title: Color and power Doppler sonography in the diagnosis of prostate cancer: comparison between vascular density and total vascularity.
abstract: OBJECTIVE
  Advances in color flow Doppler (CFD) and power Doppler imaging (PDI) have potential for prostate cancer diagnosis. Previous reports based on qualitative assessment suggest that hypervascularity increases likelihood of prostate cancer. Our objective was to compare 2 methods of vascularity assessment using PDI: total vascularity (TV) and vascular density (VD). The goal was to determine whether quantitative Doppler vascularity correlates with the likelihood of prostate cancer. Quantitative measurements were compared with subjective visual analysis of images.
  
  
  METHODS
  Ninety patients before biopsy had gray scale sonography, CFD, and PDI. Histologic analysis showed adenocarcinoma, prostate intraepithelial neoplasia, benign prostatic hypertrophy/prostatitis, and benign findings. The CFD and PDI images were analyzed for vascularity by (1) integrating the number of blood vessels over an imaged area (TV) and (2) integrating the number of vessels over a unit area of tissue (VD). Images were also assessed visually. VD, TV, and visual assessment were compared with one another and histologic findings.
  
  
  RESULTS
  Mean volume was not different. In each pathologic group, vascularity extent measured by TV and VD ranged from low to high. Disease groups did not exhibit a substantial difference in vascularity by either quantitative or qualitative analyses. Regionally, central gland TV was not significantly more vascular than peripheral gland TV except in benign prostatic hypertrophy. However, peripheral gland VD was 2.5 times greater than central gland VD. Seventy-one percent of the 31 focal hypoechoic lesions were hypervascular. Only 23% were carcinoma.
  
  
  CONCLUSIONS
  Pathologic categories were not separable by apparent vascular measurement. All pathologic categories showed low, moderate, or high vascularity; thus vascular areas by themselves did not distinguish cancer types, nor did focal hypervascular hypoechoic areas increase the likelihood of cancer. These imaging techniques provided no further resolution of tumor discrimination over multiple biopsies of the prostate.
authors.affiliation: Department of Radiology, University of Pennsylvania Medical Center, Philadelphia, Pennsylvania 19104, USA. peter.arger@uphs.upenn.edu
authors.forename: Peter H
authors.initials: PH
authors.lastname: Arger
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
authors.forename: Keith N
authors.initials: KN
authors.lastname: VanArsdalen
authors.forename: Chandra M
authors.initials: CM
authors.lastname: Sehgal
authors.forename: Anson
authors.initials: A
authors.lastname: Holzer
authors.forename: Susan M
authors.initials: SM
authors.lastname: Schultz
mesh_terms: D000230:Adenocarcinoma / Q000098:blood supply / Q000000981:diagnostic imaging*; D000368:Aged; D002278:Carcinoma in Situ / Q000098:blood supply / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011467:Prostate / Q000098:blood supply; D011470:Prostatic Hyperplasia / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging*; D011472:Prostatitis / Q000000981:diagnostic imaging; D018615:Ultrasonography, Doppler, Color