Institute of Diagnostic Radiology, University Hospital Regensburg, Regensburg, Germany.
Clin Hemorheol Microcirc. 2012;52(2-4):167-77. doi: 10.3233/CH-2012-1594.
Detection of prostate cancer lesions using transrectal contrast enhanced ultrasound (CEUS) of the prostate utilizing quantitative perfusion analysis.
20 patients (mean age 63 years, 47-71) with biopsy proven prostate cancer underwent transrectal ultrasound (TRUS) prior to radical prostatectomy by 2 experienced examiners using a multifrequency endocavitary probe (5-9 MHZ, LOGIQ E9, GE Healthcare, Chalfont St Giles, UK) to detect cancer-suspect lesions. CEUS was performed dynamically up to 3 Min after bolus injections of 2.4 ml SonoVue® (BRACCO, Italy). Digital cine loops were analyzed by an independent blinded examiner using perfusion quantification software with colour-coded parametric images in order to define suspect regions based on the perfusion-related parameters early wash in rate (WIR), mean transit time (MTT) and rise time (RT). The results of CEUS perfusion analysis were compared with the histopathology after surgery, obtained from whole mount sections.
After prostatectomy and histopathology, 34 prostate cancer foci were found in 20 patients. In 30/34 cases an early enhancement within the tumor was detected by CEUS perfusion analysis without early wash out. By evaluating the MTT and RT tumor detection was possible in 29/34 and 25/34 cases. The highest detection rate of prostate cancers was obtained by analysis of early contrast enhancement (priot to the normal prostate parenchyma), with a sensitivity of 88%, specificity 100%, NPP 60%, PPV 90%, in clinically suspicious cases with good correlation to the postoperative histopathological findings (r = 0.728).
This pilot study demonstrates, that quantitaive analysis of perfusion parameters obtained with transrectal CEUS could be helpful for characterization of neoplastic microcirculation of prostate cancer, for preoperative localization of cancer-suspect areas and for therapy guidance and management.
利用经直肠对比增强超声（CEUS）对前列腺进行定量灌注分析，检测前列腺癌病灶。
20 例经活检证实患有前列腺癌的患者（平均年龄 63 岁，47-71 岁）在接受根治性前列腺切除术前行经直肠超声（TRUS）检查，由 2 名经验丰富的检查者使用多频腔内探头（5-9MHz，LOGIQ E9，GE Healthcare，Chalfont St Giles，英国）检测可疑癌症病灶。CEUS 在注射 2.4ml SonoVue®（意大利 BRACCO）后动态进行，达 3 分钟。数字电影循环由一名独立的盲法检查者使用灌注定量软件进行分析，该软件具有彩色参数图像，用于根据灌注相关参数（早期增强率[WIR]、平均渡越时间[MTT]和上升时间[RT]）定义可疑区域。CEUS 灌注分析结果与手术后获得的全切片组织病理学进行比较。
前列腺切除术后和组织病理学检查后，20 例患者共发现 34 个前列腺癌病灶。CEUS 灌注分析在 30/34 例中检测到肿瘤内早期增强而无早期洗脱。通过评估 MTT 和 RT，在 29/34 和 25/34 例中可以检测到肿瘤。通过分析早期对比增强（先于正常前列腺实质）获得了最高的前列腺癌检出率，灵敏度为 88%，特异性为 100%，NPP 为 60%，PPV 为 90%，在具有良好相关性的可疑临床病例中与术后组织病理学发现（r=0.728）。
这项初步研究表明，经直肠 CEUS 获得的灌注参数定量分析有助于前列腺癌肿瘤新生微血管的特征化，可疑癌区的术前定位，以及治疗指导和管理。
