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2008 Annual Meeting Abstracts
Prostate Cancer Detection with Contrast-Enhanced Ultrasound Using a Flash Replenishment Imaging Technique - MicroFlow Imaging
Jitesh V Patel1, Ethan J Halpern2, James R Johannes1, Flemming Forsberg2, Leonard G Gomella1, Edouard J Trabulsi1
1Kimmel Cancer Center, Thomas Jefferson University Hospital, Philadelphia, PA;2Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
Introduction: Sonographic detection of prostate cancer is limited with conventional gray scale and Doppler imaging. In order to improve the detection of prostate cancer by needle guided biopsy, we evaluated the MicroFlow Imaging (MFI) of prostatic vascularity during infusion of an ultrasound contrast agent.
Methods: Eighty one patients referred for prostate biopsy were evaluated by transrectal US using the microbubble agent Definity in a prospective IRB approved study. MFI is a flash-replenishment technique that uses high power flash pulses to destroy bubbles, followed by low power pulses to depict vascular architecture. Up to 6 targeted biopsies (TB) were obtained from areas of abnormal vascular enhancement, followed by a systematic 12 core biopsy (SB).
Results: A positive biopsy for cancer was found in 43% of subjects. Positive biopsies were obtained in 96/972 (9.9%) SB and 60/295 (20.3%) TB (OR=3.4, p<0.001). Two patients with cancer were identified only by TB, 19 by both, and 14 only by SB (p=0.0027). Among 33 patients detected by SB, 19 patients with a positive targeted core demonstrated an average of 3.8 positive systematic cores while 14 patients who were missed by TB demonstrated an average of 1.4 positive systematic cores (p=0.004). Mean SB core involvement was 31.2% among patients with a positive targeted core, compared with 11.6% among patients who were missed by TB (p=0.01). There was a trend toward increasing Gleason score (>6) among patients with a positive TB (p=0.07).
Conclusion: TB of the prostate based upon MFI efficiently detects high volume prostate cancer which is most likely to be clinically significant.
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