Role of CEUS in multiparametric prediction in prostate cancer

Zielsetzung:

To compare MRI/US fusion guided and conventional biopsies and to investigate whether a mulitparametric ultrasound (mpUS) score can further characterize mpMRI suspicious lesions according to the prostate MRI reporting and data system (PI-RADS) score.

Material und Methodik:

From January 2012 to January 2014, 169 patients with at least one negative conventional prostate biopsy (PBX) before mulitparametric magnetic resonance imaging (mpMRI) and consistently elevated PSA levels were prospectively included. Real-time MRI/US fusion was used to biopsy the mpMRI targeted lesions. MpUS, including B-mode, Power Doppler, elastografy and CEUS was performed to further characterize those lesions. Afterwards, a conventional 10-core PBX was performed. The results of targeted and conventional PBX were compared and single US modalities were analyzed within the mpUS score. The mpUS score was further investigated for PI-RADS score prediction.

Ergebnisse:

Among 169 patients 71 prostate cancer (PCa) (42%) were detected. From these 71 cases clinically significant PCa (≥ Gleason 4 + 3 = 7) were detected exclusively by MRI/US fusion guided biopsy in 22 from 25 cases (88%). The highest sensitivity was observed in US elastografy (85%) and CEUS (80%) and their combination (92%) applied on PI-RADS classified lesions. The mpUS score predicts PCa and PI-RADS score 5 lesions with an overall accuracy of 86% and 80%, respectively.

Schlussfolgerungen:

MpUS may present a novel tool to predict PCa targeted prostate biopsy. Real-time MRI/US fusion guided PBX detects more clinically significant PCa compared with conventional TRUS. The initiated mpUS score could confirm this with a comparable accuracy within PI-RADS predefined lesions.