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Stiffness of benign and malignant prostate tissue measured by shear-wave elastography: a preliminary study

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Abstract

Objectives

To measure benign and malignant prostate tissue stiffness using shear-wave elastography (SWE).

Methods

Thirty consecutive patients underwent transrectal SWE in the axial and sagittal planes before prostatectomy. After reviewing prostatectomy specimens, two radiologists measured stiffness in regions corresponding to cancers, lateral and median benign peripheral zone (PZ) and benign transition zone (TZ).

Results

Cancers were stiffer than benign PZ and TZ. All tissue classes were stiffer on sagittal than on axial imaging, in TZ than in PZ, and in median PZ than in lateral PZ. At multivariate analysis, the nature of tissue (benign or malignant; P < 0.00001), the imaging plane (axial or sagittal; P < 0.00001) and the location within the prostate (TZ, median PZ or lateral PZ; P = 0.0065) significantly and independently influenced tissue stiffness. On axial images, the thresholds maximising the Youden index in TZ, lateral PZ and median PZ were respectively 62 kPa, 33 kPa and 49 kPa. On sagittal images, the thresholds were 76 kPa, 50 kPa and 72 kPa, respectively.

Conclusions

SWE can distinguish prostate malignant and benign tissues. Tissue stiffness is influenced by the imaging plane and the location within the gland.

Key Points

• Prostate cancers were stiffer than the benign peripheral zone

• All tissue classes were stiffer on sagittal than on axial imaging

• All tissue classes were stiffer in the transition zone than in the peripheral zone

• All tissue classes were stiffer in the median than in the lateral peripheral zone

• Taking into account imaging plane and zonal anatomy can improve cancer detection

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Abbreviations

SWE:

Shear-wave elastography

PZ:

Peripheral zone

TZ:

Transition zone

BPH:

Benign prostate hyperplasia

References

  1. Mottet N, Bellmunt J, Briers E, et al. (2016) EAU-ESTRO-SIOG Guidelines on Prostate Cancer. Available at: https://uroweb.org/individual-guidelines/oncology-guidelines

  2. Rubin R (2015) Researchers look to MRI and biomarkers to help improve detection of aggressive prostate cancers. JAMA 313:654–656

    Article  CAS  PubMed  Google Scholar 

  3. Bratan F, Niaf E, Melodelima C et al (2013) Influence of imaging and histological factors on prostate cancer detection and localisation on multiparametric MRI: a prospective study. Eur Radiol 23:2019–2029

    Article  PubMed  Google Scholar 

  4. Valerio M, Donaldson I, Emberton M et al (2015) Detection of clinically significant prostate cancer using magnetic resonance imaging-ultrasound fusion targeted biopsy: a systematic review. Eur Urol 68:8–19

    Article  PubMed  Google Scholar 

  5. Schoots IG, Roobol MJ, Nieboer D, Bangma CH, Steyerberg EW, Hunink MG (2015) Magnetic resonance imaging-targeted biopsy may enhance the diagnostic accuracy of significant prostate cancer detection compared to standard transrectal ultrasound-guided biopsy: a systematic review and meta-analysis. Eur Urol 68:438–450

    Article  PubMed  Google Scholar 

  6. Turkbey B, Mani H, Shah V et al (2011) Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol 186:1818–1824

    Article  PubMed  Google Scholar 

  7. van Hove A, Savoie PH, Maurin C et al (2014) Comparison of image-guided targeted biopsies versus systematic randomized biopsies in the detection of prostate cancer: a systematic literature review of well-designed studies. World J Urol 32:847–858

    Article  PubMed  Google Scholar 

  8. Postema A, Mischi M, de la Rosette J, Wijkstra H (2015) Multiparametric ultrasound in the detection of prostate cancer: a systematic review. World J Urol 33:1651–1659

    Article  PubMed  PubMed Central  Google Scholar 

  9. Bercoff J, Tanter M, Fink M (2004) Supersonic shear imaging: a new technique for soft tissue elasticity mapping. IEEE Trans Ultrason Ferroelectr Freq Control 51:396–409

    Article  PubMed  Google Scholar 

  10. Shiina T, Nightingale KR, Palmeri ML et al (2015) WFUMB guidelines and recommendations for clinical use of ultrasound elastography: Part 1: basic principles and terminology. Ultrasound Med Biol 41:1126–1147

    Article  PubMed  Google Scholar 

  11. Franchi-Abella S, Elie C, Correas JM (2013) Ultrasound elastography: advantages, limitations and artefacts of the different techniques from a study on a phantom. Diagn Interv Imaging 94:497–501

    Article  CAS  PubMed  Google Scholar 

  12. Zheng XZ, Ji P, Mao HW et al (2011) A novel approach to assessing changes in prostate stiffness with age using virtual touch tissue quantification. J Ultrasound Med 30:387–390

    Article  PubMed  Google Scholar 

  13. Barr RG, Memo R, Schaub CR (2012) Shear wave ultrasound elastography of the prostate: initial results. Ultrasound Q 28:13–20

    Article  PubMed  Google Scholar 

  14. Ahmad S, Cao R, Varghese T, Bidaut L, Nabi G (2013) Transrectal quantitative shear wave elastography in the detection and characterisation of prostate cancer. Surg Endosc 27:3280–3287

    Article  PubMed  Google Scholar 

  15. Woo S, Kim SY, Cho JY, Kim SH (2014) Shear wave elastography for detection of prostate cancer: a preliminary study. Korean J Radiol 15:346–355

    Article  PubMed  PubMed Central  Google Scholar 

  16. Correas JM, Tissier AM, Khairoune A et al (2015) Prostate cancer: diagnostic performance of real-time shear-wave elastography. Radiology 275:280–289

    Article  PubMed  Google Scholar 

  17. Woo S, Kim SY, Lee MS, Cho JY, Kim SH (2015) Shear wave elastography assessment in the prostate: an intraobserver reproducibility study. Clin Imaging 39:484–487

    Article  PubMed  Google Scholar 

  18. Samaratunga H, Montironi R, True L et al (2011) International society of urological pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens. Working group 1: specimen handling. Mod Pathol 24:6–15

    Article  PubMed  Google Scholar 

  19. Boehm K, Budaus L, Tennstedt P et al (2015) Prediction of significant prostate cancer at prostate biopsy and per core detection rate of targeted and systematic biopsies using real-time shear wave elastography. Urol Int 95:189–196

    Article  PubMed  Google Scholar 

  20. Boehm K, Salomon G, Beyer B et al (2015) Shear wave elastography for localization of prostate cancer lesions and assessment of elasticity thresholds: implications for targeted biopsies and active surveillance protocols. J Urol 193:794–800

    Article  PubMed  Google Scholar 

  21. Varghese T, Ophir J, Krouskop TA (2000) Nonlinear stress-strain relationships in tissue and their effect on the contrast-to-noise ratio in elastograms. Ultrasound Med Biol 26:839–851

    Article  CAS  PubMed  Google Scholar 

  22. Barr RG, Zhang Z (2012) Effects of precompression on elasticity imaging of the breast: development of a clinically useful semiquantitative method of precompression assessment. J Ultrasound Med 31:895–902

    Article  PubMed  Google Scholar 

  23. Kruse SA, Smith JA, Lawrence AJ et al (2000) Tissue characterization using magnetic resonance elastography: preliminary results. Phys Med Biol 45:1579–1590

    Article  CAS  PubMed  Google Scholar 

  24. Gennisson JL, Deffieux T, Mace E, Montaldo G, Fink M, Tanter M (2010) Viscoelastic and anisotropic mechanical properties of in vivo muscle tissue assessed by supersonic shear imaging. Ultrasound Med Biol 36:789–801

    Article  PubMed  Google Scholar 

  25. Gibbs P, Tozer DJ, Liney GP, Turnbull LW (2001) Comparison of quantitative T2 mapping and diffusion-weighted imaging in the normal and pathologic prostate. Magn Reson Med 46:1054–1058

    Article  CAS  PubMed  Google Scholar 

  26. Gibbs P, Pickles MD, Turnbull LW (2006) Diffusion imaging of the prostate at 3.0 tesla. Investig Radiol 41:185–188

    Article  Google Scholar 

  27. Park SY, Kim CK, Park BK, Ha SY, Kwon GY, Kim B (2014) Diffusion-tensor MRI at 3 T: differentiation of central gland prostate cancer from benign prostatic hyperplasia. AJR Am J Roentgenol 202:W254–W262

    Article  PubMed  Google Scholar 

  28. Sinha S, Sinha U (2004) In vivo diffusion tensor imaging of the human prostate. Magn Reson Med 52:530–537

    Article  PubMed  Google Scholar 

  29. Chesnais AL, Niaf E, Bratan F et al (2013) Differentiation of transitional zone prostate cancer from benign hyperplasia nodules: evaluation of discriminant criteria at multiparametric MRI. Clin Radiol 68:e323–e330

    Article  CAS  PubMed  Google Scholar 

  30. Hoeks CM, Hambrock T, Yakar D et al (2013) Transition zone prostate cancer: detection and localization with 3-T multiparametric MR imaging. Radiology 266:207–217

    Article  PubMed  Google Scholar 

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Acknowledgments

The scientific guarantor of this publication is Olivier Rouvière. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. This study has received funding by a grant from the French National Cancer Institute (Institut National du Cancer; Cartographix project—PAIR Prostate funding programme). One of the authors has significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. No study subjects or cohorts have been previously reported. Methodology: prospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, 69437, France

    Olivier Rouvière, Flavie Bratan, Gaele Pagnoux & Thomas Sanzalone

  2. Université de Lyon, Lyon, 69003, France

    Olivier Rouvière, Flavie Bratan, Thomas Sanzalone, Sébastien Crouzet & Marc Colombel

  3. Université Lyon 1, Faculté de Médecine Lyon Est, Lyon, 69003, France

    Olivier Rouvière, Flavie Bratan, Thomas Sanzalone, Sébastien Crouzet & Marc Colombel

  4. Inserm, U1032, LabTau, Lyon, 69003, France

    Olivier Rouvière, Au Hoang Dinh, Flavie Bratan, Sébastien Crouzet & Rémi Souchon

  5. Université Joseph Fourier, Laboratoire d’Ecologie Alpine, BP 53, Grenoble, 38041, France

    Christelle Melodelima

  6. CNRS, UMR 5553, BP 53, Grenoble, 38041, France

    Christelle Melodelima

  7. Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, 69437, France

    Sébastien Crouzet & Marc Colombel

  8. Hospices Civils de Lyon, Department of Pathology, Hôpital Edouard Herriot, Lyon, 69437, France

    Florence Mège-Lechevallier

Authors
  1. Olivier Rouvière
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  2. Christelle Melodelima
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  3. Au Hoang Dinh
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  9. Florence Mège-Lechevallier
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  10. Rémi Souchon
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Correspondence to Olivier Rouvière.

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Rouvière, O., Melodelima, C., Hoang Dinh, A. et al. Stiffness of benign and malignant prostate tissue measured by shear-wave elastography: a preliminary study. Eur Radiol 27, 1858–1866 (2017). https://doi.org/10.1007/s00330-016-4534-9

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  • DOI: https://doi.org/10.1007/s00330-016-4534-9

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