Three-dimensional Transrectal Ultrasonography Research Articles

Learning curve for fusion magnetic resonance imaging targeted prostate biopsy and three-dimensional transrectal ultrasonography segmentation.

To report the learning curve of multiple operators for fusion magnetic resonance imaging (MRI) targeted biopsy and to determine the number of cases needed to achieve proficiency. All adult males who underwent fusion MRI targeted biopsy between February 2012 and July 2021 for clinically suspected prostate cancer (PCa) in a single centre were included. Fusion transrectal MRI targeted biopsy was performed under local anaesthesia using the Koelis platform. Learning curves for segmentation of transrectal ultrasonography (TRUS) images and the overall MRI targeted biopsy procedure were estimated with locally weighted scatterplot smoothing by computing each operator's timestamps for consecutive procedures. Non-risk-adjusted cumulative sum (CUSUM) methods were used to create learning curves for clinically significant (i.e., International Society of Urological Pathology grade ≥ 2) PCa detection. Overall, 1721 patients underwent MRI targeted biopsy in our centre during the study period. The median (interquartile range) times for TRUS segmentation and for the MRI targeted biopsy procedure were 4.5 (3.5, 6.0) min and 13.2 (10.6, 16.9) min, respectively. Among the 14 operators with experience of more than 50 cases, a plateau was reached after 40 cases for TRUS segmentation time and 50 cases for overall MRI targeted biopsy procedure time. CUSUM analysis showed that the learning curve for clinically significant PCa detection required 25 to 45 procedures to achieve clinical proficiency. Pain scores ranged between 0 and 1 for 84% of patients, and a plateau phase was reached after 20 to 100 cases. A minimum of 50 cases of MRI targeted biopsy are necessary to achieve clinical and technical proficiency and to reach reproducibility in terms of timing, clinically significant PCa detection, and pain.

480 High Resolution Transrectal Ultrasound Findings Predict Manometric Responders to Biofeedback Therapy for Anal Incontinence

INTRODUCTION: In the United States, over 8% of adults are affected by anal incontinence (AI), and a large percentage of these patients have a history of damage to their pelvic floor. High resolution three-dimensional transrectal ultrasound (TRUS) can be used to assess for microstructural damage to the pelvic floor muscles. Biofeedback (BFB) therapy is a key intervention for AI in addition to anti-diarrheal medications or fiber supplements but it relies on strengthening and improving coordination of existing pelvic floor structures. TRUS is a promising tool to predict meaningful improvement with BFB. METHODS: This is a retrospective analysis of patients enrolled in BFB for AI between 2015 and 2018 at a tertiary referral motility program. Survey and high resolution anorectal manometry (HR-ARM) data were collected at baseline and during each AI BFB visit. Of the 36 patients who met criteria, 9 had TRUS as part of their care. TRUS images were obtained using a high frequency (7-15MHz) ultrasound probe. Fisher's exact test and t-test were used for statistical analysis. Improvement in maximum squeeze pressure on HR-ARM was defined as increase by greater than 30% or ≥29 mmHg from baseline to final session. RESULTS: Patients were on average 62 years old (SD 10 years), one was male, and the mean BMI was 28.0 (SD 6.7). Five of the 8 women had a suspected obstetric etiology to their AI, while two patients attributed symptoms to surgery, one to radiation therapy, and one to neurologic injury. TRUS revealed microstructural defects in the external anal sphincter (66.7%), internal anal sphincter (77.8%), puborectalis muscle (55.6%), and perineal body (66.7%) as shown in Table 1 Three patients had damage to all 4 structures and this was significantly associated with lack of improvement in squeeze on ARM (P = 0.047). Absence of an external anal sphincter defect trended towards correlation with improvement in squeeze (P = 0.07). Baseline levator hiatus abnormalities did not predict lack of improvement in manometric characteristics (P = 0.17). CONCLUSION: TRUS is an emerging tool to identify microdamage to structures of the pelvic floor including internal and external anal sphincter complexes and other key support structures. As BFB for patient with AI aims to retrain muscle coordination, absence of multiple deficits identified on TRUS may predict positive responders to BFB therapy.

Personalized biomechanical modeling of prostate deformation based on elastography for MRI three-dimensional transrectal ultrasound(TRUS) image registration

Objective To evaluate the clinical significance of personalized biomechanical modeling of prostate deformation based on ultrasound elastography for magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) image registration. Methods A total number of 5 patients and 1 commercial prostate phantom were imaged via transrectal ultrasound elastography, 3D-TRUS and MRI from June 2016 to December 2016. A personalized biomechanical model via the patient-specific ultrasound elastography was made for the deformable registration of prostate MRI and 3D-TRUS images. The registration accuracy was evaluated by the target registration error (TRE) and also the t-test was conducted to validate the statistical significance of our results. Results All the 5 sets of patient data as well as the phantom data were successfully registered. The TRE value of the phantom data was 1.65 mm. The mean TRE value of 5 patients was 1.31 mm, compared with the 2.52 mm TRE value of the registration method without patient-specific biomechanical properties via elastography, was approximately 48% lower(P<0.05). Conclusions Personalized biomechanical modeling of prostate deformation based on ultrasound elastography for MRI-TRUS image registration possesses important clinical significance and is a promising way to provide more quality guidance and improve the accuracy of prostate biopsy. Key words: Elasticity imaging techniques; Three-dimensional transrectal ultrasound; Medical image registration; Biomechanical model

Influence of Dose on Risk of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy

To assess the influence of dose on the risk of acute urinary retention (AUR) after iodine-125 prostate brachytherapy. Between January 2005 and December 2008, 714 consecutive patients with localized prostate cancer were treated with iodine-125 prostate brachytherapy at our department. All patients completed four imaging studies: magnetic resonance imaging before and 4 weeks after treatment and intraoperative three-dimensional transrectal ultrasonography before and after implantation. The development of AUR was prospectively recorded. The evaluated treatment and dosimetric parameters included prostate volume, number of needles and seeds used, intra- and postoperative prostate edema, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed dose to the prostate, minimal dose received by 90% of the prostate volume, and percentage of the urethra receiving 100%, 150%, and 200% of the prescribed dose. Logistic regression analysis was used to examine which factors were associated with AUR. Of the 714 patients, 57 (8.0%) developed AUR. On univariate analysis, the following treatment and dosimetric factors were significantly associated with AUR: International Prostate Symptom Score (odds ratio [OR], 2.07, per 10-point increase), preimplant prostate volume (OR, 1.06), postimplant prostate volume (OR, 1.04), number of needles used (OR, 1.09), and number of seeds used (OR, 1.03). On multivariate analysis, the only independent predictive factors for AUR were pretreatment prostate volume (OR, 1.05) and International Prostate Symptom Score (OR, 1.76, per 10-point increase). Patients with a pretreatment prostate volume >35 cm(3) had a 10.4% risk of developing AUR compared with 5.4% for those with a prostate volume of ≤ 35 cm(3). No association was found between any of the dosimetric parameters and the development of AUR. The radiation dose, within the range studied, did not influence the risk of AUR after iodine-125 prostate brachytherapy. Prostate volume and International Prostate Symptom Score were the most important predictors of AUR.

Repeat Prostate Biopsy Accuracy: Simulator-based Comparison of Two- and Three-dimensional Transrectal US Modalities

To compare the accuracy of biopsy with two-dimensional (2D) transrectal ultrasonography (US) with that of biopsy with conventional three-dimensional (3D) transrectal US and biopsy with guided 3D transrectal US in the guidance of repeat prostate biopsy procedures in a prostate biopsy simulator. The institutional review board approved this retrospective study. Five residents and five experts performed repeat biopsies with a biopsy simulator that contained the transrectal US prostate images of 10 patients who had undergone biopsy. Simulated repeat biopsies were performed with 2D transrectal US, conventional 3D transrectal US, and guided 3D transrectal US (an extension of 3D transrectal US that enables active display of biopsy targets). The modalities were compared on the basis of time per biopsy and how accurately simulated repeat biopsies could be guided to specific targets. The probability for successful biopsy of a repeat target was calculated for each modality. Guided 3D transrectal US was significantly (P < .01) more accurate for simulated biopsy of repeat targets than was 2D or 3D transrectal US, with a biopsy accuracy of 0.86 mm +/- 0.47 (standard deviation), 3.68 mm +/- 2.60, and 3.60 mm +/- 2.57, respectively. Experts had a 70% probability of sampling a prior biopsy target volume of 0.5 cm(3) with 2D transrectal US; however, the probability approached 100% with guided 3D transrectal US. Biopsy accuracy was not significantly different between experts and residents for any modality; however, experts were significantly (P < .05) faster than residents with each modality. Repeat biopsy of the prostate with 2D transrectal US has limited accuracy. Compared with 2D transrectal US, the biopsy accuracy of both experts and residents improved with guided 3D transrectal US but did not improve with conventional 3D transrectal US.

Management of Large (&gt;60 g) Prostate Gland: PlasmaKinetic Superpulse (Bipolar) versus Conventional (Monopolar) Transurethral Resection of the Prostate

Today, urologists around the world are encountering greater numbers of larger prostate glands, probably because of an initial trial of pharmacotherapy. The present study was performed to assess the safety and efficacy of bipolar transurethral resection of large prostate glands using the PlasmaKinetic (PK) Superpulse System. This single-blind, randomized study included 70 patients with prostate gland >60 g seen on three-dimensional transrectal ultrasonography. Patients were randomized 1:1 using envelopes into either a PK Superpulse transurethral resection of the prostate (TURP) group or conventional TURP group, and underwent the procedure accordingly. Perioperative and postoperative parameters included operative time, blood loss, need for blood transfusion, clinical transurethral resection (TUR) syndrome, and duration of catheterization and hospitalization. Of 70 patients, 67 were followed for a minimum of 9 months, and data were analyzed using SPSS software. Both groups were comparable in terms of preoperative parameters, which included American Urological Association Symptom Score, Qmax, gland size, and postvoid residual. A statistically significant difference between the two groups was found in terms of perioperative blood loss, change in serum sodium, and duration of catheterization. These complications were significantly less in the PK Superpulse group, with an obvious reduction in the duration of hospitalization in that group. The PK Superpulse System can be used as safely and effectively in the resection of the large gland (>60 g) as it has been reported to be in the resection of small and medium-sized glands. By using physiologic saline (0.9% NaCl) as irrigation fluid, it eliminates any danger of TUR syndrome and thus eliminates the conventional time limit of resection. PK Superpulse TURP is a promising treatment modality in the management of large prostate glands. It has all the features of gold-standard monopolar TURP, along with added safety and efficacy. It is ready to be included in the urologist's armamentarium.

Benign prostatic hyperplasia: Clinical benefits on Three‐Dimensional ultrasound eXtended Imaging (3D‐XI)

To prospectively evaluate whether trans-rectal Three-Dimensional eXtended Imaging (3D XI) allows characterization of the prostate gland in cases of isolated benign prostate hyperplasia (BPH) so as to elucidate the motive for discrepancy of postvoiding residual urine. The study was conducted according to the standards of the local ethics committee. Patients gave informed consent. Disclosing the 3D XI display of the prostatic urethra and prostatic gland zones was a preliminary essential. The study included 113 men with a clinical diagnosis of BPH in whom transurethral resection of the prostate was planned. Patients aged from 52 to 75 years (mean 63). Other causes of infravesical obstructive uropathy and prostate neoplastic involvement were excluded. All patients were evaluated by three-dimensional Trans-Rectal Ultrasound using 3D XI methods. Patients were grouped according to the postvoiding residual urine volume into three groups, less and more than 100 mL and urine retention. 3D XI provided excellent resolution and diagnostic authority of prostate gland anatomy and for the appraisal of BPH morphology. The balance and type of nodular eruption proved responsible for the severity of symptoms aspires by extra-axial nodular effect upon the prostate urethra. The 3D XI analysis regarding the nodular stromal to glandular ratio compared to the histopathological results proved effectual in 98.3% of stromal-dominant, 100% in glandular-dominant and 93.3% in mixed type hyperplasia. The severity of symptoms among men with BPH showed an association with the nodular credence, highlighted by 3D XI as a supportive tool in characterizing BPH.

Three-dimensional transrectal ultrasonography in adolescent patients with polycystic ovarian syndrome

Objectives: To evaluate the diagnostic value of 3-dimensional transrectal ultrasonography (3D-TRS) in adolescent patients with polycystic ovarian syndrome (PCOS). Methods: Ovarian follicle number, ovarian volume, ovarian stromal area, total ovarian area, and stromal area to total area ratio (S/A) were evaluated using 3D-TRS in 75 amenorrheic, oligomenorrheic, or asymptomatic virgin patients and 25 healthy controls. Serum biochemical markers of PCOS were assayed during the early follicular phase of the menstrual cycle in menstruating patients and controls, and on a randomly selected day in amenorrheic patients. Results: When assessing the delicate structure of the ovary in virgin patients, 3D-TRS was convenient, accurate, specific, sensitive, and more reliable overall than transabdominal ultrasonography. Ovarian stromal area and S/A ratio were significantly greater in patients with PCOS than in controls, and also in the patients who had ultrasonically diagnosed polycystic ovaries without clinical or biochemical evidence of PCOS. The S/A ratio was the studied variable most significantly correlated with androgen levels. Conclusions: These findings indicated that, in adolescent patients, 3D-TRS combined with transabdominal ultrasonography can improve the precision of the diagnosis of PCOS. The S/A ratio may become the ultrasonographic diagnostic marker for PCOS.

The value of three‐dimensional transrectal ultrasonography in staging prostate cancer

To use three-dimensional transrectal ultrasonography (3D-TRUS) to reconstruct the prostate, and thus determine its value in staging clinically localized prostate cancer. In all, 180 patients with newly diagnosed clinically localized prostate cancer were assessed using 3D-TRUS for staging. TRUS findings were compared with histopathological staging after radical prostatectomy. Pathological staging of specimens showed extracapsular extension in 69 patients, of whom 53 had pathological capsular perforation and 16 had seminal vesicle invasion. 3D-TRUS identified 58 patients with sites of extracapsular extension with 84% sensitivity, 96% specificity, 94% positive predictive value, 91% negative predictive value and an overall accuracy of 92%. Of the 16 patients with seminal vesicle invasion 14 were identified correctly on 3D-TRUS. Overall the 3D-TRUS staging sensitivity was 84%, specificity 96%, positive predictive value 93%, negative predictive value 91% and accuracy 91%. 3D-TRUS seems to be an accurate technique for staging localized prostate cancer. If 3D-TRUS indicates locally advanced disease, the probability of capsular perforation or seminal vesicle invasion is very high.

737: The Value of Three-Dimensional Transrectal Ultrasound in Staging of Prostate Cancer

You have accessJournal of UrologyPodium 25, Monday, May 21, 2007, 8:00 - 10:00 am1 Apr 2007737: The Value of Three-Dimensional Transrectal Ultrasound in Staging of Prostate Cancer Michael Mitterberger, Germar M. Pinggera, Wolfgang Hominger, Ferdinand Frauscher, Leo Pallwein, Johann Gradl, Georg Bartsch, and Hannes Strasser Michael MitterbergerMichael Mitterberger More articles by this author , Germar M. PinggeraGermar M. Pinggera More articles by this author , Wolfgang HomingerWolfgang Hominger More articles by this author , Ferdinand FrauscherFerdinand Frauscher More articles by this author , Leo PallweinLeo Pallwein More articles by this author , Johann GradlJohann Gradl More articles by this author , Georg BartschGeorg Bartsch More articles by this author , and Hannes StrasserHannes Strasser More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30977-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "737: The Value of Three-Dimensional Transrectal Ultrasound in Staging of Prostate Cancer." The Journal of Urology, 177(4S), p. 247 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 247 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Michael Mitterberger More articles by this author Germar M. Pinggera More articles by this author Wolfgang Hominger More articles by this author Ferdinand Frauscher More articles by this author Leo Pallwein More articles by this author Johann Gradl More articles by this author Georg Bartsch More articles by this author Hannes Strasser More articles by this author Expand All Advertisement Loading ...

Three-dimensional ultrasound and magnetic resonance imaging of pelvic anatomy: potential for complications from minimally invasive procedures.

Several new minimally invasive therapies have recently been popularized for both malignant and benign prostate disorders, including interstitial implantation of radioactive seeds and high-radiofrequency wires, cryoablation, transurethral thermotherapy, and laser prostatectomy. Complications can be incurred during the various procedures, often as a result of injury to adjacent anatomic structures. Some of the complications are inadvertent, whereas others are inherent in the particular treatment process. We hope to increase awareness and understanding of some of the potential complications. Magnetic resonance (MR) and three-dimensional transrectal ultrasonography (TRUS) imaging were utilized to illustrate the relevant pelvic anatomy in, respectively, a healthy volunteer and four patients undergoing evaluation for prostate symptoms. In addition, data from the Visible Human dataset (the Visible Human Project is part of the National Library of Medicine 1986 Long-Range Plan) were used. The potential complications relating to urinary sphincter and anal sphincter control, sexual function, pelvic musculature, and pelvic nerve physiology could be explained on the basis of the MR and TRUS findings using cryoablation for illustrative purposes. A clear understanding of the relevant anatomy and physiology is essential for the physician to provide patient counseling preoperatively regarding anticipated sequelae and to avoid preventable intraoperative complications related to minimally invasive therapeutic procedures for the prostate.