Contrast-Enhanced Ultrasound (CEUS) and Quantitative Perfusion Analysis in Patients with Suspicion for Prostate Cancer

Abstract

Purpose The aim of this study was to investigate contrast-enhanced ultrasound (CEUS) parameters acquired by software during magnetic resonance imaging (MRI) US fusion-guided biopsy for prostate cancer (PCa) detection and discrimination.

Materials and Methods From 2012 to 2015, 158 out of 165 men with suspicion for PCa and with at least 1 negative biopsy of the prostate were included and underwent a multi-parametric 3 Tesla MRI and an MRI/US fusion-guided biopsy, consecutively. CEUS was conducted during biopsy with intravenous bolus application of 2.4 mL of SonoVue^® (Bracco, Milan, Italy). In the latter CEUS clips were investigated using quantitative perfusion analysis software (VueBox, Bracco). The area of strongest enhancement within the MRI pre-located region was investigated and all available parameters from the quantification tool box were collected and analyzed for PCa and its further differentiation was based on the histopathological results.

Results The overall detection rate was 74 (47 %) PCa cases in 158 included patients. From these 74 PCa cases, 49 (66 %) were graded Gleason ≥ 3 + 4 = 7 (ISUP ≥ 2) PCa. The best results for cancer detection over all quantitative perfusion parameters were rise time (p = 0.026) and time to peak (p = 0.037). Within the subgroup analysis (> vs ≤ 3 + 4 = 7a (ISUP 2)), peak enhancement (p = 0.012), wash-in rate (p = 0.011), wash-out rate (p = 0.007) and wash-in perfusion index (p = 0.014) also showed statistical significance.

Conclusion The quantification of CEUS parameters was able to discriminate PCa aggressiveness during MRI/US fusion-guided prostate biopsy.

Zusammenfassung

Ziel Die Aussagekraft einzelner Parameter der Kontrastmittel gestützten Sonografie (CEUS) soll hinsichtlich der Detektion des Prostatakarzinoms und der Möglichkeit einer Aggressivitäts Unterscheidung bewertet werden.

Material und Methoden Im Untersuchungszeitraum von 2012 und 2014 wurden 158 von insgesamt 165 Patienten mit mindestens einer vorausgegangenen negativen Prostatastanzbiopsie eingeschlossen und erhielten eine multiparametrische 3 T (Magnetresonanztomografie) mpMRT und konsekutiv eine MRT/US fusionierte Biopsie. Während der MRT/US-Fusion wurde nach Gabe von 2,4 ml SonoVue^® (Bracco, Milan, Italy) die CEUS Untersuchung durchgeführt. Die gespeicherten Filme wurden doppelblind mittels quantitativer Perfusionsanalysesoftware (VueBox, Bracco, Milano) ausgewertet. Die Region in der MRT-Läsion mit der stärksten KM-Anreicherung wurde als führende ROI (region of interest) untersucht und alle gewonnen Parameter wurden auf das Vorliegen eines Prostatakarzinoms und Differenzierung in unterschiedliche Aggressivitätsgrade im Abgleich mit den histologischen Ergebnissen ausgewertet.

Ergebnisse Die Gesamtdetektionsrate von Prostatakarzinomen innerhalb der Kohorte betrug 74 (48 %) von 158 Patienten. Die besten Ergebnisse unter allen quantitativen CEUS Parametern in Bezug auf die Prostatakarzinomdetektion zeigten bei folgenden Parametern: rise time (p = 0,026) und time to peak (p = 0,037). Im Rahmen der Aggressivitäts Diskriminierung insbesondere in einer Subgruppenanalyse (> vs ≤ 3 + 4 = 7a (ISUP 2)), imponierten peak enhancement (p = 0,012), wash-in rate (p = 0,011), wash-out rate (p = 0,007) und wash-in perfusion index (p = 0,014) als statistisch signifikant.

Schlussfolgerung Die Analyse einzelner Quantifikationsparameter der CEUS zeigte sowohl das Potential einer Detektion von Prostatakarzinomen als auch der Diskriminierung zwischen klinisch signifikanter und nicht signifikanter Karzinome.

Key words

multiparametric MRI - CEUS - prostate cancer - MRI/US fusion-guided biopsy - quantitative perfusion

^# These authors contributed equally

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