title: Contrast enhanced color Doppler endorectal sonography of prostate: efficiency for detecting peripheral zone tumors and role for biopsy procedure.
abstract: OBJECTIVE
  We evaluated the accuracy of contrast enhanced color Doppler endorectal ultrasound to guide biopsy for the detection of prostate cancer.
  
  
  METHODS
  A total of 85 patients were evaluated with gray scale and color Doppler before and during intravenous injection of ultrasound contrast agent made of galactose based air microbubbles. Our biopsy protocol was performed during contrast injection. An additional 18 directed cores were obtained based on contrast enhanced imaging. Diagnostic efficiency with and without contrast medium injection for detecting prostate cancer were compared based on biopsy results.
  
  
  RESULTS
  Cancer was identified in a total of 58 biopsy sites in 54 patients. Gray scale imaging revealed 96 abnormal hypoechoic nodules or irregular zones inside the outer gland, of which 48 were malignant on pathological evaluation. Contrast enhanced color Doppler had higher sensitivity (93%) than unenhanced color Doppler (54%), while specificity increased only 79% to 87% for enhanced imaging. Nine of 10 isoechoic suspicious zones were depicted with enhancement, while unenhanced Doppler detected 7 of them. There was no significant difference between the intensity of enhancement and tumor Gleason scores.
  
  
  CONCLUSIONS
  Contrast enhanced color Doppler endorectal sonography increases the detection of prostate cancer. Improvement in sensitivity was high, while the difference in specificity was not as pertinent. It is accurate when using a common and routine application ultrasound unit. This technique is easy to perform and not time-consuming. Obtaining additional biopsy cores of suspicious enhancing foci significantly improves the detection rate of cancer.
authors.affiliation: Department of Radiology B, University Hospital of Strasbourg-Hôpital Civil, 1 place de l'hôpital, 67091 Strasbourg Cedex, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Roy
authors.forename: Xavier
authors.initials: X
authors.lastname: Buy
authors.forename: Herve
authors.initials: H
authors.lastname: Lang
authors.forename: Christian
authors.initials: C
authors.lastname: Saussine
authors.forename: Didier
authors.initials: D
authors.lastname: Jacqmin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D019160:Endosonography / Q000379:methods*; D006801:Humans; D007089:Image Enhancement; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D012680:Sensitivity and Specificity; D018608:Ultrasonography, Doppler / Q000379:methods*