title: The contribution of strain patterns in characterization of prostate peripheral zone lesions at transrectal ultrasonography.
abstract: BACKGROUND
  Elasticity is an important characteristic of tissue. During an elastography examination, various strain images of lesions are observed, and a suitable classification of strain patterns (SP) may provide vital diagnostic information about lesions. Numerous studies have shown that ultrasound elastography can improve the detection of prostate cancer, but the diagnostic value of SP classification has not yet been fully evaluated.
  
  
  OBJECTIVE
  To investigate the contribution of SP on the characterization of prostate peripheral zone lesions by transrectal real-time tissue elastography (TRTE) in combination with conventional transrectal ultrasonography (TRUS).
  
  
  METHODS
  One hundred and seventy-one patients with suspected prostate cancer underwent TRUS and TRTE examinations. The SPs of the suspicious lesions were classified into five scores by TRTE according to the degree and distribution of strain. All findings were confirmed by transrectal systematic 12-core biopsies and targeted biopsies for suspicious areas detecting by TRUS and/or TRTE.
  
  
  RESULTS
  One hundred and forty-eight of 171 patients had high-quality TRTE imaging and were included into the study. When a cut-off point of SP score III was used, the area under the receiver-operating characteristic curve (AUC) was, respectively, 0.75 (95% CI: 0.67-0.83), 0.85 (95% CI: 0.78-0.91) and 0.84 (95% CI: 0.77-0.91) for the diagnosis of prostate cancer by TRUS, TRTE and TRTE + TRUS. A linear tendency of SP and Gleason scores was observed in scores III-V. The detection rate of prostate cancer using TRTE-targeted biopsy (75.8%) was significantly higher than that of systematic 12-core biopsy plus TRUS-targeted biopsy (14.5%) (P = 0.00).
  
  
  CONCLUSIONS
  This study suggests the significant contribution of SP on characterization of prostate peripheral zone lesions and the improvement of TRTE-targeted biopsy on detection of prostate cancer.
authors.affiliation: Department of Ultrasound, Chinese People’s Liberation Army General Hospital, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.forename: Jie
authors.initials: J
authors.lastname: Tang
authors.forename: Yan-mi
authors.initials: YM
authors.lastname: Li
authors.forename: Xiang
authors.initials: X
authors.lastname: Fei
authors.forename: En-hui
authors.initials: EH
authors.lastname: He
authors.forename: Qiu-yang
authors.initials: QY
authors.lastname: Li
authors.forename: Huai-yin
authors.initials: HY
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging*; D012372:ROC Curve; D012007:Rectum; D018084:Ultrasonography, Interventional / Q000379:methods*