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by the American Institute of Ultrasound in Medicine J Ultrasound Med 23:623-630 • 0278-4297 Color and Power Doppler Sonography in the Diagnosis of Prostate CancerComparison Between Vascular Density and Total VascularityDepartments of Radiology (P.H.A., C.M.S., A.H., S.M.S.) and Urology (S.B.M., K.N.V.), University of Pennsylvania Medical Center, Philadelphia, Pennsylvania USA. Address correspondence and reprint requests to Peter H. Arger, MD, Department of Radiology, University of Pennsylvania Medical Center, 3400 Spruce St, Philadelphia, PA 19104. E-mail: peter.arger{at}uphs.upenn.edu.
Objective. Advances in color flow Doppler (CFD) and power Doppler imaging (PDI) have potential for prostate cancer diagnosis. Previous reports based on qualitative assessment suggest that hypervascularity increases likelihood of prostate cancer. Our objective was to compare 2 methods of vascularity assessment using PDI: total vascularity (TV) and vascular density (VD). The goal was to determine whether quantitative Doppler vascularity correlates with the likelihood of prostate cancer. Quantitative measurements were compared with subjective visual analysis of images. Methods. Ninety patients before biopsy had gray scale sonography, CFD, and PDI. Histologic analysis showed adenocarcinoma, prostate intraepithelial neoplasia, benign prostatic hypertrophy/prostatitis, and benign findings. The CFD and PDI images were analyzed for vascularity by (1) integrating the number of blood vessels over an imaged area (TV) and (2) integrating the number of vessels over a unit area of tissue (VD). Images were also assessed visually. VD, TV, and visual assessment were compared with one another and histologic findings. Results. Mean volume was not different. In each pathologic group, vascularity extent measured by TV and VD ranged from low to high. Disease groups did not exhibit a substantial difference in vascularity by either quantitative or qualitative analyses. Regionally, central gland TV was not significantly more vascular than peripheral gland TV except in benign prostatic hypertrophy. However, peripheral gland VD was 2.5 times greater than central gland VD. Seventy-one percent of the 31 focal hypoechoic lesions were hypervascular. Only 23% were carcinoma. Conclusions. Pathologic categories were not separable by apparent vascular measurement. All pathologic categories showed low, moderate, or high vascularity; thus vascular areas by themselves did not distinguish cancer types, nor did focal hypervascular hypoechoic areas increase the likelihood of cancer. These imaging techniques provided no further resolution of tumor discrimination over multiple biopsies of the prostate.
Key Words: color flow Doppler imaging • power Doppler imaging • prostate cancer • total vascularity • vascular density Abbreviations: BPH, benign prostatic hypertrophy • CFD, color flow Doppler • PDI, power Doppler imaging • PIN, prostate intraepithelial neoplasia • PSA, prostate-specific antigen • TV, total vascularity • VD, vascular density This article has been cited by other articles:
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