Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation

Abstract

Overly aggressive prostate cancer (PCa) treatment adversely affects patients and places an unnecessary burden on our health care system. The inability to identify and grade clinically significant PCa lesions is a factor contributing to excessively aggressive PCa treatment, such as radical prostatectomy, instead of more focal, prostate-sparing procedures such as cryotherapy and high-dose radiation therapy. We have performed 3-D in vivo B-mode and acoustic radiation force impulse (ARFI) imaging using a mechanically rotated, side-fire endorectal imaging array to identify regions suspicious for PCa in 29 patients being treated with radical prostatectomies for biopsy-confirmed PCa. Whole-mount histopathology analyses were performed to identify regions of clinically significant/insignificant PCa lesions, atrophy and benign prostatic hyperplasia. Regions of suspicion for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location. These regions of suspicion were compared with histopathology identified lesions using a nearest-neighbor regional localization approach. Of all clinically significant lesions identified on histopathology, 71.4% were also identified using ARFI imaging, including 79.3% of posterior and 33.3% of anterior lesions. Among the ARFI-identified lesions, 79.3% corresponded to clinically significant PCa lesions, with these lesions having higher indices of suspicion than clinically insignificant PCa. ARFI imaging had greater sensitivity for posterior versus anterior lesions because of greater displacement signal-to-noise ratio and finer spatial sampling. Atrophy and benign prostatic hyperplasia can cause appreciable prostate anatomy distortion and heterogeneity that confounds ARFI PCa lesion identification; however, in general, ARFI regions of suspicion did not coincide with these benign pathologies.

MR elastography to measure the effects of cancer and pathology fixation on prostate biomechanics, and comparison withT1,T2and ADC

“…Other investigators have reported several factors of increase in prostate elastic modulus with cancer (i.e., in PZ a factor of 3.2 (Krouskop et al , 1998), 2.6 (Zhang et al , 2008) (mechanical stress testing at 150 Hz), and in (Dresner et al , 2003) (mechanical frequency of 350 Hz) tumor was approximately twice as stiff as healthy prostate. Recently, acoustic radiation force imaging (ARFI) has been explored in combination with B-mode ultrasound imaging to map prostate anatomical zones (Palmeri et al , 2015), and to identify prostate cancer lesions in vivo with retrospective evaluation from whole specimen prostatectomy histopathology (Palmeri et al , 2016) (4.6–5.4 MHz). ARFI in combination with B-mode ultrasound was found to compare well with T 2 w MRI for mapping prostate anatomy, and was highly accurate in mapping prostate cancer, i.e., 71.4% of lesions were identified in ARFI.…”

The Role of Affordable, Point-of-Care Technologies for Cancer Care in Low- and Middle-Income Countries: A Review and Commentary

“…The use of ultrasound has been shown to augment breast cancer diagnosis by mammography, particularly for women with dense breast tissue [2] – [5] , and evidence continues to grow for the use of ultrasound as a primary modality of breast cancer diagnosis in resource-limited settings, including the use of ultrasound-guided fine needle aspiration [6] – [8] . Ultrasound is also used to guide targeted biopsies for prostate cancer diagnosis as well, lowering cost and overtreatment [9] . Additionally, as the development of promising, low-cost contrast agents for image-guided therapeutics continues, ultrasound has the potential to play a role in targeted treatment and disease monitoring [10] .…”

Uitc Abstracts 2018

“…2.3 Correlations between cervical smooth-muscle force generation and acoustic backscatter-coefficient parameters, Andrew P. Santoso 1 , Joy Vink 2 , George Gallos 3 , Helen Feltovich 1,4 , and Timothy J. Hall 1 , 1 Medical Physics, University of Wisconsin-Madison, Madison, WI; 2 Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; 3 Department of Anesthesia, Columbia University Medical Center, New York, NY; and 4 Maternal Fetal Medicine, Intermountain Healthcare, Provo, UT, apsantoso@wisc.edu Objectives: Smooth muscle cells in the human cervix may play a significant role in cervical function during pregnancy. (1) To date, noninvasive methods to evaluate cervical smooth muscle cell activity are lacking.…”

“…(3) Identified regions of suspicion in the in vivo data were validated with wholemount histopathology. (4) Results: Lesions were visible in the reconstructed SWEI volume for both phantom and in vivo data, with higher shear-wave speeds inside the lesion compared with the surrounding background. The 2D shear-wave speed calculation produced more homogeneous estimates compared with a conventional 1D algorithm, which had elevated biased estimates of shear-wave speed.…”