title: First results of endocavity evaluation of the microvascularization of malignant prostate tumors using contrast enhanced ultrasound (CEUS) including perfusion analysis: first results.
abstract: OBJECTIVE
  Detection of prostate cancer lesions using transrectal contrast enhanced ultrasound (CEUS) of the prostate utilizing quantitative perfusion analysis.
  
  
  METHODS
  20 patients (mean age 63 years, 47-71) with biopsy proven prostate cancer underwent transrectal ultrasound (TRUS) prior to radical prostatectomy by 2 experienced examiners using a multifrequency endocavitary probe (5-9 MHZ, LOGIQ E9, GE Healthcare, Chalfont St Giles, UK) to detect cancer-suspect lesions. CEUS was performed dynamically up to 3 Min after bolus injections of 2.4 ml SonoVue® (BRACCO, Italy). Digital cine loops were analyzed by an independent blinded examiner using perfusion quantification software with colour-coded parametric images in order to define suspect regions based on the perfusion-related parameters early wash in rate (WIR), mean transit time (MTT) and rise time (RT). The results of CEUS perfusion analysis were compared with the histopathology after surgery, obtained from whole mount sections.
  
  
  RESULTS
  After prostatectomy and histopathology, 34 prostate cancer foci were found in 20 patients. In 30/34 cases an early enhancement within the tumor was detected by CEUS perfusion analysis without early wash out. By evaluating the MTT and RT tumor detection was possible in 29/34 and 25/34 cases. The highest detection rate of prostate cancers was obtained by analysis of early contrast enhancement (priot to the normal prostate parenchyma), with a sensitivity of 88%, specificity 100%, NPP 60%, PPV 90%, in clinically suspicious cases with good correlation to the postoperative histopathological findings (r = 0.728).
  
  
  CONCLUSIONS
  This pilot study demonstrates, that quantitaive analysis of perfusion parameters obtained with transrectal CEUS could be helpful for characterization of neoplastic microcirculation of prostate cancer, for preoperative localization of cancer-suspect areas and for therapy guidance and management.
authors.affiliation: Institute of Diagnostic Radiology, University Hospital Regensburg, Regensburg, Germany. Ernst-Michael.Jung@klinik.uni-r.de
authors.forename: E M
authors.initials: EM
authors.lastname: Jung
authors.forename: P
authors.initials: P
authors.lastname: Wiggermann
authors.forename: C
authors.initials: C
authors.lastname: Greis
authors.forename: F
authors.initials: F
authors.lastname: Eder
authors.forename: J
authors.initials: J
authors.lastname: Ehrich
authors.forename: W
authors.initials: W
authors.lastname: Jung
authors.forename: A G
authors.initials: AG
authors.lastname: Schreyer
authors.forename: C
authors.initials: C
authors.lastname: Stroszczynski
authors.forename: R
authors.initials: R
authors.lastname: Ganzer
mesh_terms: D000368:Aged; D003287:Contrast Media; D005240:Feasibility Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D010865:Pilot Projects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018615:Ultrasonography, Doppler, Color / Q000379:methods*
chemical_list: D003287:Contrast Media