Contrast-enhanced ultrasound with dispersion analysis for the localization of prostate cancer: correlation with radical
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ORIGINAL ARTICLE
Contrast‑enhanced ultrasound with dispersion analysis for the localization of prostate cancer: correlation with radical prostatectomy specimens Arnoud W. Postema1 · Maudy C. W. Gayet2,3 · Ruud J. G. van Sloun3 · Rogier R. Wildeboer3 · Christophe K. Mannaerts1 · C. Dilara Savci‑Heijink4 · Stefan G. Schalk3 · Amir Kajtazovic2 · Henk van der Poel5 · Peter F. A. Mulders6 · Harrie P. Beerlage1,3 · Massimo Mischi3 · Hessel Wijkstra1,3 Received: 5 September 2019 / Accepted: 21 January 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To determine the value of two-dimensional (2D) contrast-enhanced ultrasound (CEUS) imaging and the additional value of contrast ultrasound dispersion imaging (CUDI) for the localization of clinically significant prostate cancer (csPCa). Methods In this multicentre study, subjects scheduled for a radical prostatectomy underwent 2D CEUS imaging preoperatively. CUDI maps were generated from the CEUS recordings. Both CEUS recordings and CUDI maps were scored on the likelihood of presenting csPCa (any Gleason ≥ 4 + 3 and Gleason 3 + 4 larger than 0.5 mL) by five observers and compared to radical prostatectomy histopathology. An automated three-dimensional (3D) fusion protocol was used to match imaging with histopathology. Receiver operator curve (ROC) analysis was performed per observer and imaging modality. Results 133 of 216 (62%) patients were included in the final analysis. Average area under the ROC for all five readers for CEUS, CUDI and the combination was 0.78, 0.79 and 0.78, respectively. This yields a sensitivity and specificity of 81 and 64% for CEUS, 83 and 56% for CUDI and 83 and 55% for the combination. Interobserver agreement for CEUS, CUDI and the combination showed kappa values of 0.20, 0.18 and 0.18 respectively. Conclusion The sensitivity and specificity of 2D CEUS and CUDI for csPCa localization are moderate. Despite compressing CEUS in one image, CUDI showed a similar performance to 2D CEUS. With a sensitivity of 83% at cutoff point 3, it could become a useful imaging procedure, especially with 4D acquisition, improved quantification and combination with other US imaging techniques such as elastography. Keywords Prostate cancer · Contrast-enhanced ultrasound · Dispersion analysis · Radical prostatectomy · Quantitative imaging
Introduction There is a rising interest in imaging for the diagnostic pathway of men with suspected prostate cancer (PCa) [1]. The possibility of selectively detecting and localizing clinically significant PCa could prevent unnecessary benign biopsies, reduce overdetection of insignificant PCa and guide localized treatments such as focal therapy (FT) [2–4]. Arnoud W. Postema and Maudy Gayet contributed equally to the manuscript. * Maudy C. W. Gayet [email protected] Extended author information available on the last page of the article
Multiparametric magnetic resonance imaging (mpMRI) has a recognized value in the diagnostic pathway of PCa [1, 4–6]. Strategies incorporating mpMRI in patient selecti
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