Quantitative contrast enhanced transrectal ultrasound (relative parameters) in prostate cancer diagnosis and prediction of aggressiveness: preliminary results

Objective: To assess the diagnostic value of relative parameters of quantitative contrast-enhanced transrectal ultrasound in prostate cancer diagnosis and prediction of aggressiveness. Material and methods: 75 patients with suspicion for prostate cancer based on laboratory and physical examination data and presence of hypoechoic lesions in the peripheral zone of prostate were examined. For conventional and contrast enhanced transrectal ultrasound diagnostic system Epiq 5 (Philips, Netherlands) with intracavitary probe (4-10 MHz) was utilized. SonoVue (Bracco Swiss SA, Switzerland) was used as ultrasound contrast agent. Bolus of 2.4 mL of SonoVue was administered intravenously. QLAB 11.0 software was used. According to the morphological data (targeted biopsy of hypoechoic lesions) all lesions were divided into two groups: main group (prostate cancer) consisted of 30 lesions and control one (non-prostate cancer) consisted of 45 lesions. Relative parameters (index, sum, difference, and modulus of difference) based on comparison of such absolute parameters as washin rate (WIR), time to peak (TTP), peak intensity (PI), mean transit time (MTT), time from peak to 1/2 (TPH), rise time (RT) in the region of interest and reference zone were analyzed. Results: PI index, PI difference, PI modulus of difference, WIR index, WIR difference, WIR modulus of difference, TTP index, TTP difference, and WIR showed better diagnostic accuracy in prostate cancer diagnosis. The test “PI index > 1.174 - prostate cancer” was characterized by sensitivity of 83.3%, specificity of 88.9%, AUC of 0.910 (P < 0.0001). The test “PI difference > 1.683 dB - prostate cancer” was characterized by sensitivity of 86.7%, specificity of 88.9%, AUC of 0.910 (P < 0.0001). The test “PI modulus of difference > 1.683 dB - prostate cancer” was characterized by sensitivity of 90.0%, specificity of 77.8%, AUC of 0.888 (P < 0.0001). The test “WIR index > 1.432 - prostate cancer” was characterized by sensitivity of 76.7%, specificity of 82.2%, AUC of 0.808 (P < 0.0001). The test “WIR diffe rence > 0.539 dB/sec - prostate cancer” was characterized by sensitivity of 73.3%, specificity of 86.7%, AUC of 0.804 (P < 0.0001). The test “WIR modulus of difference > 0.539 dB/sec - prostate cancer” is characterized by sensitivity of 83.3%, specificity of 75.6%, AUC of 0.804 (P < 0.0001). The test “TTP index ≤ 0.936 - prostate cancer” was characterized by sensitivity of 73.3%, specificity of 66.7%, AUC of 0.729 (P = 0.0001). The test “TTP difference ≤ -2.190 sec - prostate cancer” was characterized by sensitivity of 73.3%, specificity of 66.7%, AUC of 0.709 (P = 0.0006). PI difference, WIR modulus of difference, WIR difference, and WIR showed better diagnostic accuracy in the prediction of prostate cancer aggressiveness. The test “PI difference > 3.680 dB - ISUP ≥ 3 (4 + 3)” is characterized by sensitivity of 72.7%, specificity of 68.4%, AUC of 0.742 (P = 0.0104). The test “WIR modulus of difference > 0.723 dB/sec - ISUP ≥ 3 (4 + 3)” is characterized by sensitivity of 81.8%, specificity of 63.2, AUC of 0.732 (P = 0.0264). The test “WIR difference > 0.680 dB/sec - ISUP ≥ 3 (4 + 3)” is characterized by sensitivity of 81.8%, specificity of 63.2%, AUC of 0.727 (P = 0.0315). Conclusions: The PI and WIR relative parameters of quantitative contrast-enhanced transrectal ultrasound showed better diagnostic accuracy in the prostate cancer diagnosis (AUC > 0.8). The relative parameters of quantitative contrast-enhanced transrectal ultrasound are useful in the prediction of prostate cancer aggressiveness (ISUP ≥ 3 (4 + 3)) (AUC > 0.7).

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

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