A direct comparison of contrast-enhanced ultrasound and dynamic contrast-enhanced magnetic resonance imaging for prostate cancer detection and prediction of aggressiveness
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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.
• 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.
KeywordsMagnetic resonance imaging Transrectal ultrasound Prostate cancer Detection Contrast media
Dynamic contrast-enhanced magnetic resonance imaging
Digital rectal examination
Initial area under the curve
Multiparametric magnetic resonance imaging
Mean transit time local
Peak enhancement intensity
Prostate imaging reporting and data system
- TTPCEUS, DCE
Time to peak
Extravascular extracellular space
Wash-in area under the curve
Wash-in perfusion index
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.
Written informed consent was obtained from all subjects (patients) in this study.
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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