title: Contrast-enhanced ultrasonography using cadence-contrast pulse sequencing technology for targeted biopsy of the prostate.
abstract: OBJECTIVE
  To evaluate contrast-enhanced ultrasonography (US) using cadence-contrast pulse sequencing (CPS) technology, compared with systematic biopsy for detecting prostate cancer, as grey-scale US has low sensitivity and specificity for detecting prostate cancer.
  
  
  METHODS
  In all, 44 men with suspicious prostate-specific antigen (PSA) levels and CPS findings were assessed; all had CPS-targeted and systematic biopsy. Transrectal CPS images were taken with a low mechanical index (0.14). A microbubble contrast agent (SonoVue, Bracco International BV, Amsterdam, the Netherlands) was administered as a bolus, with a maximum dose of 4.8 mL. CPS was used to assess prostatic vascularity. Areas with a rapid and increased contrast enhancement within the peripheral zone were defined as suspicious for prostate cancer. Up to five CPS targeted biopsies were taken and subsequently a 10-core systematic biopsy was taken. Cancer detection rates for the two techniques were compared.
  
  
  RESULTS
  Overall, cancer was detected in 35 of 44 patients (80%), with a mean PSA level of 3.8 ng/mL. Lesions suspicious on CPS showed cancer in 35 of 44 patients (80%) and systematic biopsy detected cancer in 15 of 44 patients (34%). CPS-targeted cores were positive in 105 of 220 cores (47.7%) and in 41 of 440 systematic biopsy cores (9.3%) (P < 0.001). Lesions suspicious on CPS were false-positive in nine of 44 patients (20%). The mean Gleason score for systematic biopsy was 6.7 and for CPS-targeted biopsy 6.8 (P > 0.05). The sensitivity of CPS for detecting cancer was 100% (confidence interval, 95%). However, limitations in the series included that only CPS-positive cases were investigated, and CPS-targeted biopsy should be evaluated in a more extended biopsy scheme.
  
  
  CONCLUSIONS
  Contrast-enhanced US using CPS enables excellent visualization of the microvasculature associated with prostate cancer, and can improve the detection of prostate cancer compared with systematic biopsy.
authors.affiliation: Department of Radiology II, Medical University Innsbruck, Innsbruck, Austria. friedrich.aigner@uki.at
authors.forename: Friedrich
authors.initials: F
authors.lastname: Aigner
authors.forename: Leo
authors.initials: L
authors.lastname: Pallwein
authors.forename: Michael
authors.initials: M
authors.lastname: Mitterberger
authors.forename: Germar M
authors.initials: GM
authors.lastname: Pinggera
authors.forename: Gregor
authors.initials: G
authors.lastname: Mikuz
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Frauscher
mesh_terms: D000328:Adult; D000368:Aged; D001707:Biopsy, Needle / Q000379:methods*; D003287:Contrast Media; D006801:Humans; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011467:Prostate / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology*; D012680:Sensitivity and Specificity; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D003287:Contrast Media