Multiparametric ultrasound: evaluation of greyscale, shear wave elastography and contrast-enhanced ultrasound for prostate cancer detection and localization in correlation to radical prostatectomy specimens

Abstract

BackgroundThe diagnostic pathway for prostate cancer (PCa) is advancing towards an imaging-driven approach. Multiparametric magnetic resonance imaging, although increasingly used, has not shown sufficient accuracy to replace biopsy for now. The introduction of new ultrasound (US) modalities, such as quantitative contrast-enhanced US (CEUS) and shear wave elastography (SWE), shows promise but is not evidenced by sufficient high quality studies, especially for the combination of different US modalities. The primary objective of this study is to determine the individual and complementary diagnostic performance of greyscale US (GS), SWE, CEUS and their combination, multiparametric ultrasound (mpUS), for the detection and localization of PCa by comparison with corresponding histopathology.Methods/designIn this prospective clinical trial, US imaging consisting of GS, SWE and CEUS with quantitative mapping on 3 prostate imaging planes (base, mid and apex) will be performed in 50 patients with biopsy-proven PCa before planned radical prostatectomy using a clinical ultrasound scanner. All US imaging will be evaluated by US readers, scoring the four quadrants of each imaging plane for the likelihood of significant PCa based on a 1 to 5 Likert Scale. Following resection, PCa tumour foci will be identified, graded and attributed to the imaging-derived quadrants in each prostate plane for all prostatectomy specimens. Primary outcome measure will be the sensitivity, specificity, negative predictive value and positive predictive value of each US modality and mpUS to detect and localize significant PCa evaluated for different Likert Scale thresholds using receiver operating characteristics curve analyses.DiscussionIn the evaluation of new PCa imaging modalities, a structured comparison with gold standard radical prostatectomy specimens is essential as first step. This trial is the first to combine the most promising ultrasound modalities into mpUS. It complies with the IDEAL stage 2b recommendations and will be an important step towards the evaluation of mpUS as a possible option for accurate detection and localization of PCa.Trial registrationThe study protocol for multiparametric ultrasound was prospectively registered on Clinicaltrials.gov on 14 March 2017 with the registry name ‘Multiparametric Ultrasound-Study for the Detection of Prostate Cancer’ and trial registration number NCT03091231

EFSUMB Young Investigator Award 2019

“…Meanwhile, to investigate the feasibility of multiparametric US, machine learning by means of a Gaussian mixture model using only CEUS features already achieved a higher detection performance than individual parameters, increasing the accuracy from 73 % to 81 % [10]. Thus, in collaboration with clinical partners at the Academic Medical Centre (University of Amsterdam, Amsterdam, The Netherlands) and the Martini Klinik in Hamburg (University Hospital, Hamburg-Eppendorf, Germany), I conducted the first clinical study combining B-mode US, CEUS, its quantification, as well as shear-wave elastography [11]. A total of 50 patients referred for radical prostatectomy were enrolled in this study; my preliminary work on registration allowed me to accurately match the histopathology to the imaging planes and automatically segment the prostate.…”

Contrast-Enhanced Ultrasound Quantification: From Kinetic Modeling to Machine Learning

“…This provides important advantages with data sets exhibiting clear spatial dependencies. In addition to the analysis of DCE-US data, combination with other (ultrasound) modalities reflecting different physical phenomena, such as B-mode acquisitions and shear wave elastography, represent a promising approach to boost the diagnostic accuracy (Brock et al 2013;Postema et al 2015;Mannaerts et al 2018Mannaerts et al , 2019Li et al 2019).…”

“…In addition to promoting the standardization of UCA injection and acquisition protocols, and of qualitative interpretation of DCE-US exams, important steps have been made in quantitative analysis, with the publication of consensus papers providing guidelines for quantification of tumor perfusion by DCE-US (Dietrich et al 2012;Leen et al 2012). Moreover, important steps to combine quantitative parameters extracted from DCE-US and other ultrasound modalities in a multiparametric fashion are also being made (Acharya et al 2011;Brock et al 2013;Postema et al 2015;Mannaerts et al 2018Mannaerts et al , 2019Theek et al 2018).…”

Multifunctional Nanobubbles Carrying Indocyanine Green and Paclitaxel for Molecular Imaging and Treatment of Prostate Cancer

“…Early diagnosis and effective treatment are the basis for ensuring a good prognosis in patients with prostate cancer [1,2]. Previous studies have shown that ultrasound molecular imaging provides new ideas for early diagnosis, treatment and efficient monitoring of prostate cancer because of its realtime dynamic imaging, therapeutic controllability and easy operation [3,4]. However, due to the poor sensitivity and specificity of conventional ultrasound diagnosis of prostate cancer, the development of a high-sensitivity contrast-enhanced ultrasound contrast agent is pertinent in ultrasound molecular imaging of prostate cancer [5].…”