0.877 χ 2 =0.51 P 0.05

2014 1 11 1 Chin J Med Ultrasound(Electronic Edition), January 2014, Vol.11, No.1 59 2012 5 2013 1 88 95 ROC χ 2 95 47 48 95 26 19 16 21 13 76.84% 73/95 79.17% 38/48 74.47% 35/47ROC 4.67 0.622 83.33% 78.72% 81.05% ROC 0.830 ROC 0.877 χ 2 =0.51 P 0.05 The value of transrectal realtime tissue elastography in the differential diagnosis of prostatic lesions Chang Xiaofeng, Wang Wei, Zhao Xiaozhi, Ji Changwei, Lian Huibo, Zhang Shiwei, Gan Weidong, Li Xiaogong, Zhang Gutian, Guo Hongqian. Department of Urology, Affi liated Drum Tower Hospital, Medical College of Nanjing University, Nanjing 210008, China Corresponding author: Guo Hongqian, Email: dr_changxf@163.com AbstractObjective To assess the contribution of transrectal realtime tissue elastography (TRTE) on the differential diagnosis of prostatic diseases. Methods A total of 88 prostatic disease patients with 95 lesions proved by pathology from May 2012 to January 2013 in the Affiliated Drum Tower Hospital of Medical College of Nanjing University were included. The elasticity grade and strain ratio were calculated by using TRTE. According to the gold standard of pathological results, the sensitivity, specificity, accuracy rate were calculated to evaluate the effectiveness of elasticity grade and strain ratio in distinguishing benign and malignant prostatic diseases; and the receiver operating characteristic (ROC) curves were made respectively. The accuracy of elasticity grade and strain ratio in diagnosing prostatic diseases was also compared using chi-square test. Results Forty-seven benign lesions were found in the 95 prostatic lesions and the other 48 lesions were malignant. The elasticity grades of the 95 prostatic lesions were as follows: Grade 26, Grade 19, Grade 16, Grade 21, and Grade 13. Elasticity grade was considered to be benign, while grade was malignant. The sensitivity, specificity, accuracy rate of elasticity grade in diagnosis of prostatic malignant lesions was 79.17% (38/48), 74.47% (35/47) and 76.84% (73/95), respectively. According the ROC curve analysis, the cutoff point of strain ratio was 4.67, and Youden s index was 0.622. The sensitivity, specificity, accuracy rate of strain ratio was 83.33%, 78.72% and DOI 10.3877/cma.j.issn.1672-6448.2014.01.016 210008 Email dr_changxf@163.com

60 2014 1 11 1 Chin J Med Ultrasound(Electronic Edition), January 2014, Vol.11, No.1 81.05%, respectively. The area under ROC curves of strain ratio was superior to that of elasticity grade. But the diagnosis accuracy of the two approaches was almost the same in statistics (χ 2 =0.51, P 0.05). Conclusions TRTE is valuable in the differential diagnosis of the prostatic benign and malignant lesions. Both strain ratio and elasticity grade are useful approaches, and have similar diagnostic accuracy. Key wordsprostatic diseases; Ultrasonography; Elasticity imaging techniques [1-2] CT MRI [3] realtime tissue elastography RTE transrectal realtime tissue elastography TRTE 2012 5 2013 1 88 1 10 μg/l 10 μg/l 4 μg/l / 0.16 2 3 MRI 3 12 3 88 46~83 71.0 4.6 6.52~323.00 μg/l 37.21 11.63 μg/l 21.3~71.6 ml 49.2 3.7 ml Hitachi Hi Vision Preirus EUP-V 53W 4~11 MHz [4] 3~4 1~2 /s [5] 12 6 [6] 1 12 TRTE TRTE 10% HE Kamoi [5] 5 AB Hitachi B/A 3 SPSS l7.0

2014 1 11 1 Chin J Med Ultrasound(Electronic Edition), January 2014, Vol.11, No.1 61 receiver operating characteristic ROC χ 2 t P 0.05 88 95 38 12 50 10 35 45 48 47 95 88 TRTE 95 12 TRTE 88 49 10 4 2 39 Gleason 6~9 95 47 48 1. TRTE 95 1 95 26 23 3 19 12 7 16 7 9 21 3 18 13 2 11 95 47 48 76.84% 79.17% 74.47% 2 2. 48 11.76 9.61 1 2 47 3.18 3.14 3 4 t=1.66 P 0.05 95 TRTE ROC 5 0.622 4.67 83.33% 78.72% 81.05% 3. χ 2 =0.51 P 0.05ROC 595 ROC 0.877 ROC 0.830 ROC 0.7~0.9 [7] [8-9] TRTE, [10] / 1998 Krouskop [11] 1999 Pesavento [12]

62 2014 1 11 1 Chin J Med Ultrasound(Electronic Edition), January 2014, Vol.11, No.1 TRTE 2003 Sperandeo [13] TRTE [14] Kamoi, 5 TRTE, TRTE [15] TRTE TRTE 42 34 TRTE TRTE TRTE TRTE 88 95 ~ ~ 76.00% 79.17% 76.00% 79.17% 74.47% Kamoi [5] ~ ~ [16] 48 11.76 9.6147 3.18 3.14 ROC 0.622 4.67 ROC 0.877 0.830 0.7~0.9 ROC ROC 1~5 1 Gao L, Parker KJ, Lerner RM, et al. Imaging of the elastic properties of tissue--a review[j]. Ultrasound Med Biol, 1996, 22(8): 959-977. 2 Aboumarzouk OM, Ogston S, Huang Z, et al. Diagnostic accuracy of transrectal elastosonography (TRES) imaging for the diagnosis of prostate cancer: a systematic review and meta-analysis[j]. BJU Int, 2012, 110(10): 1414-1423. 3 Pummer K, Rieken M, Augustin H, et al. Innovations in diagnostic imaging of localized prostate cancer[j]. World J Urol, 2013. 4,,. [J]., 2011, 25(4): 298-300. 5 Kamoi K, Okihara K, Ochiai A, et al. The utility of transrectal real-time elastography in the diagnosis of prostate cancer[j]. Ultrasound Med Biol, 2008, 34(7): 1025-1032. 6 Hodge KK, McNeal JE, Terris MK, et al. Random systematic versus directed ultrasound guided transrectal core biopsies of the prostate[j]. J Urol, 1989, 142(1): 71-74. 7 Pallwein L, Mitterberger M, Gradl J, et al. Value of contrast-enhanced ultrasound and elastography in imaging of prostate cancer[j]. Curr Opin Urol, 2007, 17(1): 39-47. 8 Good DW, Stewart GD, Hammer S, et al. Elasticity as a biomarker for prostate cancer: a systematic review[j]. BJU Int, 2013. 9 Nygard Y, Haukaas SA, Halvorsen OJ, et al. A positive real-time elastography is an independent marker for detection of high-risk prostate cancers in the primary biopsy setting[j]. BJU Int, 2013. 10 Dewall RJ. Ultrasound elastography: principles, techniques, and clinical applications[j]. Crit Rev Biomed Eng, 2013, 41(1): 1-19. 11 Krouskop TA, Wheeler TM, Kallel F, et al. Elastic moduli of breast and prostate tissues under compression[j]. Ultrason Imaging, 1998, 20(4): 260-274. 12 Pesavento A, Perrey C, Krueger M, et al. A time-efficient and accurate strain estimation concept for ultrasonic elastography using iterative phase zero estimation[j]. IEEE Trans Ultrason Ferroelectr Freq Control, 1999, 46(5): 1057-1067. 13 Sperandeo G, Sperandeo M, Morcaldi M, et al. Transrectal ultrasonography for the early diagnosis of adenocarcinoma of the prostate: a new maneuver designed to improve the differentiation of malignant and benign lesions[j]. J Urol, 2003, 169(2): 607-610. 14,,,. [J]., 2010, 16(11): 979-983.

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