La radiologia medica

, Volume 122, Issue 12, pp 944–951 | Cite as

Elevated hardness of peripheral gland on real-time elastography is an independent marker for high-risk prostate cancers

  • Qi ZhangEmail author
  • Jing Yao
  • Yehua Cai
  • Limin Zhang
  • Yishuo Wu
  • Jingyu Xiong
  • Jun Shi
  • Yuanyuan Wang
  • Yi Wang



To examine the role of quantitative real-time elastography (RTE) features on differentiation between high-risk prostate cancer (PCA) and non-high-risk prostatic diseases in the initial transperineal biopsy setting.


We retrospectively included 103 patients with suspicious PCA who underwent both RTE and initial transperineal prostate biopsy. Patients were grouped into high-risk and non-high-risk categories according to the D’Amico’s risk stratification. With computer assistance based on MATLAB programming, three features were extracted from RTE, i.e., the median hardness within peripheral gland (PG) (H med), the ratio of the median hardness within PG to that outside PG (H ratio), and the ratio of the hard area within PG to the total PG area (H ar). A multiple regression model incorporating an RTE feature, age, transrectal ultrasound finding, and prostate volume was used to identify markers for high-risk PCA.


Forty-seven patients (45.6%) were diagnosed with PCA and 34 (33.0%) were diagnosed with high-risk PCA. Three RTE features were all statistically higher in high-risk PCA than in non-high-risk diseases (p < 0.001), indicating that the PGs in high-risk PCA patients were harder than those in non-high-risk patients. A high H ratio, high age, and low prostate volume were found to be independent markers for PCAs (p < 0.05), among which the high H ratio was the only independent marker for high-risk PCAs (p = 0.012). When predicting high-risk PCAs, the multiple regression achieved an area under receiver operating characteristic curve of 0.755, sensitivity of 73.5%, and specificity of 71.0%.


The elevated hardness of PG identified high-risk PCA and served as an independent marker of high-risk PCA. As a non-invasive imaging modality, the RTE could be potentially used in routine clinical practice for the detection of high-risk PCA to decrease unnecessary biopsies and reduce overtreatment.


Prostate cancer (PCA) Real-time elastography (RTE) Transperineal biopsy Transrectal ultrasound (TRUS) High-risk cancers Tissue elasticity 


Compliance with ethical standards


The work was funded by the National Science Foundation of China (Nos. 61671281; 61401267; 61471231).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable.

Informed consent

For this type of study formal consent is not required.


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Copyright information

© Italian Society of Medical Radiology 2017

Authors and Affiliations

  1. 1.Institute of Biomedical EngineeringShanghai UniversityShanghaiChina
  2. 2.Department of Ultrasound, Huashan HospitalFudan UniversityShanghaiChina
  3. 3.Department of Urology, Huashan HospitalFudan UniversityShanghaiChina
  4. 4.Department of Electronic EngineeringFudan UniversityShanghaiChina

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