General Ultrasound Quantitative contrast enhanced transrectal ultrasound (absolute parameters) in the diagnosis of prostate cancer: preliminary results

The aim of the study was to identify the most informative absolute quantitative parameters of contrast enhanced transrectal ultrasound in the diagnosis of prostate cancer. The study group consisted of 75 patients with suspected prostate cancer (based on the results of digital rectal examination and/or increased level of total prostate-specific antigen in the presence of suspicious (hypoechoic) foci in the peripheral zone of the prostate on grayscale transrectal ultrasound. In all cases contrast enhanced transrectal ultrasound was performed before the final diagnosis was established. Ultrasound examinations were performed using Epiq 5 (Philips, Netherlands) with high-frequency (4-10 MHz) intracavitary probe. SonoVue (Bracco Swiss S.A., Switzerland) was used as ultrasound contrast agent. Hypoechoic foci - pre-selected regions of interest for quantitative contrast enhanced transrectal ultrasound - were underwent to targeted prostate biopsy. The studied foci were divided into two groups, depending on the results of histological examination: the foci with verified prostate cancer (n = 30) (main group with prostate cancer) and foci with absence of prostate cancer (n = 45) (control group without prostate cancer). The following parameters of time-intensity curve were analyzed: 1) wash-in rate (WIR), dB/s; 2) time to peak (TTP), s; 3) peak intensity (PI), dB; 4) mean transit time (MTT), s; 5) descending time/2 (DT/2), s; 6) rise time (RT), s. Statistically significant differences of WIR (P = 0.0026) and RT (P = 0.0047) between the groups were obtained. The test “WIR > 2.114 dB/s - prostate cancer” is characterized by sensitivity of 50.0%, specificity of 84.4%, positive predictive value of 68.2%, negative predictive value of 71.7%, AUC of 0.706. The test “RT ≤ 6.718 s - prostate cancer” is characterized by sensitivity of 70.0%, specificity of 66.7%, positive predictive value of 58.3%, negative predictive value of 76.9%, AUC of 0.694. Statistically significant correlations of the Gleason sum with WIR (r_S = 0.521, P = 0.0032), TTP (r_S = -0.503, P = 0.0046), and PI (r_S = 0.378, P = 0.0393) were obtained. The use of absolute quantitative parameters of contrast-enhanced transrectal ultrasound can improve the efficiency of targeted prostate biopsies.

contrast-enhanced ultrasound (CEUS), quantitative analysis, perfusion, prostate, prostate cancer

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