Wang Jing, Yang Xiaofeng, Zhou Boran, Sohn James J, Qiu Richard L J, Patel Pretesh, Jani Ashesh B, Liu Tian
Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA.
J Appl Clin Med Phys. 2025 Sep;26(9):e70211. doi: 10.1002/acm2.70211.
Neurovascular-sparing treatment is believed to help preserve erectile function for localized prostate cancer, given the key role of the arterial supply of neurovascular bundles (NVBs) in potency recovery post-treatment. While NVB-sparing radiotherapy (RT) is emerging, imaging methods to assess NVB function are lacking.
This study aims to evaluate the functional status of bilateral NVBs using pulsed wave Doppler ultrasound in patients undergoing prostate RT.
Fifty-seven patients (mean age: 66.2 ± 7.1 years) were enrolled in this single-institute prospective study. Each patient underwent a transrectal ultrasound scan in the lithotomy position. Bilateral blood flow in the NVBs was measured using pulsed wave Doppler ultrasound. A custom program was developed to automatically detect and analyze the Doppler spectral waveform. Five Doppler parameters were extracted: peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vm), resistive index (RI), and pulsatile index (PI). Discrepancies in Doppler parameters between the left and right sides were calculated. Patient-reported sexual outcomes were assessed using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP).
The Doppler pulsed waveform parameters for the 57 patients were: PSV = 11.0 ± 4.0 cm/s, EDV = 1.3 ± 1.9 cm/s, Vm = 4.0 ± 2.4 cm/s, RI = 0.89 ± 0.14, and PI = 3.46 ± 1.80. Analysis of PSV revealed differing blood flow between the left and right NVBs: 40 patients had <50% difference, 10 patients had a 50%-100% difference, and seven patients had >100% difference. Among patients aged 65 years or younger (n = 11) with EPIC-CP scores, blood flow was negatively correlated to erectile dysfunction (Spearman correlation coefficient of -0.71, p = 0.01).
Substantial differences in blood flow between bilateral NVBs were observed. The functional information obtained from NVB Doppler ultrasound may be valuable in guiding individualized NVB-sparing treatment planning.
鉴于神经血管束（NVBs）的动脉供应在治疗后勃起功能恢复中的关键作用，保留神经血管的治疗被认为有助于保留局限性前列腺癌患者的勃起功能。虽然保留NVB的放射治疗（RT）正在兴起，但缺乏评估NVB功能的成像方法。
本研究旨在使用脉冲波多普勒超声评估接受前列腺RT患者双侧NVB的功能状态。
57例患者（平均年龄：66.2±7.1岁）纳入了这项单机构前瞻性研究。每位患者在截石位接受经直肠超声扫描。使用脉冲波多普勒超声测量NVBs的双侧血流。开发了一个定制程序来自动检测和分析多普勒频谱波形。提取了五个多普勒参数：收缩期峰值速度（PSV）、舒张末期速度（EDV）、平均速度（Vm）、阻力指数（RI）和搏动指数（PI）。计算左右两侧多普勒参数的差异。使用临床实践扩展前列腺癌指数综合量表（EPIC-CP）评估患者报告的性结局。
57例患者的多普勒脉冲波形参数为：PSV = 11.0±4.0 cm/s，EDV = 1.3±1.9 cm/s，Vm = 4.0±2.4 cm/s，RI = 0.89±0.14，PI = 3.46±1.80。对PSV的分析显示左右NVBs之间的血流不同：40例患者差异<50%，10例患者差异为50%-100%，7例患者差异>100%。在年龄65岁及以下（n = 11）且有EPIC-CP评分的患者中，血流与勃起功能障碍呈负相关（Spearman相关系数为-0.71，p = 0.01）。
观察到双侧NVBs之间的血流存在显著差异。从NVB多普勒超声获得的功能信息可能对指导个体化的保留NVB治疗计划有价值。
