The value of dynamic contrast enhanced power Doppler ultrasound imaging in the localization of prostate cancer.

OBJECTIVES The objective of this study is to define enhancement characteristics that correlate to the presence of prostate cancer (PCa) and to evaluate the value of these characteristics in the localization of prostate cancer. METHODS 29 patients with proven prostate malignancy, scheduled for radical prostatectomy, underwent an ultrasound examination prior to surgery. A bolus injection of contrast agent was administered intravenously. The distribution of the contrast enhanced blood to the prostate was monitored using Transrectal Contrast Enhanced Power Doppler Ultrasound. Fixed protocols and settings were used for all patients. The percentage of a selected area that showed enhancement was observed in time. The resulting enhancement curves were described using the parameters time to start, time to the maximum of the enhancement, the maximum value of the enhancement, and the rise time of the enhancement. Three evaluation-protocols divided the prostate into a number of areas of interest: into two areas using the Left-Right (LR) and Dorsal-Ventral (DV) protocols and into four areas using the Quadrant-protocol (Q). The enhancement parameters of the areas of interest were compared to identify the most affected area. The results were compared to the histopathological findings. RESULTS For the LR-protocol, the minimal time to peak proved to be the most predictive parameter for selecting the major malignant area. 78% of the patients were diagnosed correctly (N=23). Accurate localization of the major malignancy in either the ventral or dorsal side of the prostate was not feasible using the current protocol. CONCLUSIONS Malignancies can be accurately localized in either the left or the right side of the prostate based on the time to the maximum of the enhancement. An accurate discrimination between malignancies in either the dorsal or ventral side of the prostate cannot be performed. This is most likely due to anatomical differences between the dorsal and ventral area.

[1]  J. D. Chapman,et al.  Increasing levels of hypoxia in prostate carcinoma correlate significantly with increasing clinical stage and patient age , 2000, Cancer.

[2]  D. Lubeck,et al.  Under staging and under grading in a contemporary series of patients undergoing radical prostatectomy: results from the Cancer of the Prostate Strategic Urologic Research Endeavor database. , 2001, The Journal of urology.

[3]  A R Jayaweera,et al.  Quantification of myocardial blood flow with ultrasound-induced destruction of microbubbles administered as a constant venous infusion. , 1998, Circulation.

[4]  J. Stanford,et al.  Predicting extracapsular extension of prostate cancer in men treated with radical prostatectomy: results from the population based prostate cancer outcomes study. , 1999, The Journal of urology.

[5]  F. Moriyasu,et al.  Analysis of flash echo from contrast agent for designing optimal ultrasound diagnostic systems. , 1999, Ultrasound in medicine & biology.

[6]  J J de la Rosette,et al.  Reproducibility of contrast-enhanced transrectal ultrasound of the prostate. , 2001, Ultrasound in medicine & biology.

[7]  E. Halpern,et al.  Prostate cancer: contrast-enhanced us for detection. , 2001, Radiology.

[8]  B. Goldberg,et al.  Initial experience with contrast-enhanced sonography of the prostate. , 2000, AJR. American journal of roentgenology.

[9]  F. Prinzen,et al.  High-resolution functional imaging with ultrasound contrast agents based on RF processing in an in vivo kidney experiment. , 2001, Ultrasound in medicine & biology.

[10]  P. Schellhammer,et al.  Results of radical prostatectomy in men with locally advanced prostate cancer: multi-institutional pooled analysis. , 1997, European urology.

[11]  P. Burns,et al.  Nonlinear imaging. , 2000, Ultrasound in medicine & biology.

[12]  A. Hanlon,et al.  Increasing levels of hypoxia in prostate carcinoma correlate significantly with increasing clinical stage and patient age: an Eppendorf pO(2) study. , 2000 .

[13]  D. Cosgrove,et al.  Functional imaging of tissue response to bolus injection of ultrasound contrast agent , 1998, 1998 IEEE Ultrasonics Symposium. Proceedings (Cat. No. 98CH36102).

[14]  H. Beerlage,et al.  Contrast Angiosonography: A Technology to Improve Doppler Ultrasound Examinations of the Prostate , 1999, European Urology.

[15]  D. Johnston,et al.  Detailed mapping of prostate carcinoma foci , 2000, Cancer.

[16]  Hessel Wijkstra,et al.  Microvessel Density: Correlation between Contrast Ultrasonography and Histology of Prostate Cancer , 2001, European Urology.

[17]  T. Stamey,et al.  Zonal Distribution of Prostatic Adenocarcinoma: Correlation with Histologic Pattern and Direction of Spread , 1988, The American journal of surgical pathology.

[18]  Taylor Murray,et al.  Cancer Statistics, 2001 , 2001, CA: a cancer journal for clinicians.

[19]  C. Chin,et al.  Pulse inversion Doppler: a new method for detecting nonlinear echoes from microbubble contrast agents , 1999, IEEE Transactions on Ultrasonics, Ferroelectrics and Frequency Control.

[20]  A. Hanlon,et al.  Hypoxic regions exist in human prostate carcinoma. , 1999, Urology.

[21]  Helmut Ermert,et al.  Ultrasonic assessment of perfusion conditions in the brain and in the liver , 2000, 2000 IEEE Ultrasonics Symposium. Proceedings. An International Symposium (Cat. No.00CH37121).

[22]  M. Blute,et al.  Extended experience with radical prostatectomy for clinical stage T3 prostate cancer: outcome and contemporary morbidity. , 1995, The Journal of urology.

[23]  N de Jong,et al.  Usefulness of power Doppler contrast echocardiography to identify reperfusion after acute myocardial infarction. , 2001, The American journal of cardiology.

[24]  F. Frauscher,et al.  High-frequency Doppler US of the prostate: effect of patient position. , 2002, Radiology.