Contrast-enhanced three-dimensional power Doppler angiography of the humanprostate: Correlation with biopsy outcome

Objectives. To determine the feasibility of contrast-enhanced three-dimensi onal (3D) imaging of the prostatic vasculature using power Doppler imaging and to analyze whether semiquantitative judgments of 3D images with respect to symmetry and distribution of vascular structures correlated with biopsy outcome. Methods. 3D power Doppler images were obtained before and after intravenous administration of 2.5 g Levovist. Subsequently, random and/or directed tra nsrectal ultrasound (TRUS)-guided biopsies were per formed. Vascular images were analyzed by two experts. Prostate vasculature was judged with respect to symmetry and vessel distribution using a (scale) grading system. Results. Eighteen patients with a suspicion of prostate cancer either becau se of an elevated prostate-specific antigen (greater than 4.0 ng/mL; Tandem -R-assay) or an abnormal digital rectal examination were included in the st udy. Prostate cancer was detected in 13 patients. Vascular anatomy was judg ed abnormal in unenhanced images in 6 cases, of which 5 proved malignant. E nhanced images were considered suspicious for malignancy in 12 cases, inclu ding 1 benign and 11 malignant biopsy results. Sensitivity of enhanced imag es was 85% (specificity 80%) compared with 38% for unenhanced images (speci ficity 80%) and 77% for conventional gray-scale TRUS (specificity 60%). Of 6 patients who showed no B-mode abnormalities, vascular patterns were judge d abnormal in 4 cases, of which 3 were malignant. Conclusions. Contrast-enhanced 3D power Doppler angiography is feasible in patients with suspicion of prostate cancer who are scheduled for prostate b iopsies. The sensitivity of power Doppler 3D imaging for the detection of p rostate malignancy increased from 58% (5 of 13) to 85% (11 of 13) after adm inistration of intravascular microbubble contrast (Levovist), and specifici ty was found to be 80% (4 of 5) for both imaging modalities. Thus, the use of Levovist when combined with the power Doppler display mode and 3D image reconstruction offers a promising new research area that might prove useful in prostate cancer detection in the future. UROLOGY 54: 97-104, 1999. (C) 1999, Elsevier Science Inc.