- Email: [email protected]
Prostatic Cancer: Role of Color Doppler Imaging in Transrectal Sonography
IMAGING
363
to radiation. Recently, power Doppler ultrasound has been promoted for this diagnosis but in general its sensitivity is somewhat less than that of nuclear medicine. I have advocated enhanced computerized tomography to clinicians because it also will demonstrate the presence or absence of abscesses, involvement of the perinephric spaces and will provide anatomical information that may not be available with the use of nuclear medicine. However, in the Pediatric population renal abscesses are rare and, therefore, computerized tomography is less important. In the past magnetic resonance imaging was not sensitive enough to be used. However, with newer imaging sequences and the use of gadolinium as a contrast medium agent, the ability to demonstrate renal involvement with infection has significantly improved. Certainly this technique will not have the drawback of radiation exposure. However, I believe the major drawbacks to its current use are expense (it should be noted that this study was performed at military institutions) and, even more serious, sedation may be necessary in children to obtain a satisfactory study. Stanford M. Goldman, M.D. Prostatic Cancer: Role of Color Doppler Imaging in Transrectal Sonography A. M. LAVOIPIERRE, R. M. SNOW, M. FRYDENBERG, D. GUNTER, G. REISNER, P. L. ROYCE AND G. J. LAVOIPIERRE, Department of Medical Imaging, St. Frances Xavier Cabrini Hospital, Malvern, Victoria, Australia AJR, 171: 205-210, 1998 OBJECTIVE. The aim of this study was to assess the roles of transrectal color Doppler and gray-scale sonography in revealing prostatic cancer, using biopsy as the reference standard. SUBJECTS AND METHODS. Two hundred fifty-six patients referred for urologic studies underwent transrectal sonography using gray-scale and color Doppler scanning. All abnormal areas shown on grayscale or color Doppler sonography or both were targeted and biopsies were performed. The patients also underwent random sextant biopsies. All biopsies were individually correlated with histopathologic findings and all results were analyzed. RESULTS. Cancer was found on biopsy in 100 patients (39%), and equivocal sonographic results or prostatic intraepithelial neoplasia was found in 22 other patients (9%).In 16 of the patients in whom cancer was detected, the tumors were correctly revealed only with color Doppler sonography. These 16 patients had a mean Gleason score of 6.4 (range, 5-81. Biopsy findings in these 16 patients showed eight patients with extensive lesions, three with moderate lesions, and five with minimal lesions. However, in nine other patients with cancer (9% of cancers detected), both gray-scale and color Doppler sonography failed to reveal lesions that were found on sextant biopsy. An analysis showed that, although highly sensitive, color Doppler sonography was somewhat less specific than gray-scale sonography. CONCLUSION. Color Doppler sonography should become a routine part of transrectal sonography of the prostate gland to improve detection and targeting of lesions. The practice of performing random sextant biopsies should also continue. Editorial Comment: This study, using transrectal gray scale and color Doppler ultrasound, consisted of 256 patients. In 100 patients (39%) cancer was found on biopsy with intraepithelial neoplasia in an additional 22 (9%). In 16 of the 100 patients color Doppler alone demonstrated abnormal flow and, therefore, resulted in a correct biopsy diagnosis of these lesions. These 16 patients had a Gleason score of 6.4 (range 5 to 8). The lesions were extensive in 8 of the 16 cases, moderate in 3 and minimal in 5. However, there were 9 other patients (9% of cancers detected) in whom neither the gray scale nor the color Doppler sonogram demonstrated the tumor, which was found on routine sextant biopsy. It is clear from this study that color Doppler is an important addition to gray scale ultrasound in demonstrating additional areas that require biopsy. However, this study also clearly indicates that one cannot rely on gray scale and color Doppler alone to demonstrate prostatic neoplasia. Random sextant biopsies should be obtained in addition to biopsies of suspicious lesions seen on gray scale andor color Doppler ultrasound. Stanford M. Goldman, M.D. Sonography of the Female Urethra C. L. SIEGEL,W. D. MIDDLETON, S.A. TEEFEY,M. A. WAINSTEIN, E. M. MCDOUCALL AND C. G. KLLTKE, Mallinckrodt Institute of Radiology and Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri AJR, 170 1269-1274, 1998 OBJECTIVE. The purpose of this study was to explore the role of sonography for women with urethral symptoms and a suspected urethral diverticulum. SUBJECTS AND METHODS. Nineteen women with urethral symptoms underwent voiding cystourethrography (VCUG) and transvaginal, transperineal, and urethral sonography (using a catheter-based
363
to radiation. Recently, power Doppler ultrasound has been promoted for this diagnosis but in general its sensitivity is somewhat less than that of nuclear medicine. I have advocated enhanced computerized tomography to clinicians because it also will demonstrate the presence or absence of abscesses, involvement of the perinephric spaces and will provide anatomical information that may not be available with the use of nuclear medicine. However, in the Pediatric population renal abscesses are rare and, therefore, computerized tomography is less important. In the past magnetic resonance imaging was not sensitive enough to be used. However, with newer imaging sequences and the use of gadolinium as a contrast medium agent, the ability to demonstrate renal involvement with infection has significantly improved. Certainly this technique will not have the drawback of radiation exposure. However, I believe the major drawbacks to its current use are expense (it should be noted that this study was performed at military institutions) and, even more serious, sedation may be necessary in children to obtain a satisfactory study. Stanford M. Goldman, M.D. Prostatic Cancer: Role of Color Doppler Imaging in Transrectal Sonography A. M. LAVOIPIERRE, R. M. SNOW, M. FRYDENBERG, D. GUNTER, G. REISNER, P. L. ROYCE AND G. J. LAVOIPIERRE, Department of Medical Imaging, St. Frances Xavier Cabrini Hospital, Malvern, Victoria, Australia AJR, 171: 205-210, 1998 OBJECTIVE. The aim of this study was to assess the roles of transrectal color Doppler and gray-scale sonography in revealing prostatic cancer, using biopsy as the reference standard. SUBJECTS AND METHODS. Two hundred fifty-six patients referred for urologic studies underwent transrectal sonography using gray-scale and color Doppler scanning. All abnormal areas shown on grayscale or color Doppler sonography or both were targeted and biopsies were performed. The patients also underwent random sextant biopsies. All biopsies were individually correlated with histopathologic findings and all results were analyzed. RESULTS. Cancer was found on biopsy in 100 patients (39%), and equivocal sonographic results or prostatic intraepithelial neoplasia was found in 22 other patients (9%).In 16 of the patients in whom cancer was detected, the tumors were correctly revealed only with color Doppler sonography. These 16 patients had a mean Gleason score of 6.4 (range, 5-81. Biopsy findings in these 16 patients showed eight patients with extensive lesions, three with moderate lesions, and five with minimal lesions. However, in nine other patients with cancer (9% of cancers detected), both gray-scale and color Doppler sonography failed to reveal lesions that were found on sextant biopsy. An analysis showed that, although highly sensitive, color Doppler sonography was somewhat less specific than gray-scale sonography. CONCLUSION. Color Doppler sonography should become a routine part of transrectal sonography of the prostate gland to improve detection and targeting of lesions. The practice of performing random sextant biopsies should also continue. Editorial Comment: This study, using transrectal gray scale and color Doppler ultrasound, consisted of 256 patients. In 100 patients (39%) cancer was found on biopsy with intraepithelial neoplasia in an additional 22 (9%). In 16 of the 100 patients color Doppler alone demonstrated abnormal flow and, therefore, resulted in a correct biopsy diagnosis of these lesions. These 16 patients had a Gleason score of 6.4 (range 5 to 8). The lesions were extensive in 8 of the 16 cases, moderate in 3 and minimal in 5. However, there were 9 other patients (9% of cancers detected) in whom neither the gray scale nor the color Doppler sonogram demonstrated the tumor, which was found on routine sextant biopsy. It is clear from this study that color Doppler is an important addition to gray scale ultrasound in demonstrating additional areas that require biopsy. However, this study also clearly indicates that one cannot rely on gray scale and color Doppler alone to demonstrate prostatic neoplasia. Random sextant biopsies should be obtained in addition to biopsies of suspicious lesions seen on gray scale andor color Doppler ultrasound. Stanford M. Goldman, M.D. Sonography of the Female Urethra C. L. SIEGEL,W. D. MIDDLETON, S.A. TEEFEY,M. A. WAINSTEIN, E. M. MCDOUCALL AND C. G. KLLTKE, Mallinckrodt Institute of Radiology and Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri AJR, 170 1269-1274, 1998 OBJECTIVE. The purpose of this study was to explore the role of sonography for women with urethral symptoms and a suspected urethral diverticulum. SUBJECTS AND METHODS. Nineteen women with urethral symptoms underwent voiding cystourethrography (VCUG) and transvaginal, transperineal, and urethral sonography (using a catheter-based