Prostate ultrasound--for urologists only? Frauscher, Ferdinand; Gradl, Johann; Pallwein, Leo
Cancer imaging,
2005-Nov-23, Letnik:
5 Spec No A, Številka:
special issue A
Journal Article
Recenzirano
Odprti dostop
The value of ultrasound (US) in the diagnosis of prostate cancer has dramatically increased in the past decade. This is mainly related to the increasing incidence of prostate cancer, the most common ...cancer in men and one of the most important causes of death from cancer in men. The value of conventional gray-scale US for prostate cancer detection has been extensively investigated, and has shown a low sensitivity and specificity. Therefore conventional gray-scale US is mainly used by urologists for guiding systematic prostate biopsies. With the development of new US techniques, such as color and power Doppler US, and the introduction of US contrast agents, the role of US for prostate cancer detection has dramatically changed. Advances in US techniques were introduced to further increase the value of US contrast agents. Although most of these developments in US techniques, which use the interaction of the contrast agent with the transmitted US waves, are very sensitive for the detection of microbubbles, they are mostly unexplored, in particular for prostate applications. Early reports of contrast-enhanced US investigations of blood flow of the prostate have shown that contrast-enhanced US adds important information to the conventional gray-scale US technique. Furthermore, elastography or 'strain imaging' seems to have great potential in prostate cancer detection. Since these new advances in US are very sophisticated and need a long learning curve, radiologists, who are overall better trained with these new US techniques, will play a more important role in prostate cancer diagnosis. Current trends show that these new US techniques may allow for targeted biopsies and therefore replace the current 'gold standard' for prostate cancer detection--the systematic biopsy. Consequently the use of these new US techniques for the detection and clinical staging of prostate cancer is promising. However, future clinical trials will be needed to determine if the promise of these new US advances of the prostate evolves into clinical application.
OBJECTIVE
To assess the value of a microbubble‐based ultrasonographic contrast agent for enhancing blood vessels in colour Doppler imaging (CDI) of small renal masses.
PATIENTS AND METHODS
Fifty‐one ...patients with small renal masses (<3 cm in diameter) had prospective CDI before and after intravenous administration of the contrast agent Levovist® (Schering, Berlin, Germany). The degree of tumour vascularity was subjectively graded from 0 to IV (indicating an increasing vessel count). Furthermore, peak systolic velocity (PSV), resistive index, and pulsatility index were measured. The CDI findings were then compared with those obtained at histopathological examination.
RESULTS
Intra‐ and/or peritumoral vessels were detected in 26 lesions (51%) by unenhanced CDI and in 48 by enhanced CDI (94%; P = 0.006, McNemar test). Higher grades of tumour vascularity (grade III and IV) were more common in malignant renal masses (P < 0.01). There were PSVs of >80 cm/s only in malignant lesions. Based on receiver operating characteristic analysis, enhanced CDI (area under the curve 0.789) was more accurate than unenhanced CDI (0.576) for differentiating benign from malignant renal masses (P < 0.004).
CONCLUSION
Enhanced CDI is better than unenhanced CDI for detecting tumour vascularity, and for discriminating between benign and malignant small renal masses.
OBJECTIVE
To compare the precision of transurethral endoscopic‐ vs ultrasound (US)‐guided injections, as transurethral application of various injectables under endoscopic view are widely used to ...treat urinary incontinence.
MATERIAL AND METHODS
Bovine collagen was injected into the lower urinary tract in 20 dead female pigs. In each pig five depots of collagen were injected and there were five pigs in each group. In group I collagen was injected into the urethral wall under endoscopic control. In group II collagen depots were injected periurethrally under endosocopic guidance. In group III collagen was injected into the urethral wall under US control. In group IV collagen depots were injected periurethrally under US guidance. A transurethral US probe (6 F, 15 MHz) and injection device were used for transurethral US‐guided injections. In all pigs the urethra and the periurethral tissue were removed after injection and investigated using anatomical preparations and histological sections.
RESULTS
In group I only two collagen depots were actually located in the urethral wall in two pigs (two of 25 depots, 8%). In group II five depots in two pigs were located in the urethral wall (five of 25 depots, 20%). The periurethral collagen depots were found to spread out in the loose connective and fat tissue around the urethra. In group III all US‐guided injections of collagen were situated in the urethral wall and in group IV they were all located periurethrally.
CONCLUSIONS
The present study shows that endoscopic application of injectables is an inaccurate technique, while US‐guided injections are precise. US‐guided injection enables excellent control of the therapeutic procedure.
To sonographically investigate whether mountain bikers have a higher prevalence of scrotal abnormalities compared with on-road cyclists.
We studied 85 male mountain bikers (mean age: 25 years; range ...17-45 years) and 50 male on-road cyclists (mean age: 23 years, range 15-46 years) with regard to scrotal findings on ultrasound (US).
Medical University Innsbruck, Austria.
Only males who gave a history of extensive mountain biking or on-road bicycling (2 hours or more per day on 6 days a week with a covered distance of more than 5,000 km/year) were entered in our study.
In addition to clinical evaluation, a standard ultrasonographic examination of the scrotum was performed using a linear array transducer operating at a frequency of 8.0 MHz (Acuson Sequoia 512).
The sonographic findings obtained in mountain bikers were compared with those obtained in on-road cyclists.
Eighty of 85 mountain bikers (94%) and 24 of 50 on-road cyclists (48%) presented with abnormal findings on scrotal US. Abnormal US findings in mountain bikers included scrotoliths in 69 bikers (81%), spermatoceles in 39 bikers (46%), and epididymal calcifications in 34 bikers (40%). US findings in on-road cyclists were scrotoliths in 8 cyclists (16%), spermatoceles in 13 cyclists (26%), and epididymal calcifications in 6 cyclists (12%). The overall number of scrotal abnormalities was significantly greater in mountain bikers than in on-road cyclists (P < 0.001).
Mountain bikers compared with on-road cyclists have shown to be at a higher risk for scrotal disorders on US examination. Not only protective measures but also the awareness of the bikers are required to reduce the potential risk. Further studies should be undertaken to determine the clinical significance of the sonographic changes.
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