The Clinicai Appillcation Of Contrast-enhanced Ultrasound In The Diaguosis Of Prostatic Cancer

Objective:l.To explore the differences of perfusion characteristics and quantitative parameters (time to peak, TTP、derived peak intensity,DPI) in CEUS between benign and malignant nodules of prostate in peripheral zone.Investigated the correlation between DPI and gleason score of malignant nodules in peripheral zone.2.To explore the differences of perfusion characteristics and quantitative parameters (TTP、DPI) in CEUS between diffuse prostate carcinoma and moderate or severe benign prostate hyperplasia (BPH).To explore the clinical significance of resistance index (RI) of capsular artery in the prediction of diffuse prostate carcinoma, and get the best cut point forecast diffuse prostate carcinoma.3.To evaluate the significance of CEUS Combined with MRS application in the diagnosis and differential diagnosis of prostate cancerMethods:Amount to160cases with hypo-echoic biopsy-proven in this study。46malignant nodules and24benign nodules in peripheral zone,18patients with diffuse prostate cancer and12patients with moderate or severe benign prostate hyperplasia were included in the study of the first topic,40patients with benign and30patients with malignant were included in the study of the second topic.Topic one:1. Sixty patients with hypo-echoic biopsy-proven46malignant nodules and24benign nodules in peripheral zone underwent CEUS.The enhancement appearances were overviewed and the acoustic quantified parameter of time to peak (TTP) and derived peak intensity (DPI) was analyzed using time-intensity curve (TIC). In addition, Correlation between DPI of malignant nodules in peripheral zone and gleason score was also investigated.2. Eighteen diffuse prostate cancer patients (diffuse prostate cancer group) and12moderate or severe benign prostate hyperplasia (BPH) patients (BPH group) confirmed with transrectal biopsy underwent CEUS. The enhancement appearances were overviewed, the acoustic quantified parameter of time to peak (TTP) and derived peak intensity (DPI) was analyzed using time-intensity curve (TIC). The resistance index (RI) of capsular artery and urethral arteries of prostate gland were tested before CEUS.Topic two:Seventy patients with elevated level of serum prostate specific antigen and suspected prostate diseases were examined with transrectal ultrasound(TRUS), contrast-enhanced ultrasound(CEUS) and magnetic resonance spectroscopy (MRS) respectively.The data of above examination from70patients with suspected prostate diseases were anlysized.Result:Topic one:1.The TTP of malignant nodules in peripheral zone were shorter than benign nodules in peripheral zone and circumjacent the normal peripheral zone, while DPI were higher than those benign nodules in peripheral zone and circumjacent the normal peripheral zone (both P<0.05),respectively. Compared with DPI and TTP between benign nodules and circumjacent the normal peripheral zone didn’t have no statistical significance(both P>0.05).Linear correlative analysis showed that excellent positive correlation was found between DPI of malignant nodules in peripheral zone and gleason score (7=0.82,P<0.05).High-density enhancement with signal of fast washin and fast washout was found in73.91%(34/46) of malignant nodules, while simultaneously homogeneous perfused enhancement was observed in87.50%(21/24) of benign nodules in peripheral zone.2. TTP of inner glands in diffuse prostate cancer group were shorter, while DPI was higher than those in BPH group (both P<0.01). TTP of external glands in diffuse prostate cancer group was shorter, while DPI was higher than those in BPH group (both P<0.01). DPI of in prostatic inner gland was higher, while TTP was shorter than that of outer gland in diffuse prostate cancer and moderate or severe BPH group, respectively (both P<0.01). In diffuse prostate cancer group (n=18), the lesions were hyper-enhanced as a whole rapidly and unevenly, while the lesions were homogenously enhanced in moderate or severe BPH (n=18). The average RI value for capsular artery in the group of diffuse prostate cancer was higher than that of the control group (P<0.01). Taking RI=0.77for capsular artery as diagnostic value, the sensitivity in diagnosing diffuse prostate cancer was89.01%and the specificity was83.25%.Topic two:The rate of sensitivity,specificity,accuracy,positive predictive value,negative predictive and the diagnostic accuracy value for diagnosising prostate cancer TRUS was70.00%,82.50%,77.14%,75.00%and78.57%; CEUS was90.00%,87.50%,88.57%,84.38%, and92.11%; MRS was86.67%,90.00%,88.57%,86.67%and90.00%; TRUS and CEUS combined with MRS was93.33%,87.50%,90.00%,84.85%and94.59%. With pathologic diagnosis as the gold standard,the diagnosis of TRUS、CEUS、MRS、TRUS and CEUS combined with MRS as the result, draw the ROC curve separately, and the Az were0.76±0.06,0.88±0.04,0.88±0.05,0.90±0.04.Conclusion:1. Perfusion characteristics and quantitative parameters (time to peak, TTP、 derived peak intensity,DPI) in CEUS between benign and malignant nodules of prostate in peripheral zone existed obvious differences.Linear correlative analysis showed that excellent positive correlation was found between DPI of malignant nodules in peripheral zone and gleason score.2. Perfusion characteristics and quantitative parameters (time to peak, TTP、 derived peak intensity,DPI) in CEUS between prostate carcinoma and moderate or severe benign prostate hyperplasia existed obvious differences. RI of capsular artery is useful for the differentiation.3.TRUS,CEUS and MRS all have high sensitivity,specificity,accuracy,positive predictive value,negative predictive and the diagnostic accuracy value for diagnosis of prostate cancer.However,The highest rate of sensitivity,accuracy,negative predictive and the diagnostic accuracy value were seen in the patients examined with TRUS and CEUS combined with MRS.They were93.33%,,90.00%and94.59%.