Department of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Urology, Jeroen Bosch Hospital, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands.
World J Urol. 2020 Nov;38(11):2811-2818. doi: 10.1007/s00345-020-03103-4. Epub 2020 Feb 20.
To determine the value of two-dimensional (2D) contrast-enhanced ultrasound (CEUS) imaging and the additional value of contrast ultrasound dispersion imaging (CUDI) for the localization of clinically significant prostate cancer (csPCa).
In this multicentre study, subjects scheduled for a radical prostatectomy underwent 2D CEUS imaging preoperatively. CUDI maps were generated from the CEUS recordings. Both CEUS recordings and CUDI maps were scored on the likelihood of presenting csPCa (any Gleason ≥ 4 + 3 and Gleason 3 + 4 larger than 0.5 mL) by five observers and compared to radical prostatectomy histopathology. An automated three-dimensional (3D) fusion protocol was used to match imaging with histopathology. Receiver operator curve (ROC) analysis was performed per observer and imaging modality.
133 of 216 (62%) patients were included in the final analysis. Average area under the ROC for all five readers for CEUS, CUDI and the combination was 0.78, 0.79 and 0.78, respectively. This yields a sensitivity and specificity of 81 and 64% for CEUS, 83 and 56% for CUDI and 83 and 55% for the combination. Interobserver agreement for CEUS, CUDI and the combination showed kappa values of 0.20, 0.18 and 0.18 respectively.
The sensitivity and specificity of 2D CEUS and CUDI for csPCa localization are moderate. Despite compressing CEUS in one image, CUDI showed a similar performance to 2D CEUS. With a sensitivity of 83% at cutoff point 3, it could become a useful imaging procedure, especially with 4D acquisition, improved quantification and combination with other US imaging techniques such as elastography.
确定二维（2D）对比增强超声（CEUS）成像的价值和对比超声弥散成像（CUDI）在定位临床显著前列腺癌（csPCa）中的附加价值。
在这项多中心研究中，计划接受根治性前列腺切除术的患者术前接受 2D CEUS 成像。从 CEUS 记录中生成 CUDI 图谱。由五名观察者对 CEUS 记录和 CUDI 图谱进行评分，以评估其呈现 csPCa（任何 Gleason≥4+3 和 Gleason 3+4 大于 0.5ml）的可能性，并与根治性前列腺切除术的组织病理学进行比较。使用自动三维（3D）融合协议将影像学与组织病理学进行匹配。对每个观察者和成像方式进行接收者操作特征曲线（ROC）分析。
共有 216 名患者中的 133 名（62%）纳入最终分析。所有 5 名读者的平均 ROC 曲线下面积，CEUS、CUDI 和联合检测分别为 0.78、0.79 和 0.78。这产生了 81%和 64%的 CEUS 检测、83%和 56%的 CUDI 检测和 83%和 55%的联合检测的敏感性和特异性。CEUS、CUDI 和联合检测的观察者间一致性分别显示kappa 值为 0.20、0.18 和 0.18。
2D CEUS 和 CUDI 对 csPCa 定位的敏感性和特异性均为中等。尽管 CUDI 将 CEUS 压缩到一张图像中，但它的性能与 2D CEUS 相似。在截断值为 3 时，敏感性为 83%，它可能成为一种有用的成像方法，特别是与 4D 采集、改进的定量和与其他超声成像技术（如弹性成像）结合使用时。
