Trans-rectal ultrasonography (TRUS) with lipiodol injection for localization of the prostatic apex before radiotherapy planning

Purpose: To evaluate reliability of Trans-rectal ultra-sonography (TRUS) gu idance with lipiodol injection for prostate localization before radiotherap y planning. Material and methods: From October 1997 to March 2000, 31 patients with pro static adenocarcinoma and six patients with anastomotic recurrence after ra dical prostatectomy had TRUS-guided injection of lipiodol. Two milliliters of lipiodol were injected into each side of the prostate and 1 ml into both seminal vesicles with a 22 Gauge CHIBA needle and US probe guide before ra diotherapy planning. We had established a contrast quality index (0 for no prostate enhancement to 5 for efficient pacification without any diffusion) . On simulation films, we had performed anatomic measurements for compariso n with other anatomic studies. Results: For all 37 patients, TRUS-guided injection was well tolerated. Amo ng 31 patients with the prostate in situ, three had no apex opacification a nd 15 had no vesicle enhancement or peri-vesicle space diffusion. However, in 19 patients there was good contrast quality with an index score of great er than or equal to3. The majority of patients had prostatic apex between 1 .5 and 3.5 cm from ischial tuberosities ligne (27 from 28 evaluable for ape x). Among 19 evaluable patients, 15 had seminal vesicles 2-4 cm above the t op of pubis. For six patients with anastomotic recurrence after radical pro statectomy, lipiodol was precious aid to locate it. We had only one failure because of a precocious bladder absorption relating to a delay which is to o long between rectal probe locating and portal films. Conclusion: TRUS injection of lipiodol is a simple, inexpensive, relatively safe technique for focalization of prostatic apex, but not appropriate for seminal vesicles enhancement. This is also an interesting method to locate anastomotic recurrence. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.