Sunday, November 25 | 10:45 a.m.-10:55 a.m. | SSA20-01 | Room S102CD
Contrast-enhanced transrectal subharmonic ultrasound improves the diagnosis of prostate cancer compared with conventional transrectal ultrasound, according to this Sunday morning scientific presentation.A team led by Flemming Forsberg, PhD, of Thomas Jefferson University in Philadelphia evaluated the two techniques, using histopathology as the reference standard. The study included 55 men who underwent 12-core prostate biopsy. The men were imaged with a transrectal ultrasound transducer using conventional ultrasound and subharmonic imaging.
The group ranked the imaging modes on a five-point scale at each biopsy location, tracking measures such as peak intensity, time to peak, and estimated perfusion; these measures were then compared with biopsy results.
Prostate cancer was present in 55 of 660 cores from 24 of the 55 patients. Two subharmonic imaging parameters -- estimated perfusion and peak intensity -- showed a significant difference between benign and malignant biopsy cores that conventional ultrasound did not. This led the researchers to conclude that "subharmonic imaging appears to improve the diagnosis of prostate cancer relative to conventional transrectal ultrasound."
This paper received a Roadie 2018 award for the most popular abstract by page views in this Road to RSNA section.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
