Transrectal Colour Doppler Contrast Sonography in the Diagnosis of Local Recurrence after Radical Prostatectomy - Comparison with MRI

F. M. Drudi; F. Giovagnorio; A. Carbone; P. Ricci; S. Petta; V. Cantisani; F. S. Ferrari; F. Marchetti; R. Passariello

doi:10.1055/s-2006-926583

Ultraschall in der Medizin - European Journal of Ultrasound, Inhaltsverzeichnis

Ultraschall Med 2006; 27(2): 146-151
DOI: 10.1055/s-2006-926583

Original Article

Transrectal Colour Doppler Contrast Sonography in the Diagnosis of Local Recurrence after Radical Prostatectomy - Comparison with MRI

Transrektale Farbdoppler-Kontrastmittel-Sonographie bei der Diagnose von Lokalrezidiven nach radikaler Prostatektomie - Vergleich mit MRTF. M. Drudi¹ , F. Giovagnorio¹ , A. Carbone² , P. Ricci¹ , S. Petta² , V. Cantisani¹ , F. S. Ferrari³ , F. Marchetti¹ , R. Passariello¹

¹Department of Radiology, University “La Sapienza”, Policlinico Umberto I, Rome
²Department of Urology, University “La Sapienza”, Policlinico Umberto I, V.le Regina Elena 324, Rome
³Department of Radiology, University of Siena, Ospedale Le Scotte, Siena

Abstract

Zusammenfassung

Ziel: Die Bestimmung der Wertigkeit der transrektalen Farb-Power-Doppler-Sonographie bei der Diagnose von Lokalrezidiven vor/nach der Anwendung von Kontrastmitteln bei Patienten mit ansteigenden PSA-Werten nach radikaler Prostatektomie sowie der Vergleich mit der MRT-Darstellung. Material und Methoden: 18 Patienten mit ansteigenden PSA-Werten nach Prostatektomie wurden untersucht mittels digitaler rektaler Palpation, Knochenszintigraphie, MRT, transrektaler Farb-Power-Doppler-Sonographie vor/nach Kontrastmittelapplikation und transrektaler ultraschallgezielter Biopsie. Sensitivität, Spezifität, Genauigkeit, positive und negative Vorhersagewerte wurden bestimmt. Die Ergebnisse wurden mittels des McNemar-2-stufigen Binominal-P-Tests korreliert. Ergebnisse: Die transrektale Farb-Power-Doppler-Sonographie mit und ohne Kontrastmittel und das Kontrastmittel-MRT ergaben Rezidive bei jeweils 6, 10 und 10 Patienten. Die Biopsie bestätigte ein Rezidiv bei 10 Patienten, erbrachte aber auch positive Ergebnisse bei 2 Patienten, die bei der rektalen Farb-Power-Doppler-Sonographie und im Kontrastmittel-MRT unauffällig waren. Die übrigen 6 Patienten waren sowohl bei den bildgebenden Verfahren als auch bei der Biopsie nach 30 Tagen weiterhin negativ. Die Werte der transrektalen B-Bild-Sonographie waren: Sensitivität 91,7 %, Spezifität 66 %, PPV 91,6 %, NPV 40 %. Die Werte der transrektalen Farb-Power-Doppler waren: Sensitivität 38,5 %, Spezifitiät 85 %, diagnostische Genauigkeit 50 %, PPV 83,3 %, NPV 33,3 %. Die transrektale kontrastmittelgestützte Farb-Power-Doppler-Sonographie und das MRT ergaben folgende Werte: Sensitivität 76,9 %, Spezifität 100 %, diagnostische Genauigkeit 83,3 %, PPV 100 %, NPV 62,5 %. Schlussfolgerung: Die kontrastmittelgestützte transrektale Farb-Power-Doppler-Sonographie erhöht die Spezifität bei der Diagnose von Lokalrezidiven nach radikaler Prostatektomie. Das MRT erreicht eine entsprechende Genauigkeit. Die Biopsie bleibt der diagnostische Goldstandard. Die Anwendung bildgebender Verfahren könnte jedoch die Zahl der notwendigen Biopsien verringern.

Abstract

Objective: To assess the usefulness of colour power-Doppler transrectal sonography before/after contrast agent in the detection of local recurrence in patients with rising prostate-specific antigen values after radical prostatectomy and to compare with magnetic resonance imaging. Materials and Methods: 18 patients with rising prostate-specific antigen values after prostatectomy underwent digital rectal examination, bone scintigraphy, magnetic resonance imaging, transrectal colour power-Doppler sonography before/after contrast agent, and transrectal sonography-guided biopsy. Sensitivity, specificity, accuracy, positive and negative predictive values were calculated. Results were correlated using McNemar binomial 2-tailed P-test. Results: Baseline and contrast-enhanced transrectal colour power-Doppler sonography and contrast-enhanced magnetic resonance imaging identified recurrent disease in 6, 10 and 10 patients, respectively. Biopsy confirmed recurrence in 10 patients, but was positive also in 2 additional patients who were negative at contrast-enhanced transrectal colour power-Doppler sonography and contrast-enhanced magnetic resonance imaging. The remaining 6 patients were negative also at diagnostic imaging and biopsy after 30 days. Grey-scale transrectal sonography values were: sensitivity 91.7 %, specificity 66 %, PPV 91.6 %, NPV 40 %. Baseline colour power-Doppler transrectal sonography values were: sensitivity 38.5 %, specificity 85 %, diagnostic accuracy 50 %, PPV 83.3 %, NPV 33.3 %. Contrast enhanced colour power-Doppler transrectal sonography and magnetic resonance imaging values were: sensitivity 76.9 %, specificity 100 %, diagnostic accuracy 83.3 %, PPV 100 %, NPV 62.5 %. Conclusion: Contrast-enhanced transrectal colour power-Doppler sonography increases specificity in the detection of local recurrence after prostatectomy. Magnetic resonance imaging yields equivalent accuracy. Biopsy remains the diagnostic gold standard, but the use of imaging methods may reduce the number of biopsies.

Schlüsselwörter

Prostatakarzinom - Lokalrezidiv - transrektale Sonographie - MRT - Kontrastmittel - Biopsie

Key words

Prostatic cancer - local recurrence - transrectal sonography - MR - contrast agent - biopsy

Volltext

Referenzen

References

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Francesco M. Drudi

Department of Radiology, II Chair, Policlinico Umberto I

V.le Regina Elena 324

00161 Rome, Italy

Telefon: ++ 39/6/44 - 5 56 02, - 6 85 87, - 6 39 27

Fax: ++ 39/6/49 02 43

eMail: FrancescoM.Drudi@uniroma1.it