RSNA 2003 

Abstract Archives of the RSNA, 2003


T02-1394

Contrast-enhanced Imaging of the Prostate for Cancer Detection

Scientific Papers

Presented on December 5, 2003
Presented as part of T02: Genitourinary/Ultrasound (Kidney, Bladder, Prostate)

Participants

John Ramey MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: Sonographic detection of prostate cancer is improved with contrast-enhanced targeted biopsy (Lancet 357:1849-1850, 2001; AJR 178:915-919, 2002; J Urol 167:1648-1652, 2002). We evaluated the discrimination of benign from malignant outer gland tissue during contrast-enhanced sonography of the prostate. Methods and Materials: 201 subjects were evaluated by transrectal sonography during infusion of a microbubble contrast agent (Imagent; Alliance Pharmaceuticals). Contrast-enhanced imaging was performed with harmonic gray scale, color and power Doppler imaging. Six biopsy cores were obtained in a modified sextant distribution with one core from the most suspicious area in each sextant. A sextant with no suspicious area was sampled with a laterally directed core. Each biopsy site was prospectively rated for suspicion of cancer on a 1-5 scale on pre-contrast and post-contrast imaging. Sensitivity and specificity for detection of cancer were computed with a cutoff ³ 3 as positive. Results: Cancer was detected in 128 sextant cores from 58 of 201 subjects (29%). On pre-contrast imaging, gray scale, color and power Doppler imaging demonstrated a sensitivity/specificity of 48%/65%, 20%/93% and 24%/89% respectively. Contrast enhancement of prostatic parenchyma was demonstrated in every patient. Contrast-enhanced harmonic gray scale, color and power Doppler imaging demonstrated a sensitivity/specificity of 40%/84%, 70%/35% and 79%/31% respectively. Receiver operating characteristic analysis for pre-contrast imaging demonstrated areas under the curve (Az) of 0.59 for gray scale, 0.55 for color Doppler and 0.58 for power Doppler. Contrast-enhanced imaging demonstrated Az values of 0.64 for gray scale harmonic imaging, 0.55 for color Doppler and 0.58 for power Doppler. There was no significant difference between the Az values for pre-contrast and contrast-enhanced imaging. All imaging techniques with the exception of color Doppler were significantly better than random chance (Az>0.5 p<0.05). Conclusion: Contrast-enhanced transrectal sonography does not improve sonographic discrimination between benign and malignant areas within the prostate outer gland. The sensitivity of color and power Doppler imaging is dramatically increased after contrast administration at the expense of reduced specificity. We suggest that contrast-enhanced targeted biopsy may result in increased cancer detection due to improved visibility of targeted sites even though it does not improve the discrimination between benign and malignant foci.       Questions about this event email: ethan.halpern@jefferson.edu

Cite This Abstract

Ramey MD, J, Contrast-enhanced Imaging of the Prostate for Cancer Detection.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3100866.html