Arnoud W Postema1, Maudy C W Gayet2,3, Ruud J G van Sloun4, Rogier R Wildeboer4, Christophe K Mannaerts1, C Dilara Savci-Heijink5, Stefan G Schalk4, Amir Kajtazovic6, Henk van der Poel7, Peter F A Mulders8, Harrie P Beerlage1,4, Massimo Mischi4, Hessel Wijkstra1,4. 1. Department of Urology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 2. Department of Urology, Jeroen Bosch Hospital, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands. m.gayet@jbz.nl. 3. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. m.gayet@jbz.nl. 4. Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands. 5. Department of Pathology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 6. Department of Urology, Jeroen Bosch Hospital, Jeroen Bosch Ziekenhuis, Henri Dunantstraat 1, 5223 GZ, 's Hertogenbosch, The Netherlands. 7. Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands. 8. Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands.
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.
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.
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