Dissertations / Theses on the topic 'Transrectal ultrasound'

The purpose of this thesis was to evaluate the diagnostic potential of a new ultrasound contrast agent,Sonazoid^TM, intended for use in patients with suspicion of prostate cancer.

The sonographic appearance of normal prostatic vascularity in dogs was evaluated before and after injection of Sonazoid,using different Doppler flow detection modes.The use of Sonazoid significantly improved the visibility of the vascular pattern in normal dog prostate,both with colour and power Doppler imaging.There was a significant difference in the depiction of blood flow in the prostate between the two imaging modalities,showing the power Doppler superior to colour Doppler imaging.The contrast revealed a radial,spoke-like intraprostatic pattern,not seen prior to contrast injection.

Different ultrasound imaging modalities were tested in a small group of young healthy male volunteers to evaluate the visibility of the normal prostate blood flow with and without Sonazoid.

The ultrasound contrast agent improved the visibility of the normal human prostate vascular anatomy for both colour and power Doppler imaging.Again,the improvement was significantly better for power Doppler than for colour Doppler imaging.Using fundamental B-mode,there was no major difference in the ultrasound appearance of the prost ate vascular it y before and after i njection of Sonazoid.Cont rast dynamic st udies of blood flow wit hi n t he normal gland showed a filling from the periphery towards the centre in all subjects,demonstrating a symmetric, radial vascular pattern.

A canine prostate model was used to investigate if Sonazoid,could improve the visualisation of prostatic vessels to better delineate areas on normal and decreased blood flow.Both 2D and 3D power Doppler imaging was performed in this study.The visibility of the prostate blood flow improved significantly following injection of Sonazoid for both 2D and 3D power Doppler imaging.There was,however,no major difference in depicting the vascularity using 2D and 3D imaging.After injection of Sonazoid,a disturbance of the radial vascular pattern and a lack of blood flow symmetry between the two prostate lobes were possible to identify.The added information gained by injection of Sonazoid made it possible to identify areas of decreased blood flow not seen prior to contrast injection.

The vascular pattern of lesions,identified with B-mode imaging in patients with suspicion of prostate cancer,was studied,using Sonazoid.Contrast dynamic inflow in the lesions,compared to the adjacent tissue was investigated in the same study.Prostate cancer lesions appeared hypervasuclar prior to ultrasound contrast agent.Three of six cancer lesions changed from hypervascular to marked hypervascular following injection of Sonazoid,a finding that might be interpreted as a higher level of confidence.None of the non-cancer lesions were assessed as hypervascular after Sonazoid injection,a possible increased value of a negative finding.Four of the cancer lesions enhanced earlier compared to the surrounding prostate tissue,following ultrasound contrast injection.The results indicate that changes in vascular architecture,e.g.induction of angiogenesis by tumour cells,can be observed by ultrasonographically determining the inflow pattern of an intravenously injected ultrasound contrast agent.

This thesis describes a system for intraoperative transrectal ultrasound imaging in robotic-assisted laparoscopic radical prostatectomy, and related image registration work. First, a novel method for registering three-dimensional ultrasound data to an external coordinate frame is presented. The method uses a registration tool pressed against an air-tissue boundary to provide common target points in the the ultrasound frame and the external frame. This method has two applications in our system: registering the ultrasound data captured by the system to a laparoscopic stereo camera to allow augmented-reality style overlays in laparoscopic or robotic surgery, and registering the system to the da Vinci Surgical System so the ultrasound imaging arrays can automatically track the da Vinci tools during surgery. In an initial feasibility study, the method was used to register a mechanical three-dimensional ultrasound transducer to high-disparity stereo cameras through a tissue phantom. Average registration error was found to be 1.69 ± 0.60 mm. Accuracy of localizing ultrasound fiducials pressed against an air-tissue boundary was found to range from 0.54 mm to 1.04 mm. In a second study, the method was used to register three-dimensional transrectal ultrasound data to a da Vinci stereo endoscope. In this study, fiducials imaged at multiple registration tool positions were incorporated into a single registration. Registration error imaging through a tissue phantom ranged from 3.85 ± 1.76 mm using one registration tool position to 1.82 ± 1.03 mm using four positions. Registration error imaging through an ex-vivo porcine liver tissue sample ranged from 2.36 ± 1.01 mm using one registration tool position to 1.51 ± 0.70 mm using four positions.

Evaluate the applicability of a novel technique using dynamic tridimensional transvaginal / transrectal ultrasound as an alternative diagnostic method to evaluate the obstructed defecation, comparing with Echodefecography. It is a prospective and comparative exam, involving female patients with obstructed defecation, mean Wexner constipation score higher than 6. All patients were submitted to dynamic tridimensional ultrasound by two different techniques to identify all the obstructed defecation dysfunctions. The Echodefecography was used as the standard method to evaluate the dynamic tridimensional transvaginal / transrectal ultrasound technique. After introducing 120 mL gel into the rectum, it was used the transvaginal approach to evaluate the anorectal angle at rest and during evacuatory effort to identify the Puborectal muscle relaxation or paradoxical contraction (Anismus). Using the transrectal approach, it was evaluated the presence of different sizes of Rectocele, Intussusception and Enterocele / Sigmoidocele during evacuatory effort. All data were compared. It was used Student t Test and Lee Kappa Correlation Coefficient for statistical analysis. It was calculated efficacy, sensibility, specificity, positive predictive valour, negative predictive valour of the combined transvaginal / transrectal ultrasound technique to identify each dysfunction. Thirty three female patients, mean age 48 years old, mean Wexner constipation score 10 (range 7 - 14) were included. There was substantial concordance between both exams to identify Anismus and normal relaxation (K=0.683). There was significant reduction in the anorectal angle in 19 patients submitted to Echodefecography (84.79 Â Â 1.008 x 80.11Â Â 1.725), with mean change of 5Â ( Â4,738 ) and in 17 patients evaluated by the transvaginal / transrectal Ultrasound (120.5Â Â 2.378 x 109.6Â Â 3.449), with mean change of 10,82ÂÂ8,164. The difference between the angles was significantly higher in patients evaluated by transvaginal / transrectal Ultrasound when compared with Echodefecography (15.45Â Â 1.539 x 7.182Â Â 0.9804) (p=0,0001). It was identified Rectocele in 27 patients and absent in 6 in both techniques used, demonstrating almost perfect concordance index (K=1.0). It was demonstrated 12 patients with grade III Rectocele, 9 with grade II and 3 with grade I in both techniques used, demonstrating almost perfect concordance index for different grades of Rectocele (K= 0.812) (K=0.857) (K= 0.841). There was disagreement in only 3 patients between both methods, 2 with grade III in Echodefecography and grade I and II in transvaginal / transrectal Ultrasound. Another one with grade II in Echodefecography and grade III in transvaginal / transrectal Ultrasound. Comparing both methods, there was no statistically significant difference with respect to the degree of Rectocele (1,076Â0,6838 x 1,139Â0,7267) (p=0,7153). There was almost perfect concordance index in identification of rectal Intussusception (K= 0.914) and Enterocele / Sigmoidocele (K= 0.659). It was demonstrated valor higher than 87,6% of efficacy, sensibility, specificity, positive predictive valor, negative predictive for each evaluated dysfunction. In conclusion, the technique using dynamic tridimensional transvaginal / transrectal Ultrasound showed high concordance index with Echodefecography and can be used as an alternative method to evaluate patients with obstructed defecation symptoms.
O estudo busca verificar a aplicabilidade de uma nova tÃcnica utilizando o Ultrassom trans-vaginal / trans-retal tridimensional dinÃmica como um mÃtodo diagnÃstico alternativo na avaliaÃÃo da evacuaÃÃo obstruÃda, comparando com a Ecodefecografia. Trata-se de um estudo prospectivo e comparativo, envolvendo pacientes do sexto feminino, com evacuaÃÃo obstruÃda e escore mÃdio de constipaÃÃo de Wexner acima de 6. Todas as pacientes foram submetidas ao exame ultrassonogrÃfico tridimensional dinÃmico por duas tÃcnicas distintas para identificar as disfunÃÃes responsÃveis pela defecaÃÃo obstruÃda. A Ecodefecografia foi utilizada como mÃtodo padrÃo na avaliaÃÃo comparativa da tÃcnica de Ultrassom combinado transvaginal/transretal tridimensional dinÃmica. ApÃs a introduÃÃo de 120 mL de gel na ampola retal, utilizou-se o acesso transvaginal para avaliar o Ãngulo anorretal em repouso e durante o esforÃo evacuatÃrio para identificar o relaxamento ou contraÃÃo paradoxal do mÃsculo Puborretal (Anismus). Utilizando o acesso transretal avaliou-se a presenÃa de Retocele nos diferentes tamanhos, IntussuscepÃÃo e Enterocele / Sigmoidocele durante o esforÃo evacuatÃrio. Os achados foram comparados entre si. A anÃlise estatÃstica foi realizada utilizando o test t de Student e o Coeficiente de correlaÃÃo Lee Kappa. Calculou-se a eficÃcia, sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo da tÃcnica do Ultrassom combinado transvaginal e transretal para identificaÃÃo de cada disfunÃÃo. Foram incluÃdas 33 pacientes do sexo feminino, idade mÃdia 48 anos, escore mÃdio de constipaÃÃo de Wexner de 10 (7 - 14). Houve substancial concordÃncia entre os dois exames para identificaÃÃo de Anismus e relaxamento normal (K=0.683). Houve reduÃÃo significante do Ãngulo anorretal em 19 pacientes submetidas a Ecodefecografia (84.79 Â Â 1.008 x 80.11Â Â 1.725), com variaÃÃo mÃdia de 5Â ( Â4,738 ) e em 17 pacientes avaliadas pelo Ultrassom transvaginal / transretal (120.5Â Â 2.378 x 109.6Â Â 3.449), com variaÃÃo mÃdia de 10,82ÂÂ8,164. A diferenÃa entre os Ãngulos foi significantemente maior nas pacientes avaliadas pelo Ultrassom transvaginal / transretal quando comparada com a Ecodefecografia (15.45Â Â 1.539 x 7.182Â Â 0.9804) (p=0,0001). Foi identificada Retocele em 27 pacientes e ausÃncia em 6 em ambas as tÃcnicas utilizadas, demonstrando Ãndice de concordÃncia quase perfeito (K=1.0). Doze pacientes apresentaram Retocele grau III, 9 grau II e 3 grau I em ambas as tÃcnicas utilizadas, demonstrando um Ãndice de concordÃncia quase perfeito para os diferentes graus da Retocele (K= 0.812) (K=0.857) (K= 0.841). Somente 3 pacientes foram discordantes entre os dois mÃtodos, sendo duas com grau III na Ecodefecografia e grau I e II no ultrassom transvaginal / transretal. Uma outra com grau II na Ecodefecografia e grau III no Ultrassom transvaginal / transretal. Comparando os dois mÃtodos, nÃo houve diferenÃa estatisticamente significante com relaÃÃo ao grau da Retocele (1,076Â0,6838 x 1,139Â0,7267) (p=0,7153). Houve um Ãndice de concordÃncia quase perfeito na identificaÃÃo de IntussucepÃÃo retal (K= 0.914) e Enterocele/Sigmoidocele (K= 0.659). Foram demonstrados valores acima de 87,5% de eficÃcia, sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo para cada disfunÃÃo avaliada. Conclui-se que a tÃcnica utilizando Ultrassom transretal / transvaginal tridimensional dinÃmica apresenta elevado Ãndice de concordÃncia com a Ecodefecografia, podendo ser utilizada como mÃtodo alternativo para avaliaÃÃo de pacientes portadoras de sintomas de evacuaÃÃo obstruÃda.

Includes abstract.
Includes bibliographical references.
Prostate cancer is the most common male malignancy amongst black males in South Africa and the second commonest amongst white males (1,2). Prostate biopsy, via the rectum, is an essential part of diagnosing and treating this disease. Traditionally needle biopsies of the prostate were performed blindly by digital palpation of the gland per rectum.

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable
Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Este relatório foi realizado no âmbito da conclusão do mestrado integrado em medicina veterinária e está estruturado em duas partes. Na primeira parte deste relatório é apresentada a casuística acompanhada ao longo do estágio curricular e a segunda parte é constituída por uma revisão bibliográfica subordinada ao tema, importância da ecografia em reprodução de bovinos, seguida da exposição de um caso clínico sobre orquite em bovinos e a discussão do mesmo; Abstract: clinic and surgery in livestock species This report was carried out under the curriculum of the integrated master in veterinary medicine and is structured in two parts. In the first part of this report is presented the casuistry observed throughout the traineeship and in the second part was made a literature review on the topic ultrasound importance in bovine reproduction, followed by exposure of one clinical case of orchitis in bovine and is respective discussion.

[Truncated abstract] Transrectal ultrasound (TRUS) has become the urologist’s primary tool for diagnosing and staging prostate cancer due to its real-time and non-invasive nature, low cost, and minimal discomfort. However, the interpretation of a prostate ultrasound image depends critically on the experience and expertise of a urologist and is still difficult and subjective. To overcome the subjective interpretation and facilitate objective diagnosis, computer aided analysis of ultrasound images of the prostate would be very helpful. Computer aided analysis of images may improve diagnostic accuracy by providing a more reproducible interpretation of the images. This thesis is an attempt to address several key elements of computer aided analysis of ultrasound images of the prostate. Specifically, it addresses the following tasks: 1. modelling B-mode ultrasound image formation and statistical properties; 2. reducing ultrasound speckle; and 3. extracting prostate contour. Speckle refers to the granular appearance that compromises the image quality and resolution in optics, synthetic aperture radar (SAR), and ultrasound. Due to the existence of speckle the appearance of a B-mode ultrasound image does not necessarily relate to the internal structure of the object being scanned. A computer simulation of B-mode ultrasound imaging is presented, which not only provides an insight into the nature of speckle, but also a viable test-bed for any ultrasound speckle reduction methods. Motivated by analysis of the statistical properties of the simulated images, the generalised Fisher-Tippett distribution is empirically proposed to analyse statistical properties of ultrasound images of the prostate. A speckle reduction scheme is then presented, which is based on Mallat and Zhong’s dyadic wavelet transform (MZDWT) and modelling statistical properties of the wavelet coefficients and exploiting their inter-scale correlation. Specifically, the squared modulus of the component wavelet coefficients are modelled as a two-state Gamma mixture. Interscale correlation is exploited by taking the harmonic mean of the posterior probability functions, which are derived from the Gamma mixture. This noise reduction scheme is applied to both simulated and real ultrasound images, and its performance is quite satisfactory in that the important features of the original noise corrupted image are preserved while most of the speckle noise is removed successfully. It is also evaluated both qualitatively and quantitatively by comparing it with median, Wiener, and Lee filters, and the results revealed that it surpasses all these filters. A novel contour extraction scheme (CES), which fuses MZDWT and snakes, is proposed on the basis of multiresolution analysis (MRA). Extraction of the prostate contour is placed in a multi-scale framework provided by MZDWT. Specifically, the external potential functions of the snake are designated as the modulus of the wavelet coefficients at different scales, and thus are “switchable”. Such a multi-scale snake, which deforms and migrates from coarse to fine scales, eventually extracts the contour of the prostate

Background: Transrectal ultrasound is commonly performed in the clinical evaluation of the prostate. Ultrasound-guided randomized sextant biopsy became the standard procedure for the diagnosis of carcinoma of the prostate (CaP). A guided biopsy of sonographically irregular lesions of the prostate is not performed in randomized biopsies. An almost generally accepted opinion is that hypoechoic lesions are suspicious for the presence of CaP. However, the role of prostatic lesions with an echogenicity other than iso- or hypoechoic, e.g. hyperechoic or irregular lesions in relation to CaP is not clear. The intention of the present prospective study was to clarify the role of different prostatic ultrasound findings with a new-generation ultrasound probe in regard to their relevance concerning the presence of cancer. Material and Methods: 265 patients who were referred for prostatic evaluation because of an elevated PSA serum level or a positive digital rectal examination were enrolled in a prospective study. All patients had a systematic ultrasound-guided sextant biopsy of the prostate and a 4-core biopsy of the transition zone. All biopsy cores taken were guided by transrectal ultrasound. In case of a sonographically suspicious lesion, biopsy was always directed into this area. The predominant ultrasound appearance was separately recorded for each core. Results: Carcinoma of the prostate was detected in 87 (32.8%) of the 265 patients. Biopsy cores with isoechoic ultrasound findings revealed CaP in 7.6%. The data for hypoechoic, hyperechoic, mixed-echoic and anechoic lesions were 34.5, 26.9, 21.1 and 0%, respectively. Hypoechoic ultrasound findings were less frequently found in the transition zone of the prostate, but the rate of CaP detection was the same as in the peripheral zone of the prostate. Conclusions:The transrectal ultrasound pattern of the prostate yields important information about the presence of carcinoma of the prostate. Especially hypoechoic lesions indicate the presence of CaP in a significant proportion of cases. However, hyperechoic lesions and lesions of mixed or irregular echogenicity were found to contain cancer in significant numbers as well, and should therefore be considered to be suspicious for cancer when performing transrectal ultrasound of the prostate. Directed biopsy of irregular ultrasound patterns in the prostate seems therefore to be recommendable.
Hintergrund: Der transrektale Ultraschall ist die häufigste bildgebende Untersuchung zur klinischen Beurteilung der Prostata. Zur Diagnostik des Prostatakarzinoms (PCa) hat sich die ultraschallgesteuerte Sextanten-Biopsie als Standardverfahren etabliert. Eine gezielte Biopsie irregulärer Ultraschallbezirke ist hier nicht vorgesehen. Es ist jedoch bekannt, daß sonographisch echoarm erscheinende Areale suspekt für die Präsenz eines PCa sind. Die Wertigkeit nicht einheitlicher oder echoreicher Ultraschallmuster ist jedoch bisher nicht zweifelsfrei geklärt. Ziel der vorliegenden Arbeit war es, mit einem Ultraschallgerät der neuesten Generation die Bedeutung der verschiedenen Ultraschallmuster bezüglich des Vorhandenseins von Prostatakarzinomen zu klären. Material und Methoden: 265 Patienten mit erhöhten PSA-Serumwerten oder suspekten Tastbefunden der Prostata wurden in die prospektive Untersuchung eingeschlossen. Bei allen Patienten wurden systematische, ultraschallgesteuerte Prostatabiopsien, wie in der Sextantenbiopsie vorgesehen, und 4 Zylinder aus der Transitionalzone entnommen. Bei der Biopsie wurde jedoch gezielt die Punktion in Bereichen von – falls vorhanden – irregulärem Ultraschallmuster vorgenommen und das entsprechende Ultraschallbild dokumentiert. Ergebnisse: Bei 87 der 265 Patienten (32,8%) wurden Prostatakarzinome nachgewiesen. Biopsiezylinder aus isodensen Bereichen wiesen in 7,6% ein Prostatakarzinom auf. Die Karzinomhäufigkeit bei Biopsie von echoarmen und echoreichen Arealen sowie von Arealen mit unterschiedlichen Echomustern und von zystischen Arealen wurde mit 34,5, 26,9, 21,1 bzw. 0% ermittelt. Echoarme Befunde wurden seltener in der Transitionalzone nachgewiesen, waren jedoch dort in etwa gleicher Häufigkeit mit einem Karzinom verbunden wie in der peripheren Zone. Schlußfolgerungen: Das transrektale Ultraschallmuster in der Prostata liefert wichtige Hinweise auf das Vorhandensein eines Prostatakarzinoms. Insbesondere echoarme Läsionen deuten auf ein PCa hin. Echoreiche Läsionen und solche mit unterschiedlichen Echomustern enthielten jedoch Karzinome in so bedeutender Anzahl, daß diese Läsionen ebenfalls als karzinomverdächtig eingestuft werden müssen und auch eine gezielte Biopsie dieser Areale im Rahmen der Sextantenbiopsie empfehlenswert erscheint.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Objectives: We compared the transperineal MRI/ultrasoundfusion biopsy (fusPbx) to transrectal systematic biopsy (sys-Pbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. Material and Methods: A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. Results: Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL2 harboured more csPCa than those with a PSA-density < 0.2 ng/mL2 (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. Conclusions: The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich

Prostatacancer är den vanligaste cancerformen hos män. Prostatan tillhör de manliga reproduktionsorganen och producerar bland annat prostataspecifikt antigen (PSA) som kan påvisas i blodet. Förhöjda värden av PSA kan bero på prostatacancer. Transrektalt ultraljuds (TRULS)-ledda systematiska biopsier används i högre frekvens än magnetkamera med riktad biopsi. Röntgensjuksköterskans möte med dessa patienter är före, under och efter bildtagningen med magnetkameran. Syftet var att göra en översikt av den diagnostiska träffsäkerheten för TRULS-ledda systematiska biopsier och magnetresonans (MR)-undersökning med riktade biopsier vid misstanke om prostatacancer. Metoden bestod av en litteraturöversikt med systematisk ansats. Inkluderingskriterier var vetenskapliga artiklar skrivna mellan 2015–2020. Artiklarna skulle vara peer-reviewed och etiskt granskade. Databasen Medline användes till sökningen. Kvalitetsgranskning gjordes med granskningsprotokoll hämtade från Avdelningen för omvårdnad på Hälsohögskolan. I resultatet inkluderades 15 artiklar som visade att skillnaden i den diagnostiska träffsäkerheten för prostatacancer hos män inte var stor mellan metoderna. Däremot hittade MR-undersökning med riktade biopsier större andel kliniskt signifikanta cancrar och mindre del insignifikanta cancrar än vad TRULS-ledda systematiska biopsier gjorde. MR-undersökning med riktad biopsi är en bra metod för att öka träffsäkerheten att hitta kliniskt signifikant cancer. Dock går det inte utesluta TRULS-ledda systematiska biopsier då kontraindikationer och missade cancrar på MR-undersökning med riktade biopsier förkommer.
Prostate cancer is the most common cancer in men. The prostate belongs to the male reproductive organs and produces, among other things, prostate-specific antigen (PSA) that can be detected in the blood. Elevated levels of PSA may be due to prostate cancer. Transrectally ultrasound (TRULS)-guided systemic biopsies are used at higher frequency than magnetic cameras with directed biopsy. The X-ray nurse's meeting with these patients is before, during and after the imaging with the magnetic camera. The aim was to make an overview of the diagnostic accuracy of TRULS guided systematic biopsies and MRI with targeted biopsies on suspicion of prostate cancer. The method consisted of a literature review with systematic approach. Inclusion criteria were scientific articles written between 2015-2020. The articles would be peer-reviewed and ethically approved. The Medline database was used for the search. Quality review was done with review protocols obtained from the Department of Nursing at the School of Health. The result included 15 articles showing that there was no big difference in the diagnostic accuracy of prostate cancer in men between the methods. In contrast, MRI with targeted biopsies found a greater proportion of clinically significant cancers and a smaller proportion of insignificant cancers than TRULS guided systematic biopsies did. MRI with targeted biopsy is a good method for increasing the accuracy of finding clinically significant cancer. However, TRULS guided systematic biopsies cannot be ruled out as contraindications and missed cancers on MRI with targeted biopsies occur.

Transition zone biopsies have been found to increase the detection rates of cancer of the prostate in patients with negative digital rectal examination. There are however no data available whether the higher biopsy rate is associated with greater morbidity. The present study was therefore designed to evaluate the complication rate of extended sextant biopsy. In this prospective study, 162 consecutive patients who presented for prostatic evaluation were included. After starting prophylactic antibiotic treatment 48 h prior to the procedure, transrectal ultrasound-guided core biopsies were obtained from each lobe: three each from the peripheral zone (apex, mid-zone and base) and two from the transition zone of each prostatic lobe. In all patients a questionnaire was obtained 10–12 days after the procedure. Major complications occurred in 3 patients. In 2 of the 3 cases major macroscopic hematuria was treated by an indwelling catheter for 1 or 2 days and 1 patient developed fever >38.5°C for 1 day. Minor macroscopic hematuria was present in 68.5% of the patients. In 17.9% of these cases, the hematuria lasted for more than 3 days. Hematospermia was observed in 19.8% and minor rectal bleeding occurred in 4.9%. Ten-core biopsies did not lead to an increase in adverse effects or complications when compared to the results of sextant biopsies reported in the literature.
Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The early detection of prostate cancer plays a significant role in the success of treatment and outcome. To detect prostate cancer, imaging modalities such as TransRectal UltraSound (TRUS) and Magnetic Resonance Imaging (MRI) are relied on. MRI images are more comprehensible than TRUS images which are corrupted by noise such as speckles and shadowing. However, MRI screening is costly, often unavailable in many community hospitals, time consuming, and requires more patient preparation time. Therefore, TRUS is more popular for screening and biopsy guidance for prostate cancer. For these reasons, TRUS images are chosen in this research. Radiologists first segment the prostate image from ultrasound image and then identify the hypoechoic regions which are more likely to exhibit cancer and should be considered for biopsy. In this thesis, the focus is on prostate segmentation and on Regions of Interest (ROI)segmentation. First, the extraneous tissues surrounding the prostate gland are eliminated. Consequently, the process of detecting the cancerous regions is focused on the prostate gland only. Thus, the diagnosing process is significantly shortened. Also, segmentation techniques such as thresholding, region growing, classification, clustering, Markov random field models, artificial neural networks (ANNs), atlas-guided, and deformable models are investigated. In this dissertation, the deformable model technique is selected because it is capable of segmenting difficult images such as ultrasound images. Deformable models are classified as either parametric or geometric deformable models. For the prostate segmentation, one of the parametric deformable models, Gradient Vector Flow (GVF) deformable contour, is adopted because it is capable of segmenting the prostate gland, even if the initial contour is not close to the prostate boundary. The manual segmentation of ultrasound images not only consumes much time and effort, but also leads to operator-dependent results. Therefore, a fully automatic prostate segmentation algorithm is proposed based on knowledge-based rules. The new algorithm results are evaluated with respect to their manual outlining by using distance-based and area-based metrics. Also, the novel technique is compared with two well-known semi-automatic algorithms to illustrate its superiority. With hypothesis testing, the proposed algorithm is statistically superior to the other two algorithms. The newly developed algorithm is operator-independent and capable of accurately segmenting a prostate gland with any shape and orientation from the ultrasound image. The focus of the second part of the research is to locate the regions which are more prone to cancer. Although the parametric dynamic contour technique can readily segment a single region, it is not conducive for segmenting multiple regions, as required in the regions of interest (ROI) segmentation part. Since the number of regions is not known beforehand, the problem is stated as 3D one by using level set approach to handle the topology changes such as splitting and merging the contours. For the proposed ROI segmentation algorithm, one of the geometric deformable models, active contours without edges, is used. This technique is capable of segmenting the regions with either weak edges, or even, no edges at all. The results of the proposed ROI segmentation algorithm are compared with those of the two experts' manual marking. The results are also compared with the common regions manually marked by both experts and with the total regions marked by either expert. The proposed ROI segmentation algorithm is also evaluated by using region-based and pixel-based strategies. The evaluation results indicate that the proposed algorithm produces similar results to those of the experts' manual markings, but with the added advantages of being fast and reliable. This novel algorithm also detects some regions that have been missed by one expert but confirmed by the other. In conclusion, the two newly devised algorithms can assist experts in segmenting the prostate image and detecting the suspicious abnormal regions that should be considered for biopsy. This leads to the reduction the number of biopsies, early detection of the diseased regions, proper management, and possible reduction of death related to prostate cancer.

碩士
國立臺北護理健康大學
護理研究所
102
Purpose: To assess the utilization of “stress management” to relieve anxiety and pain for patients who underwent transrectal ultrasound (TRUS) guided biopsy of prostate. Background: The incidence of prostate cancer in Taiwan increased yearly and so did the number of the patients and morbidity. Early diagnosis and effective treatment for prostate cancer, survival rate can reach about 77% in five years. If the value of Prostate-Specific Antigen (PSA) in the blood exceeds 4ng/ml, the doctor will advise patients to receive TRUS guided biopsy. When patients received TRUS guided biopsy, about 20% of the patients suffered from extremely large pressure, anxiety and pain. Currently there’s no example of utilizing stress-relieving management such as music therapy and one-by-one simulation education for the patients. Thus, we hope to alleviate anxiety and pain for these patients through stress management and promote to clinical practice extensively. Methods: The research was a case-control study demonstrating at surgery wards in a teaching local hospital of northern Taiwan. We categorized 82 patients into experimental group and control group. Experimental group was provided with stress management whereas control group received routine nursing care. Tests were performed before and after surgery including state-anxiety inventory, visual acuity score (VAS), respiratory rate, heart rate and blood pressure. We used SPSS 18.0 software to carry out multivariate analysis. Result: Baseline and disease characteristics between two groups showed no significant difference (p>0.05). VAS of both two groups increased after surgery. We discovered that difference of VAS between post- and pre-operation was lower in experimental group with statistical significance (p=0.03). Both two groups experienced mild anxiety before and after surgery but experimental group displayed greater decrease in state-anxiety inventory after surgery compared to control group, with statistical significance (p=0.02). While control group had an increase in respiratory rate after surgery, experimental group had an opposite result. Post-operation heart rate decreased and systolic blood pressure increased in both groups. In comparison with control group, there was a statistically significant (p=0.38) greater decrease in post-operation diastolic pressure in experimental group. Conclusion: According to our research, stress management is able to alleviate anxiety and pain of the patients receiving TRUS guided biopsy of prostate and we medical workers can apply it to clinical practice. Key word: Transrectal ultrasound (TRUS) guided biopsy of prostate, stress management, one-by-one simulation education, music therapy, anxiety, pain

Prostate cancer continues to be the most commonly diagnosed cancer among men. Brachytherapy has emerged as one of the definitive treatment options for early stage prostate cancer which entails permanent implantation of radioactive seeds into the prostate to eradicate the cancer with ionizing radiation. Successful brachytherapy requires the ability to perform dosimetry -which requires seed localization- during the procedure but such function is not available today. If dosimetry could be performed intraoperatively, physicians could implant additional seeds into the under-dosed portions of the prostate while the patient is still on the operating table. This thesis addresses the brachytherapy seed localization problem with introducing intensity based registration between transrectal ultrasound (TRUS) that shows only the prostate and a 3D seed model drawn from fluoroscopy that shows only the implanted seeds. The TRUS images are first filtered and compounded, and then registered to the seed model by using mutual information. A training phantom was implanted with 48 seeds and imaged. Various ultrasound filtering techniques were analyzed. The effect of false positives and false negatives in ultrasound was investigated by randomly masking seeds from the fluoroscopy volume or adding seeds to that in random locations. Furthermore, the effect of sparse and dense ultrasound data was analyzed by running the registration for ultrasound data with different spacing. The registration error remained consistently below clinical threshold and capture range was significantly larger than the initial guess guaranteed by the clinical workflow. This fully automated method provided excellent registration accuracy and robustness in phantom studies and promises to demonstrate clinically adequate performance on human data.
Thesis (Master, Electrical & Computer Engineering) -- Queen's University, 2008-09-27 12:35:16.691

Prostate cancer is one of the leading causes of death by cancer for men. Focal therapy is being tested to target only the dominant cancer lesion in the prostate. However, due to the need to ensure that the laser is targeting only the cancer, a real-time treatment monitoring system is required. A combined optical-ultrasound monitoring system is in development at Princess Margaret Hospital based on different optical properties for coagulated versus normal tissue. In this project, we developed a light delivery and collection device that is compatible for use with an existing trans-rectal ultrasound-imaging probe. Computer-aided design software was used to visualize the prototype in relation to the trans-rectal ultrasound probe. This thesis describes the critical tasks necessary to assemble the final prototype, including listing of specifications, selection of device material based on safety and mechanical properties, method of prototype fabrication, positioning and fixation of optical fibers and testing.