Korean J Radiol.  2010 Feb;11(1):75-83. 10.3348/kjr.2010.11.1.75.

Contrast-Enhanced Harmonic Ultrasonography for the Assessment of Prostate Cancer Aggressiveness: a Preliminary Study

• Zhu Y
• Chen Y
• Jiang J
• Wang R
• Zhou Y
• Zhang H

• KMID: 1787017
• DOI: http://doi.org/10.3348/kjr.2010.11.1.75

Abstract

OBJECTIVE
To determine whether contrast-enhanced harmonic ultrasonography can be used to predict the aggressiveness of prostate cancer. MATERIALS AND METHODS: Contrast-enhanced harmonic ultrasonography was performed in 103 patients suspected of prostate cancer before biopsy. Time intensity curves were reconstructed for systematic biopsy sites and sonographic abnormalities. The characteristics of the curves were described using hemodynamic indices including arrival time (AT), time-to-peak (TTP), and peak intensity (PI). The differences of hemodynamic indices between high-grade and low-grade cancer were analyzed and the correlations between the hemodynamic indices and biopsy Gleason score were studied.
RESULTS
Prostate cancer was detected in 41 of 103 patients and there were significant differences in the hemodynamic indices between the biopsy sites of the non-malignant patients and prostate cancer lesions (p < 0.05). The prostate biopsies revealed 154 prostate cancer lesions, including 31 low-grade lesions and 123 high-grade lesions. The hemodynamic indices AT and TTP of high-grade tumors were significantly shorter than those of low-grade tumors (p = 0.001, 0.002). In addition, high-grade peripheral zone (PZ) tumors had higher PI than low-grade PZ tumors (p = 0.009). The PZ prostate cancer Gleason score correlated with PI, AT and TTP, with Spearman correlation coefficients of 0.223, -0.335, and -0.351, respectively (p = 0.013, < 0.001 and < 0.001).
CONCLUSION
Contrast-enhanced ultrasound measurements of hemodynamic indices correlate with the prostate cancer Gleason score.

Keyword

Prostate neoplasms; Transrectal ultrasound; Contrast agents; Gleason score

MeSH Terms

Aged
Aged, 80 and over
Biopsy, Needle
*Contrast Media
Hemodynamics
Humans
Male
Middle Aged
Phospholipids/*diagnostic use
Prostate/pathology
Prostatic Neoplasms/blood supply/diagnosis/*ultrasonography
Sulfur Hexafluoride/*diagnostic use
Ultrasonography, Doppler
Ultrasonography, Interventional

Figure

• 

  Fig. 1 Figures showing biopsy procedure. A. Postcontrast image of prostate gland of 68-year-old man with elevated prostate specific antigen level of 6.85 ng/ml. Substantial enhancement and earlier arrival of contrast-enhanced blood were observed in lateral part of left peripheral zone (arrow). B. During biopsy, biplane probe was rotated to sagittal plane of area showing abnormal findings using anatomic landmarks as reference, after biopsy gun was fired, probe was switched to convex transducer. Biopsy site (black arrow, comet tail sign) was determined precisely at area showing abnormal findings. Biopsy revealed prostate lesion with Gleason score of 4 + 3.

• 

  Fig. 2 Figures showing method of image interpretation. A. Postcontrast image of prostate gland of 78-year-old man with elevated prostate specific antigen level of 7.3 ng/ml, substantial enhancement was found in right peripheral zone (arrow). B. Region of interest was drawn to fit abnormality of postcontrast image. C. Time intensity curve of region of interest.

• 

  Fig. 3 Figures demonstrating correlation biopsy site and region of interest placement. A. Biopsy site of middle part of left peripheral zone on reproduced transverse image. B. Region of interest was placed over biopsy site. C. Time intensity curve of region of interest.

• 

  Fig. 4 Scatter plot diagram of peripheral zone hemodynamic indices. A. Scatter plot diagram shows peak intensity versus peripheral zone pathology findings, columns represent mean value and error bars indicate standard deviation. B. Scatter plot diagram shows arrival time versus peripheral zone pathology findings, columns represent mean value and error bars indicate standard deviation. C. Scatter plot diagram shows time-to-peak versus peripheral zone pathology findings, columns represent mean value and error bars indicate standard deviation.

• 

  Fig. 5 High-grade versus low-grade peripheral zone prostate cancers. A. Postcontrast image and time intensity curve of prostate cancer lesion with Gleason score of 5 + 4 (arrows) in 73-year-old man with elevated prostate specific antigen level of 31 ng/ml, while hemodynamic indices arrival time, time-to-peak and peak intensity of lesion were 15 s, 23 s and 20.5 dB respectively. B. Postcontrast image and time intensity curve of prostate cancer lesion with Gleason score of 3 + 4 (arrows) in 78-year-old man with elevated prostate specific antigen level of 7.3 ng/ml, while hemodynamic indices arrival time, time-to-peak and peak intensity of lesion was 22 s, 26 s and 9.2 dB, respectively. C. Postcontrast image and time intensity curve of prostate cancer lesion with Gleason score of 3 + 3 (arrows) in 70-year-old man with elevated prostate specific antigen level of 4.8 ng/ml, while hemodynamic indices arrival time, time-to-peak and peak intensity of lesion were 25 s, 35 s and 7 dB, respectively.

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