European Radiology

, Volume 28, Issue 5, pp 1949–1960 | Cite as

A direct comparison of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for prostate cancer detection and prediction of aggressiveness

  • Alexander D. J. Baur
  • Julia Schwabe
  • Julian Rogasch
  • Andreas Maxeiner
  • Tobias Penzkofer
  • Carsten Stephan
  • Marc Rudl
  • Bernd Hamm
  • Ernst-Michael Jung
  • Thom Fischer



Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) analyse tissue vascularization. We evaluated if CEUS can provide comparable information as DCE-MRI for the detection of prostate cancer (PCa) and prediction of its aggressiveness.

Material and methods

A post-hoc evaluation of 92 patients was performed. In each patient CEUS and DCE-MRI parameters of the most suspicious lesion identified on MRI were analysed. The predictive values for discrimination between benign lesions, low-/intermediate- and high-grade PCa were evaluated. Results of targeted biopsy served as reference standard (benign lesions, n=51; low- and intermediate-grade PCa [Gleason grade group 1 and 2], n=22; high-grade PCa [≥ Gleason grade group 3], n=19).


In peripheral zone lesions of all tested CEUS parameters only time to peak (TTPCEUS) showed significant differences between benign lesions and PCa (AUC 0.65). Of all tested DCE-MRI parameters, rate constant (Kep) was the best discriminator of high-grade PCa in the whole prostate (AUC 0.83) and in peripheral zone lesions (AUC 0.89).


DCE-MRI showed a superior performance for detection of PCa and prediction of its aggressiveness. CEUS and DCE-MRI performed better in peripheral zone lesions than in transition zone lesions.

Key Points

• DCE-MRI gathers information about vascularization and capillary permeability characteristics of tissues.

• DCE-MRI can detect PCa and predict its aggressiveness.

• CEUS also gathers information about vascularization of tissues.

• For detection of PCa and prediction of aggressiveness DCE-MRI performed superiorly.

• Both imaging techniques performed better in peripheral zone lesions.


Magnetic resonance imaging Transrectal ultrasound Prostate cancer Detection Contrast media 



Arrival time


Contrast-enhanced ultrasound


Dynamic contrast-enhanced magnetic resonance imaging


Digital rectal examination


Diffusion-weighted imaging


Fall time


Initial area under the curve


Rate constant


Transfer constant


Multiparametric magnetic resonance imaging


Mean transit time local


Peak enhancement


Peak enhancement intensity


Prostate imaging reporting and data system


Prostate-specific antigen


Rise time


T2-weighted imaging


Transrectal ultrasound


Time to peak


Extravascular extracellular space


Wash-in area under the curve


Wash-in perfusion index


Wash-in rate




Wash-out rate




Wash-in and wash-out area under the curve


Wash-out area under the curve


Compliance with ethical standards


The scientific guarantor of this publication is Alexander D.J. Baur.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Alexander Baur has received payments as a speaker for Bayer Healthcare. Bernd Hamm has worked as a consultant for Toshiba Medical and received research grants for the department of radiology from Toshiba Medical, Siemens, and Bracco Imaging. Ernst Michael Jung has received payments as a speaker for Bracco Imaging. Thom Fischer has received payments as a speaker for Toshiba Medical and Bracco Imaging.


The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

The institutional review board (Ethikkommission der Charité - Universitätsmedizin Berlin) approved the study (EA1/283/14).

Study subjects or cohorts overlap

Patients included in the final evaluation of the study at hand (n=92) represent a subgroup of a larger cohort of patients (n=159) who were included in a prospective study evaluating the value of contrast enhanced ultrasound (CEUS) in patients with suspicion for prostate cancer. Results of this study are not yet published. However, since the initial submission of our manuscript at European Radiology, a manuscript titled “Clinical value of contrast enhanced ultrasound (CEUS) and quantitative perfusion analysis in patients with suspicion for prostate cancer” has been submitted to Ultraschall in der Medizin - European Journal of Ultrasound.

The study at hand focuses on the comparison of CEUS and dynamic contrast-enhanced MRI DCE. In addition, different analytical approaches and statistical test were performed including a separate evaluation of peripheral and transition zone lesions of the prostate. Thus, results from both publications are based at least in parts on overlapping databases are substantially different and will substantially add to each other. In the manuscript we clearly state that it contains results from parts of an overlapping database with a yet unpublished study.



diagnostic or prognostic study

performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Alexander D. J. Baur
    • 1
  • Julia Schwabe
    • 2
  • Julian Rogasch
    • 3
  • Andreas Maxeiner
    • 4
  • Tobias Penzkofer
    • 1
  • Carsten Stephan
    • 4
    • 5
  • Marc Rudl
    • 5
    • 6
  • Bernd Hamm
    • 1
  • Ernst-Michael Jung
    • 7
  • Thom Fischer
    • 2
  1. 1.Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für StrahlenheilkundeBerlinGermany
  2. 2.Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Institut für RadiologieBerlinGermany
  3. 3.Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für NuklearmedizinBerlinGermany
  4. 4.Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Klinik für UrologieBerlinGermany
  5. 5.Berliner Forschungsinstitut für UrologieBerlinGermany
  6. 6.Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Institut für PathologieBerlinGermany
  7. 7.Universitätsklinikum Regensburg, Institut für RöntgendiagnostikRegensburgGermany

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