| Objective1 to evaluate the application of contrast-enhanced trasnrectal ultrasound to identify prostate cancer from benign prostatic hyperplasia.2 to compared enhancement patterns in prostate cancer (PCa) with difference Gleason score (GS) by contrast-enhanced transrectal ultrasound (CETRUS).Materials and Methods1 a total of 86 patients with focal prostatic disease detected by TRUS were enrolled in this study. Each patient underwent grey-scale TRUS, CETRUS, and 12-core systematic and targeted-biopsy of prostate under ultrasound guidance successively on the same day. The criteria of perfusion pattern would be statistically analyzed among groups divided by pathological findings. Every patient's images of CETRUS were observed and features of perfusion pattern were recorded by two doctors who were blind to any clinical data of patient. Then these features recorded by two doctors were compared.2 a total of 65 conspicuous prostatic cancers detected by transrectal ultrasound (TRUS) were enrolled in this study. Each patient underwent grey-scale TRUS, CETRUS, and 12-core systematic and targeted-biopsy of prostate under ultrasound guidance successively on the same day. Patients were divided into PCa with GS≤3+4=7 (n=30) and PCa with GS>4+3=7 (n=35) groups according to the pathologic findings. Videotapes and cineloops of CETRUS were reviewed by two radiologists blinded the final diagnosis, who answered identical questions about enhancement patterns of the lesion. Theκvalues were calculated for interreaders agreement.Results1 compared with BPH group, the enhancement features of PCa group were rapid enhancement, increased enhancement, heterogeneous enhancement, well-defined boundary of lesion after enhancement, asymmetric appearance of intraprostatic vessels, rapid decrease, perfusion defect areas within lesions and the roughly discontinuous juncture between enhancement and no enhancement area within lesions.2 33.3% PCa with GS≤3+4=7 and 62.9% PCa with Gs>4+3=7 displayed rapid enhancement,30% PCa with GS≤3+4=7 and 68.6% PCa with Gs>4+3=7 displayed increased enhancement (p=0.002); suspiciously asymmetric vessels could be observed in 33.3% PCa with GS<3+4=7 and 80% PCa with GS>4+3=7 (p=0.000); 54.3% PCa with GS>4+3=7 and 13.3% PCa with GS<3+4=7 displayed rapid washout of agent (p=0.001); clear border of lesion after enhancement could be observed in 91.4% PCa with GS>4+3=7 and 53.3% PCa with GS≤3+4=7 (p=0.001).Conclusion1 there were significant difference in enhancement patterns between BPH and PCa groups, observing enhancement pattern could help to identify prostate cancer from benign prostate hyperplasia.2 there were significant difference enhancement patterns between PCa with difference Gleason score. Observing enhancement patterns probably help to identify PCa with difference Gleason score. Objective1 To evaluate the clinical application of contrast-enhanced transrectal ultrasound (CETRUS) with parametric imaging in differential diagnosis of prostatic nodules.2 To evaluate the prediction of prostate cancer with CETRUS using parametric imaging in patients with increased PSA level.Materials and Methods1 This study was approved by the institutional review board; all patients gave their written informed consent. Fifty-nine patients with 63 nodules in transition and peripheral zones were divided into benign prostatic hyperplasia (BPH) group and prostate cancer group (PCa) according to pathological findings. BPH group consisted of 26 patients and PCa group consisted of 33 patients. The ages in BPH and PCa groups were (mean±SD,70±4.93) years, (mean±SD,69.69±12.37) years respectively. Serum PSA levels of BPH and PCa groups were (mean±SD, 12.97±8.22)ng/mL, (mean±SD,97.22±125.24) ng/mL respectively. Serum PSA levels were significant difference (p<0.05) in two groups. All patients underwent CETRUS examination and lesion-targeted TRUS guided biopsy successively on the same day. The characteristics of parametric imaging were observed and 10 parameters of AUC, mTT, PI, TTP, IMAX, ResT, RT, WiR, WoR, WiRxWoR were measured with SonoProstate software.2 A total of 30 patients with increased PSA level but no foci detected by gray-scale TRUS were enrolled in this study. Each patient was performed TRUS, CETRUS and TURS-guided sextant biopsy of prostate successively on the same day. Parametric images and CETRUS images were observed and suspicious areas were recorded. The results of parametric images were statistically compared with pathological findings.Results1 There were significant difference in 9 parameters of mTT, PI, TTP, IMAX, ResT, RT, WiR, WoR, WiRxWoR (p<0.05) between the 2 groups. The value of each parameter in PCa and BPH groups respectively was as follow:mTT (21.94±8.89 vs 38.09±22.31), PI (42.02±23.17 vs 22.68±13.29), TTP (10.72±3.04 vs 13.38±4.18), IMAX (41.45±22,69 vs 22.85±12.79), ResT (17.95±10.39 vs 41.34±36.25), RT(8.72±2.87 vs 11.22±3.91), WiR(8.89±5.98 vs 4.47±3.77), WoR(1.75±1.17 vs 0.72±0.53), WiRxWoR(21.12±26.86 vs 4.33±6.35). There were 44 matches of parameters, in which 39 matches were significant differences by bivariate correlation(p<0.05).24 matches of parameters were positive correlation, while 15 matches of parameters were negative correlation. However, there were no correlations in the match of AUC and TTP, mTT and PI, mTT and IMAX, PI and ResT, ResT and WiR (p>0.05). 2 15 of 19 patients with PCa proved by pathology could be detected by parametric imaging, while 9 of 11 patients with BPH proved by pathology could be detected by parametric imaging. There was no significant difference in detecting PCa (p=0.687).Conclusions1 Values of parameters which reflect characteristics of perfusion mode can be got by parametric imaging, meanwhile, it can help to identify prostatic nodules.2 CETURS with parametric imaging is helpful to detect suspicious areas of PCa in patient with no conspicuous foci by TRUS but with increased PSA level.
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