Liu Yushan, Zeng Shi, Zhou Dan, He Haiqing, Wu Shuiqing, Huang Changkun, Ai Kai, Zhu Xuan, Xu Ran
Department of Ultrasound, the Second Xiangya Hospital of Central South University, Changsha, PR China.
Department of Urology, the Second Xiangya Hospital of Central South University, Changsha, PR China.
Clinics (Sao Paulo). 2025 May 11;80:100680. doi: 10.1016/j.clinsp.2025.100680. eCollection 2025.
To evaluate the performance of Grayscale Ultrasound (GSU), Color Doppler Ultrasound/Power Doppler Ultrasound (CDU/PDU), Transrectal Real-Time Tissue Elastography (TRTE) and Contrast-Enhanced Ultrasound (CEUS) in the diagnosis of Prostate Cancer (PCa).
All analyzed patients underwent GSU, CDU/PDU, TRTE and CEUS examinations before radical prostatectomy. Receiver Operating Characteristic (ROC) curves were drawn, and the Areas Under the Curve (AUCs) were calculated for the four ultrasonic modalities alone and in combination. Binary logistic analysis was used to evaluate the predictive value of lesion features observed with the 4 modalities.
The results of the chi-square test showed that the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of TRTE for diagnosing PCa were higher than those of CEUS (p-values were < 0.05 for all). The ROC curves analysis showed that the diagnostic performance of TRTE for PCa was better than that of CEUS (p = 0.046). Moreover, the diagnostic performance of the combination of four ultrasonic technologies (AUC = 0.873) was significantly better than that of any technology alone. Multivariate binary logistic regression analysis showed that enhancement strength on CEUS, presence of a blue area on TRTE and total serum Prostate Specific Antigen (PSA) level were independent predictors for prostate malignancy.
The diagnostic performance of TRTE was higher than that of CEUS. Early hyperenhancement on CEUS and stiffness on TRTE had high predictive value for the diagnosis of PCa. The combination of multiple ultrasonic modalities can significantly improve the positive diagnostic rate for PCa over that of a single ultrasonic mode.
评估灰阶超声（GSU）、彩色多普勒超声/能量多普勒超声（CDU/PDU）、经直肠实时组织弹性成像（TRTE）及超声造影（CEUS）在前列腺癌（PCa）诊断中的性能。
所有纳入分析的患者在前列腺癌根治术前均接受了GSU、CDU/PDU、TRTE及CEUS检查。绘制受试者工作特征（ROC）曲线，并计算单独及联合应用这四种超声检查方式的曲线下面积（AUC）。采用二元逻辑回归分析评估这四种检查方式所观察到的病变特征的预测价值。
卡方检验结果显示，TRTE诊断PCa的灵敏度、特异度、阳性预测值、阴性预测值及准确率均高于CEUS（所有p值均<0.05）。ROC曲线分析显示，TRTE对PCa的诊断性能优于CEUS（p = 0.046）。此外，四种超声技术联合应用的诊断性能（AUC = 0.873）显著优于任何一种单独的技术。多因素二元逻辑回归分析显示，CEUS增强强度、TRTE蓝色区域的存在及血清总前列腺特异性抗原（PSA）水平是前列腺恶性肿瘤的独立预测因素。
TRTE的诊断性能高于CEUS。CEUS早期高增强及TRTE硬度对PCa诊断具有较高的预测价值。多种超声检查方式联合应用可显著提高PCa的阳性诊断率，优于单一超声检查方式。
