European Journal of Radiology
Volume 54, Issue 1 , Pages 148-155, April 2005

The value of contrast enhanced power Doppler ultrasonography in differentiating hypoehoic lesions in the peripheral zone of prostate☆

  • Can Zafer Karaman

      Affiliations

    • Department of Radiology 09100, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
    • Corresponding Author InformationCorresponding author. Tel.: +90 256 2120 020/221; fax: +90 256 212 6399.
    • ,
  • Alparslan Ünsal

      Affiliations

    • Department of Radiology 09100, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
    • ,
  • Alev Akdilli

      Affiliations

    • Department of Radiology 09100, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
    • ,
  • Füsun Taşkın

      Affiliations

    • Department of Radiology 09100, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey
    • ,
  • Haluk Erol

      Affiliations

    • Department of Urology 09100, Faculty of Medicine, Adnan Menderes University, Aydin, Turkey

Received 6 November 2003; received in revised form 14 April 2004; accepted 19 April 2004.

Abstract 

Objective: To characterize the hypoechoic prostate nodules in the peripheral zone by means of power Doppler ultrasonography (PDUS) and contrast enhanced PDUS (CE-PDUS). Materials and Methods: Thirty-two patients with dijital rectal examination findings suspicious for malignancy and/or a serum PSA level higher than 4ng/dl, and who had hypoechoic nodules on transrectal ultrasonography were enrolled in this prospective study. Power Doppler ultrasonography (PDUS) images before and after sonocontrast (Levovist®) injection were photographed for further evaluation. All patients were also evaluated by a systematic and nodule targeted biopsy approach. The photographs were re-evaluated by two radiologists for the presence and type of vascularity. The type of vascularity was categorized as peripheral, central, mixed and penetrating. The latter two were accepted as representatives of malignancy. The results of PDUS and CE-PDUS were compared to each other and to the pathological results. Results: There was a high level of interobserver agreement (Kappa: 0.80–0.95). Nineteen patients, but only 14 nodules were malignant on pathological examination. Sensitivity, specificity positive and negative predictive values for PDUS were 57, 50, 47, and 60%, respectively. On CE-PDUS, the sensitivity increased (93%) in expense of specifity (17%). The positive and negative predictive values were 46 and 75%, respectively. There was no significant difference between PDUS and CE-PDUS. Conclusion: This study revealed that both benign and malignant nodules might be hypervascular and show malignant type of vascularity on PDUS. Contrary to some recent reports, we can conclude that the CE-PDUS does not provide a considerable aid to the diagnosis of prostate carcinoma on morphological basis due to its very low specificity despite its relatively higher sensitivity.

Keywords:  Prostate, Nodule, Ultrasound contrast agent, Power Doppler ultrasonography

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☆ This study had been presented at the ‘Scientific Sessions’ of the ECR 2003.

PII: S0720-048X(04)00153-6

doi:10.1016/j.ejrad.2004.04.013

European Journal of Radiology
Volume 54, Issue 1 , Pages 148-155, April 2005

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