Ethan J. Halpern MD, Presenter: Research grant, Koninklijke Philips Electronics NV Research grant, Lantheus Medical Imaging, Inc Equipment support, Toshiba Corporation

Edouard J. Trabulsi MD, Abstract Co-Author: Consultant,Intuitive Surgical, Inc Stockholder, Intuitive Surgical, Inc Consultant, Amgen Inc Speaker, Amgen Inc Consultant, Cougar Biotechnology, Inc Speaker, Cougar Biotechnology, Inc

Flemming Forsberg PhD, Abstract Co-Author: Equipment support, Toshiba Corporation Equipment support, Siemens AG Research collaboration, General Electric Company Research collaboration, Ultrasonix Medical Corporation Research collaboration, Toshiba Corporation Advisory Board, Siemens AG Advisory Board, Toshiba Corporation

Peter McCue MD, Abstract Co-Author: Nothing to Disclose

Leonard G. Gomella MD, Abstract Co-Author: Consultant, GlaxoSmithKline plc Consultant, Watson Pharmaceuticals, Inc Consultant, Johnson & Johnson Consultant, Bayer AG Consultant, Ferring Group

To evaluate detection of prostate cancer using contrast-enhanced ultrasound with flash replenishment maximum intensity projection (MIP) MicroFlow Imaging (MFI).

259 patients referred for prostate biopsy (mean age: 60years ±12; PSA: 6.4ng/mL ±6) were evaluated by transrectal ultrasound using a PVT-661VT endocavitary probe on the Aplio scanner (Toshiba America Medical Systems, Tustin, CA). The microbubble agent Definity (Lantheus Medical Imaging, N Billerica, MA) was diluted with saline to a concentration of 49.4uL/mL and infused at 4mL/min. MFI is a flash-replenishment technique that uses high power flash pulses to destroy bubbles, followed by low power pulses to demonstrate contrast replenishment and depict vascular architecture with a MIP display. Up to 6 targeted biopsy cores were obtained from areas of abnormal vascular enhancement or morphology on MFI, followed by a systematic 12 core biopsy protocol.

Contrast enhancement was observed in all patients. A positive biopsy for cancer was found in 436/3847 cores from 110/259 (42%) of subjects. Positive biopsies were obtained in 249/3108 (8.0%) of systematic cores and 187/1175 (15.9%) of targeted cores. Among patients with a positive biopsy, the odds ratio for a positive core with targeted biopsy versus systematic biopsy was 3.1 (95% CI: 2.4-4.0, p<0.001). On a per-patient basis, cancer was more frequently detected by systematic biopsy (n=99) relative to targeted biopsy (n=67); McNemar Chi-square = 18.3, p<0.001. Prostate cancer was detected only in targeted biopsy in 12 patients.  Among the 99 patients detected by systematic biopsy, patients with a positive targeted core (n=55) demonstrated a mean of 3.6 positive systematic cores while patients undetected by targeted biopsy (n=44) demonstrated a mean of 1.6 positive systematic cores (p<0.001). Mean percentage biopsy core involvement was 32% among patients with a positive targeted core, compared with 15% among patients who were undetected by targeted biopsy (p<0.001). Higher grade cancer (Gleason score >6) was more common among patients with a positive targeted biopsy (53% versus 18%; p<0.001).

Targeted biopsy of the prostate using contrast-enhanced MFI selectively detects higher volume/grade cancers as compared with systematic biopsy.

MFI imaging of the prostate identifies high volume/grade cancers (Gleason score >= 7) which are most likely to be clinically significant.

Halpern, E, Trabulsi, E, Forsberg, F, McCue, P, Gomella, L, Contrast-enhanced Sonography of the Prostate: Utility of Targeted Biopsy with Flash Replenishment MIP Imaging.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11034227.html