and again during CE-TRUS with intravenous infusion of perflutren lipid microsphere (Definity, Lantheus Medical Imaging, N Billerica, MA). A subjective 5 point scale was used to rate each sextant of the prostate in 3 baseline imaging modes and in 5 contrast-enhanced imaging modes. Baseline TRUS and CE-TRUS findings were compared with digitized whole-mount findings. A clustered logistic regression model was computed to compare the area under the receiver operating characteristic curve (Az) for detection of prostate cancer by various modes of ultrasound imaging. ResultsAmong the 58 whole-mount specimens, a maximum Gleason score of 6 was identified in 29 subjects, a score of 7 was identified in 24 and a score of 8 was identified in 5. The Az for baseline TRUS parameters was 0.55 for grayscale, 0.61 for color Doppler and 0.59 for power Doppler. CE-TRUS parameters demonstrated significant increases in Az with the highest Az for CE-power Doppler (0.66) and flash replenishment imaging (0.64) (P = .04 for comparison to baseline). The combination of CE-power Doppler and flash replenishment imaging resulted in improved Az compared with baseline imaging (0.70 vs 0.59, P= .006). ConclusionContrast-enhanced ultrasonography demonstrates greater diagnostic accuracy than baseline imaging. Diagnostic accuracy is further improved for "clinically significant" tumor volumes >1 cc.

The utility and limitations of contrast-enhanced transrectal ultrasound scanning for the detection of prostate cancer in different area of prostate.

To evaluate the ability of contrast-enhanced transrectal ultrasound (CETRUS) scanning for prostate cancer detection in different area, compared with conventional transrectal ultrasound (TRUS). 228 patients underwent TRUS-guided prostate biopsy after examinations of TRUS and CETRUS scanning. Cancer detection between CETRUS and TRUS were compared by patient and by site in different areas (right, left; base, mid-gland, apex). The receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic performance of CETRUS. 89 patients were malignant and 48 patients were significant cancer. Compared with TRUS, CETRUS could increase the detection rates of overall and significant cancer (P = 0.008; P = 0.031). CETRUS had higher sensitivity, specificity (except right lobe), accuracy, positive predictive value (PPV) and negative predictive value (NPV) in total, right and left lobe (P < 0.05). The sensitivity were greater for CETRUS in all areas except left base and right apex (P < 0.05). The accuracy were greater for CETRUS in all areas except left mid-gland and right apex (P < 0.05). ROC analysis showed CETRUS totally got the AUC of 0.816. The AUC was higher in left lobe than right lobe (0.837 vs. 0.793). It was most accurate at the base (0.833), then mid-gland (0.826), and lowest in apex (0.772). CETRUS had a significant advantage over conventional TRUS for prostate cancer detection in different areas. CETRUS much more easily missed the cancer in apex, we must focus more on apex and may add other imaging modalities to improve the visualization and detection of prostate cancer.

The clinical value of transrectal ultrasound elastography and the contrast-enhanced ultrasonography in early diagnosis of prostate cancer

Objective To evaluate the clinical value of transrectal real-time elastography(TRTE) and contrast-enhanced transrectal ultrasound(CETRUS) in early diagnosis of prostate cancer. Methods From August 2016 to August 2017, 119 patients with suspected prostate cancer were divided into low risk group (n=21) , moderate risk group (n=24) and high risk group (n=28) according to Gleason sores. The rest 46 patients were found with benign prostatic hyperplasia (BPH group) enrolled in this study. The transrectal ultrasound(TRUS), TRTE and CETRUS were performed for all patients. The accuracy rate of prostate cancer detection using TRUS, TRTE and CETRUS were compared with the pathologic results. Results There was no statistical differences of accuracy rate between low risk group and BPH group with TRTE and CETRUS. There were statistical differences of accuracy rate between low risk group and BPH group with the combination TRTE and CETRUS. Totally 119 patients underwent TRUS, TRUS with TRTE、TRUS with CETRUS and TRTE with CETRUS. The sensitivity, specificity, positive predictive value, negative predictive value of TRUS, TRTE, CETRUS, TRTE and CETRUS in diagnosis of prostate cancer was 46.77%, 58.18% , 49.23%, 55.77%, 66.13%, 70.91%, 65.00%, 71.93%, 80.64% , 81.82% , 78.95%, 83.33%, 90.32%, 85.45%, 88.68%, 87.50%, respectively. Conclusions CETRUS combined With TRTE can detect early prostate cancer and contribute to differential diagnosis between benign and malignant lesions. Key words: Prostatic Neoplasms; Ultrasonography; Elasticity Imaging Techniques; Angiography; Rectum

Contrast-Enhanced Transrectal Ultrasound in Focal Therapy for Prostate Cancer.

Contrast-enhanced transrectal ultrasound (CeTRUS) is an emerging imaging technique in prostate cancer (PCa) diagnosis and treatment. We review the utility and implications of CeTRUS in PCa focal therapy (FT). CeTRUS utilizes intravenous injection of ultrasound-enhancing agents followed by high-resolution ultrasound to evaluate tissue microvasculature and differentiate between benign tissue and PCa, with the latter demonstrating increased enhancement. The potential utility of CeTRUS in FT for PCa extends to pre-, intra- and post-operative settings. CeTRUS may detect PCa, facilitate targeted biopsy and aid surgical planning prior to FT. During FT, the treated area can be visualized as a well-demarcated non-enhancing zone and continuous real-time assessment allows immediate re-treatment if necessary. Following FT, the changes on CeTRUS are immediate and consistent, thus facilitating repeat imaging for comparison during follow-up. Areas suspicious for recurrence may be detected and target-biopsied. Enhancement can be quantified using time-intensity curves allowing objective assessment and comparison. Based on encouraging early outcomes, CeTRUS may become an alternative imaging modality in prostate cancer FT. Further study with larger cohorts and longer follow-up are needed.

Clinical value for contrast-enhanced transrectal ultrasound in diagnosis of prostate cancer

To explore the value for contrast-enhanced transrectal ultrasound (CETRUS) in the diagnosis of prostate cancer. Methods: Prostate biopsy from 207 cases of suspected prostate cancer were collected between January 2013 and March 2015. These patients were performed ultrasound-guided prostate biopsy in Central Hospital of Changsha. They were randomly divided into a radiography group (n=104) and a non-radiography group (n=103) according to the order of treatment. Transrectal ultrasonography (TRUS) was the first choice in the 2 groups, and CETRUS was conducted in the radiography group. Then, the transrectal biopsy was carried out in the 2 groups. The diagnostic value of CETRUS in prostate cancer was evaluated by pathological examination, a gold standard. Results: The sensitivity, specificity, and coincidence rates of TRUS in diagnosing prostate cancer were 65%, 60.4%, and 62.8%, respectively, while those rates of CETRUS in diagnosing prostate cancer were 89%, 78%, and 84%, respectively, with significant difference between the above 2 groups (all P<0.05). Conclusion: The sensitivities, specificities, and coincidence rates for CETRUS are superior to TRUS in diagnosing prostate cancer, which can provide a clinical basis for the diagnosis and differential diagnosis of prostate cancer.

Contrast-Enhanced Transrectal Ultrasound for Follow-up After Focal HIFU Ablation for Prostate Cancer.

The optimal strategy for imaging after focal therapy for prostate cancer is evolving. This series is an initial report on the use of contrast-enhanced transrectal ultrasound (TRUS) in follow-up of patients after high-intensity focused ultrasound (HIFU) hemiablation for prostate cancer. In 7 patients who underwent HIFU hemiablation, contrast-enhanced TRUS findings were as follows: (1) contrast-enhanced TRUS clearly showed the HIFU ablation defect as a sharply marginated nonenhancing zone in all patients; (2) contrast-enhanced TRUS identified suspicious foci of recurrent enhancement within the ablation zone in 2 patients, facilitating image-guided prostate biopsy, which showed prostate cancer; and (3) contrast-enhanced TRUS findings correlated with multiparametric magnetic resonance imaging and biopsy histologic findings.

Early post-interventional sonographic evaluation of prostatic artery embolization. A promising role for contrast-enhanced ultrasonography (CEUS).

To assess the feasibility, findings and potential value of early post-interventional, contrast-enhanced ultrasonographic (CEUS) study of prostate artery embolization (PAE). Fourteen patients treated with PAE for symptomatic benign prostatic hyperplasia were prospectively included in the study. Sonographic evaluation of the prostate included: 1) baseline transabdominal and transrectal CEUS (ta-CEUS and tr-CEUS, respectively) 1-3 days prior to PAE; 2) early post PAE CEUS, with ta-CEUS immediately post PAE and tr-CEUS 3 days post PAE; and 3) follow-up with ta-CEUS and tr-CEUS 3 months post PAE. A brief unenhanced US study preceded each CEUS. Post-therapeutic changes in size, echogenicity and enhancement of the prostate were recorded and were correlated with clinical outcomes. PAE resulted in clinical success in 11/14 patients (78.5%). All sonographic studies were technically adequate, with the exception of ta-CEUS immediately post PAE in 2/14 (14.2%) patients. CEUS studies immediately post PAE and 3 days post PAE showed non-enhancing, welldefined infarctions of the prostate in 10/14 patients (71.4%). There was a strong correlation between ta-CEUS immediately post PAE and tr-CEUS 3 days post PAE regarding the measurements of prostatic infarctions (r =0.98, p< 0.01). The presence of infarctions on early post PAE CEUS was associated with clinical success (p=0.01) and their extent correlated with the degree of prostate shrinkage on 3-month follow-up (r=0.84, p<0.05). The 3 cases of failed PAE showed no infarctions and no prostate shrinkage. Early post-interventional CEUS of PAE is feasible and may have clinical and prognostic value.

The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer

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.

Value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients

Objective To assess the value of multi-modal image-guided transrectal ultrasonography in the diagnosis of prostatic nodules in elderly patients. Methods Sixty-four elderly patients suspected of prostate cancer (PCA) were enrolled from December 2015 to December 2016.Sixty-four patients with 72 nodules underwent transrectal ultrasound (TRUS), contrast-enhanced transrectal ultrasound (CETRUS) and transrectal real-time tissue elastography (TRTE). A combination of systematic biopsy and suspicious site-targeted biopsy was conducted.The accuracies of different detection methods for prostate cancer were assessed against the gold standard of histological examination of prostate biopsy samples. Results Among the 72 nodules, 31 were prostatic hyperplasia, 5 were chronic prostatitis, 35 were prostatic cancer, and one was prostatic lymphoma.There were significant differences in enhancement strength, enhancement time fast-in and degree of elasticity on TRTE and CETRUS between the malignant and benign groups (χ2=28.794, 10.889, 52.898; P=0.000, 0.001, 0.000, respectively). When the 35 PCA nodules were divided into two subgroups based on the Gleason score, there were statistically significant differences in enhancement strength, homogeneity of enhancement, and enhancement time fast-in and fast-out between them (χ2=6.073, 12.315, 4.717, 18.093; P=0.048, 0.001, 0.030, 0.000, respectively). The combination of CETRUS and TRTE in diagnosing prostate nodules produced a sensitivity of 83.3%, a specificity of 86.1%, an accuracy of 84.7%, a positive predictive value of 85.7%, and a negative predictive rate of 83.8%, better than either method alone. Conclusions Multi-modal image-guided transrectal ultrasonography has an advantage in providing information on the perfusion and elasticity of prostate nodules in the elderly patients and thus has important clinical value for the diagnosis of prostate nodules. Key words: Prostatic neoplasms; Ultrasonography; Contrast media; Elasticity imaging techniques

Value of three-section contrast-enhanced transrectal ultrasonography in the detection of prostate cancer.

To assess the efficacy of three-section contrast-enhanced transrectal ultrasonography (CETRUS) in prostate cancer (PCa) detection. A total of 169 consecutive patients with either PSA level ≥ 4 ng/ml or abnormal digital rectal examination findings were prospectively enrolled in this single center study. All patients underwent baseline transrectal ultrasonography (TRUS) and three-section CETRUS by one investigator blinded to any clinical data before TRUS-guided transperineal biopsy. The performances of baseline TRUS, single-section, and three-section CETRUS for PCa detection were compared. On a per-patient basis, the sensitivity, specificity, and overall accuracy for detecting PCa with three-section CETRUS was 92.3%, 69.2%, and 78.1%, respectively. In comparison with conventional (single-section) CETRUS (sensitivity 75.4%, specificity 72.1%, and accuracy 73.4%), three-section CETRUS performed significantly better (p < 0.05, McNemar test). Additionally, the low-grade PCa detection rate for three-section CETRUS was significantly higher than that of conventional CETRUS (26.7% versus 10.2%, p < 0.05). Our study demonstrated a significant benefit of three-section CETRUS relative to conventional CETRUS, and this technique may find more PCa patients eligible for active surveillance. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:304-309, 2017.