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.

中文翻译：

---

超声增强与弥散分析用于前列腺癌的定位：与根治性前列腺切除术标本的相关性。

目的

确定二维（2D）对比增强超声（CEUS）成像的价值以及对比超声弥散成像（CUDI）对临床上重要的前列腺癌（csPCa）定位的附加价值。

方法

在这项多中心研究中，计划进行根治性前列腺切除术的受试者在术前接受了2D CEUS成像。CUDI地图是从CEUS记录生成的。CEUS记录和CUDI图均由五名观察者对出现csPCa（大于0.5 mL的任何Gleason≥4 + 3和Gleason 3 + 4的可能性）进行评分，并与根治性前列腺切除术的组织病理学进行比较。使用自动三维（3D）融合方案将成像与组织病理学匹配。接收者操作员曲线（ROC）分析是按观察者和成像方式进行的。

结果

最终分析包括216名患者中的133名（62％）。CEUS，CUDI及其组合的所有五个读取器的ROC下平均面积分别为0.78、0.79和0.78。这对CEUS的敏感性和特异性为81％和64％，对CUDI的敏感性和特异性为83％和56％，对于组合而言为83％和55％。CEUS，CUDI及其组合的观察者间协议分别显示出kappa值为0.20、0.18和0.18。

结论

二维CEUS和CUDI对csPCa定位的敏感性和特异性中等。尽管在一张图像中压缩了CEUS，但CUDI表现出与2D CEUS类似的性能。截止点3的灵敏度为83％，它可能成为有用的成像程序，尤其是在4D采集，改进的定量以及与其他美国成像技术（例如弹性成像）的组合中。