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2016 ; 42
(6
): 1251-62
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Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic
Radiation Force Impulse Imaging with Whole-Mount Histology Validation
#MMPMID26947445
Palmeri ML
; Glass TJ
; Miller ZA
; Rosenzweig SJ
; Buck A
; Polascik TJ
; Gupta RT
; Brown AF
; Madden J
; Nightingale KR
Ultrasound Med Biol
2016[Jun]; 42
(6
): 1251-62
PMID26947445
show ga
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.