The Value Of The Diagnosis Of Prostate Cancer By Transrectal Contrast-enhanced Ultrasonography And Real-time Elastography In Combination With Targeted Biopsy

Objective1.The aim of this study is to explore the value of diagnosis of prostate cancer by transrectal real-time ultrasound elastography score, SR, SI method.2. To explore the value of prostate cancer detection rate using the transrectal ultrasonography-guided prostate systematic biopsy (SB), real-time ultrasound elastography (TRTE) targeted biopsy, transrectal contrast-enhanced ultrasonography (CEUS) combined with TRTETargeted biopsy (CEUS+TRTE targeted biopsy).Methods Transrectal ultrasound (TRUS) were performed in127men who had elevated serum prostate specific antigen (PSA) level or abnormal findings digital rectal examination (DRE) and other imaging examination.127patient were randomly divided into three groups, namely systematic biopsy group (SB), transrectal elastography targeted biopsy group (TRTE) and transrectal contrast-enhanced ultrasonography combined with elastography targeted biopsy group (CEUS+TRTE), where SB of group44patients, TRTE of53patients, CEUS+TRTE of30patients. Transrectal ultrasound elastography using Hitachi preirus ultrasonic diagnostic apparatus, end-fire rectal probe frequency, frequency is4MHz～9MHz; Prostate contrast-enhanced ultrasonography and biopsy using the Philips company IU22ultrasonography, end-fire rectal probe frequency, frequency is5MHz-9MHz, equipped with PIH (pulse inversion harmonic imaging) contrast-enhanced ultrasonography technology and special puncture guiding device. SonoVue ultrasound contrast agent bolus injection through elbow intravenous, every time you use a dose of SonoVue suspension4.8ml (suspension was added to each bottle SonoVue lyophilized powder for injection5ml normal saline).Inspection method is as follows: All subjects were first conventional transrectal ultrasonography to determine the lesion and The benign and malignant judgment; TRTE group were performed by transrectal real-time ultrasound elastography, and elasticity score and strain ratio(SR) and stiffness index (SI) of each case study object which was suspected prostate cancer was measured, CEUS+TRTE group were first performed by TRTE inspection. Evaluation methods and indicators same with TRTE group; subsequently CEUS examination, including visual observation of indicators of prostate lesions enhanced imaging features and application software QLAB the quantitative results related parameters, including initial intensity (Ⅱ), arrival time (AT), slope rate of ascending curve (A), the peak time (TTP), peak intensity (PI) and the area under the curve (AUC), and in accordance with visual and quantitative analysis of the results to make judgments benign and malignant lesions. Biopsy Methods:SB group with transrectal ultrasound-guided prostate11cores systematic biopsy method; TRTE group were TRTE targeted biopsy+6-cores systematic biopsies.To determine the target method: elastic graph score of3to5score or blue region of the nodule(nodules or blue area≥5mm. Every point to take1-score to3-scores; CEUS+TRTE group were abnormal enhancement of regional by the CEUS examination and TRTE abnormal area as targeted biopsy puncture points, each point to take1-core to3-cores such as CEUS suspicious lesions with TRTE identical or similar, the same target as puncture point. All biopsies were placed in the marked containers sent to pathology.Results127cases studied prostate biopsy pathology results were obtained. On TRUS, CEUS, TRTE score, TRTE-SR and TRTE-SI for efficient diagnosis of prostate cancer.The results show a high sensitivity method CEUS method, a method for the high specificity of elasticity ratio method, high accuracy methods for the elasticity ratio method, the positive predictive value means a higher elastic ratio method, a high negative predictive value of a method for the elasticity index, but the above five methods of sensitivity, specificity, accuracy, positive predictive value, negative predictive values were not significantly different (P=0.135). On three groups of prostate cancer biopsy positive rate of biopsy results compared, SB group for prostate cancer detection rate than TRTE group and CEUS TRTE group, and the difference was statistically significant (P<0.05), but TRTE group and CEUS+TRTE group comparison between prostate biopsy positive rate difference was not statistically significant. Biopsy of the three groups and the total number of stitches positive biopsy needles comparison, SB group and TRTE same group, the average number of biopsy score, but TRTE group of prostate cancer biopsy positive rate increased, the difference was statistically significant; TRTE group with CEUS+TRTE group, Average biopsy score reduce the number of positive score count increased, and the difference was statistically significant.Conclusion Transrectal real-time ultrasound elastography and ultrasound imaging can be improved to some extent of prostate cancer the detection rate. Elasticity score level of prostate cancer, SR and SI values were higher than benign prostatic lesions. Transrectal biopsy and CEUS+TRTE targeted combined with TRTE targeted biopsy can improve the detection rate of prostate cancer. CEUS transrectal prostate biopsy targeting combined with TRTE can improve prostate cancer biopsy positive rate while reducing the number of needle.