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Aging and disease    2018, Vol. 9 Issue (3) : 480-488     DOI: 10.14336/AD.2017.0704
Orginal Article |
The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer
Chang Ying1, Yang Jingchun1,*, Hong Hua2, Ma Huijuan1, Cui Xin3, Chen Li4
1Departments of Ultrasonography, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
2Departments of Ultrasonography, Inner Mongolia Autonomous Region People’s Hospital, Hohhot 010017, China
3Departments of Urology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
4Departments of Pathology, Xuan Wu Hospital, Capital Medical University, Beijing 100053, China
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To evaluate the performance of a combination of real-time strain elastography (RTSE) and contrast-enhanced transrectal ultrasound (CETRUS) for prostate cancer detection. Patients with serum prostate-specific antigen (PSA) levels of ≥4.0 ng/ml were prospectively enrolled between June 2014 and December 2016. 153 prostate nodules diagnosed by conventional ultrasound were prospectively enrolled and examined by CETRUS and RTSE before a biopsy. Multivariate logistic regression models were established for CETRUS, and CETRUS combined with RTSE to diagnose prostate malignancy. The diagnostic performances of CETRUS, RTSE, and their combined use were evaluated with the receiver operating characteristic (ROC) curve. The multivariate logistic regression for CETRUS combined with RTSE showed that enhanced strength, enhanced uniformity, and elasticity scores were the independent predictors of prostate malignancy. The area under the ROC curve of CETRUS combined with RTSE (0.921±0.023) was higher than that of CETRUS and RTSE (0.88±0.029 and 0.80±0.038, respectively; both p<0.05). Moreover, the sensitivity, accuracy and negative predictive value of CETRUS combined with RTSE were 92.1%, 86.2%, and 84.6%, respectively. The omission diagnostic rate of CETRUS combined with RTSE (7.9%) was reduced. And the diagnostic accuracy of CETRUS combined with RTSE was significantly higher than that of CETRUS and RTSE (p<0.05). While the diagnostic accuracy of CETRUS was close to the RTSE, the difference was not statistically significant (p>0.05). The combined RTSE with CETRUS approach significantly improved the sensitivity and overall accuracy for correctly identifying prostate cancer.

Keywords elastography      contrast agent      prostatic neoplasms      biopsy      ultrasonography     
Corresponding Authors: Yang Jingchun   
About author:

Those authors contributed equally to this work.

Issue Date: 05 June 2018
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Chang Ying
Yang Jingchun
Hong Hua
Ma Huijuan
Cui Xin
Chen Li
Cite this article:   
Chang Ying,Yang Jingchun,Hong Hua, et al. The Value of Contrast-Enhanced Ultrasonography Combined with Real-Time Strain Elastography in the Early Diagnosis of Prostate Cancer[J]. Aging and disease, 2018, 9(3): 480-488.
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CharacteristicsMean ± SD
Age (years)70.1±7.6
Prostate-specific antigen (ng/ml)
Prostate volume (ml)
Pathological stage
Gleason score
N (%)
8-1038 (24.8%)
5-743 (28.1%)
49 (5.9%)
Benign prostatic hyperplasia27 (17.6%)
Inflammatory24 (15.7%)
Prostatic intraepithelial neoplasia12 (7.8%)
Table 1  Clinical and demographic characteristics of the study population.
Figure 1.  Ultrasonography of prostate cancer. (A) Transverse transrectal ultrasound (TRUS) image showing a round hypoechoic lesion in the right posterolateral prostate gland (arrow). (B) Left: transverse real-time strain elastography (RTSE) image showing a blue lesion (arrow) in the prostate base peripheral zone, with decreased elasticity. Right: grayscale ultrasound images corresponding to elastography image. (C) The upper left: transverse contrast-enhanced TRUS (CETRUS) target lesion (arrow); the upper right: grayscale ultrasound images corresponding to CETRUS image; the bottom: time intensity profiles showed the target lesion increased intensity (red curve) compared with the adjacent peripheral zone tissues (yellow curve). (D) Histopathological analysis (H&E staining) of the biopsy revealing cancer (Gleason score 6).
Figure 2.  Transverse real-time strain elastography (RTSE) image of patient with prostate hyperplasia. A typical elastogram (A) and the corresponding B-mode image (B).
Figure 3.  Prostate zone anatomy. Peripheral zone is divided into base, mid gland and apex at each site. Study did not focus on inner gland.
ultrasound indicatorsvariableassignment
enhanced strengthX1hyper-enhanced=0, hypo-enhanced or equal enhanced=1
enhanced uniformityX2uniformity =0, ununiformity =1
the beginning of enhancement timeX3early in the surrounding organization =0
later or equal in the surrounding organization =1
the peak of enhancement timeX4early in the surrounding organization =0
later or equal in the surrounding organization =1
elasticity scoresX51~3 =0, 4~5 =1
PathologicalYbenign=0, malignant=1
Table 2  Ultrasonographic risk factors for maligant prostate lesions.
Figure 4.  CETRUS, RTSE and the combined diagnosis of prostate nodules ROC curve.
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