This 80 yr. Transabdominal ultrasound scan images reveal obvious intravesical enlargement of the enlarged median lobeof the prostate. Diagnosis: these ultrasound images are diagnostic of benign hyperplasia of prostate. The above TRUS ultrasound and color doppler images in a young male patient show a hypoechoic prostate b gross augmentation of vascularity in the prostate tissue. These ultrasound findings suggest presence of acute prostatitis.
Keywords: Prostate cancer, biopsy, contrast enhanced, imaging, ultrasound. You may need to remove all clothing and jewelry in the area to be examined. Figure 4. Once the test is done, you can take off the gown and put your clothes back on. All Rights Reserved. He or she can hear how fast blood is flowing through a blood vessel and in which direction Image ultrasound of the prostate is flowing.
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Cadence-contrast pulse sequencing CPS imaging shows a rapidly enhancing lesion 18 s after bolus injection on the right side between crosslines. Sign Up. Prostate anatomy The prostate gland lies between the bladder neck and Image ultrasound of the prostate urogenital diaphragm, just anterior to the rectum, an ideal position to be imaged via TRUS. Learn how this test differs from PSA test and biopsy. Od US is a widely used and well-tolerated imaging modality for evaluation of Hot ass tight panties prostate. Transrectal grey-scale imaging Since its Image ultrasound of the prostate in transrectal grey-scale imaging has improved by application of higher frequency probes and new signal reception techniques. New PCa-specific microbubbles are under development for exact detection and differentiation of PCa and benign prostatic tissue. Ultrasound exams in which the transducer ultrasounnd inserted into an opening of the body may produce minimal discomfort. Three of five targeted oof were positive for cancer, whereas SB was negative. Journal List Cancer Imaging v.
Abstract: Rationale and Objectives : This study aims to investigate the feasibility and performance of a two-step scoring system of ultrasound imaging in the diagnosis of prostate cancer.
- Welcome to Ultrasound Image Gallery.
- This test is used to examine your prostate for the presence of any abnormalities, cancer , or other prostate-related conditions.
Ultrasound of the prostate uses sound waves to produce pictures of a man's prostate gland and to help diagnose symptoms such as difficulty urinating or an elevated blood test result. It's also used to investigate a nodule found during a rectal exam, detect abnormalities, and determine whether the gland is enlarged.
Ultrasound is safe, noninvasive, and does not use ionizing radiation. This procedure requires little to no special preparation. Leave jewelry at home and wear loose, comfortable clothing. You may be asked to wear a gown and to lie on your side with your knees toward your chest.
To obtain high-quality images, an ultrasound transducer — a plastic cylinder about the size of a finger — is inserted short distance into the rectum. If a biopsy is planned, you may be told to avoid aspirin and other blood thinners for seven to 10 days prior to the procedure.
You may be instructed to use an enema to clean out your bowel. Ultrasound is safe and painless. It produces pictures of the inside of the body using sound waves. Ultrasound imaging is also called ultrasound scanning or sonography. It uses a small probe called a transducer and gel placed directly on the skin.
High-frequency sound waves travel from the probe through the gel into the body. The probe collects the sounds that bounce back. A computer uses those sound waves to create an image. Ultrasound exams do not use radiation as used in x-rays. Because images are captured in real-time, they can show the structure and movement of the body's internal organs.
They can also show blood flowing through blood vessels. Ultrasound imaging is a noninvasive medical test that helps physicians diagnose and treat medical conditions. Prostate ultrasound, also called transrectal ultrasound, provides images of a man's prostate gland and surrounding tissue. The exam typically requires insertion of an ultrasound probe into the rectum of the patient. The probe sends and receives sound waves through the wall of the rectum into the prostate gland which is situated right in front of the rectum.
A transrectal ultrasound of the prostate gland is performed to:. A transrectal ultrasound of the prostate gland is typically used to help diagnose symptoms such as:. Because ultrasound provides real-time images, it also can be used to guide procedures such as needle biopsies , in which a needle is used to sample cells tissue from an abnormal area in the prostate gland for later laboratory testing.
Wear comfortable, loose-fitting clothing. You may need to remove all clothing and jewelry in the area to be examined. You may be instructed to avoid taking blood thinners, such as aspirin, for seven to 10 days prior to the procedure if a biopsy is planned. An enema may be taken two to four hours before the ultrasound to clean out the bowel. Ultrasound scanners consist of a computer console, video display screen and an attached transducer. The transducer is a small hand-held device that resembles a microphone.
Some exams may use different transducers with different capabilities during a single exam. The transducer sends out inaudible, high-frequency sound waves into the body and then listens for the returning echoes. The principles are similar to sonar used by boats and submarines. The technologist applies a small amount of gel to the area under examination and places the transducer there. The gel allows sound waves to travel back and forth between the transducer and the area under examination.
The ultrasound image is immediately visible on a video display screen that looks like a computer monitor. The computer creates the image based on the loudness amplitude , pitch frequency and time it takes for the ultrasound signal to return to the transducer.
For ultrasound procedures such as transrectal exams that require insertion of an imaging probe, also called a transducer, the device is covered and lubricated with a gel. Ultrasound imaging is based on the same principles involved in the sonar used by bats, ships and fishermen. When a sound wave strikes an object, it bounces back, or echoes.
By measuring these echo waves, it is possible to determine how far away the object is as well as the object's size, shape and consistency. This includes whether the object is solid or filled with fluid. In medicine, ultrasound is used to detect changes in the appearance of organs, tissues, and vessels and to detect abnormal masses, such as tumors.
In an ultrasound exam, a transducer both sends the sound waves and records the echoing waves. When the transducer is pressed against the skin, it sends small pulses of inaudible, high-frequency sound waves into the body. As the sound waves bounce off internal organs, fluids and tissues, the sensitive receiver in the transducer records tiny changes in the sound's pitch and direction. These signature waves are instantly measured and displayed by a computer, which in turn creates a real-time picture on the monitor.
Short video loops of the images may also be saved. The same principles apply to ultrasound procedures such as transrectal ultrasound which require insertion of a special imaging probe or transducer into the body.
In men, the prostate gland is located directly in front of the rectum, so the ultrasound exam is performed transrectally in order to position the imaging probe as close to the prostate gland as possible. For a transrectal ultrasound, you will be asked to lie on your side with your knees bent. A disposable protective cover is placed over the transducer, it is lubricated, inserted through the anus and placed into the rectum. If a suspicious lesion is identified with ultrasound or with a rectal examination, an ultrasound-guided biopsy can be performed.
This procedure involves advancing a needle into the prostate gland while the radiologist watches the needle placement with ultrasound. A small amount of tissue is taken for microscopic examination. A prostate-specific antigen PSA test, which measures the amount of PSA in the blood, may be administered to determine if a patient is at high risk for cancer. In this case, a biopsy is performed and an ultrasound probe is used to guide the biopsy to specific regions of the prostate gland.
When the exam is complete, you may be asked to dress and wait while the ultrasound images are reviewed. Ultrasound exams in which the transducer is inserted into an opening of the body may produce minimal discomfort. If no biopsy is required, transrectal ultrasound of the prostate is similar to or may have less discomfort than a rectal exam performed by your doctor. If a biopsy is performed, additional discomfort due to the needle insertion is usually minimal because the rectal wall is relatively insensitive to the pain in the region of the prostate.
A biopsy will add time to the procedure. After an ultrasound examination, you should be able to resume your normal activities immediately. A radiologist, a doctor trained to supervise and interpret radiology exams, will analyze the images.
The radiologist will send a signed report to the doctor who requested the exam. Follow-up exams may be needed. If so, your doctor will explain why.
Sometimes a follow-up exam is done because a potential abnormality needs further evaluation with additional views or a special imaging technique. A follow-up exam may also be done to see if there has been any change in an abnormality over time. Follow-up exams are sometimes the best way to see if treatment is working or if an abnormality is stable or has changed. Men who have had the tail end of their bowel rectum removed during prior surgery are not good candidates for ultrasound of the prostate gland because this type of ultrasound typically requires placing a probe into the rectum.
However, the radiologist may attempt to examine the prostate gland by placing a regular ultrasound imaging probe on the perineal skin of the patient, between the legs and behind the scrotum of the patient. Sometimes the gland can be examined by ultrasound this way, but the images may not be as detailed as with the transrectal probe. An MRI of the pelvis may be obtained as an alternative imaging test, because it may be obtained with an external phased array receiver coil.
Radiation Therapy for Prostate Cancer. Please type your comment or suggestion into the text box below. Note: we are unable to answer specific questions or offer individual medical advice or opinions. To locate a medical imaging or radiation oncology provider in your community, you can search the ACR-accredited facilities database. This website does not provide cost information. The costs for specific medical imaging tests, treatments and procedures may vary by geographic region. Web page review process: This Web page is reviewed regularly by a physician with expertise in the medical area presented and is further reviewed by committees from the Radiological Society of North America RSNA and the American College of Radiology ACR , comprising physicians with expertise in several radiologic areas.
Outside links: For the convenience of our users, RadiologyInfo. Toggle navigation. What is Ultrasound Imaging of the Prostate? What are some common uses of the procedure? How should I prepare? What does the equipment look like? How does the procedure work? How is the procedure performed? What will I experience during and after the procedure? What are the benefits vs. What are the limitations of Prostate Ultrasound Imaging? Which test, procedure or treatment is best for me?
A transrectal ultrasound of the prostate gland is performed to: detect disorders within the prostate. A transrectal ultrasound of the prostate gland is typically used to help diagnose symptoms such as: a nodule felt by a physician during a routine physical exam or prostate cancer screening exam.
You may be asked to wear a gown during the procedure. The images are obtained from different angles to get the best view of the prostate gland.
If scanning transabdominally a 3. The use of conventional Doppler imaging enhanced by microbubbles is the frequently reported in the literature. Cancer statistics, A prostate ultrasound is often used early as a way of diagnosing prostate cancer. Several different signal reception techniques can be applied for contrast agent detection such as cadence-contrast pulse sequencing CPS or microvessel imaging MVI technology. Best of all, the whole gallery of images is free!
Image ultrasound of the prostate. What are some common uses of the procedure?
Cadence-contrast pulse sequencing CPS imaging shows a rapidly enhancing lesion 18 s after bolus injection on the right side between crosslines. The enhancement is stronger than in the remaining prostate tissue.
Three of five targeted cores were positive for cancer, whereas SB was negative. In another study Seitz et al. Seitz et al. Another newly implemented technique is real-time sonoelastography RTE , which enables the illustration of distribution of tissue elasticity in one US slice [ 26 ]. This promising technique is calculated by post-processing algorithms and needs no contrast medium.
RTE is therefore a real-time technique and shows different areas with different stiffness in a colour-coded image simultaneously with the B-mode or grey-scale image.
Sperandeo et al. They used tissue elasticity to detect cancer based on tissue deformation of grey-scale images under manual compression of the prostate with a transrectal probe. Sumura et al. Tsutsumi et al. Miyanaga et al. Salomon et al. One hundred and nine patients with biopsy-proven localized PCa underwent elastography before radical prostatectomy.
They found a sensitivity and specificity for detecting PCa of A total of suspicious areas in elastography were recorded, and cancerous areas were found in radical prostatectomy specimens. Therefore they concluded that elastography can detect PCa foci within the prostate with good accuracy and has potential to increase US-based PCa detection. Pallwein et al. The best sensitivity and specificity was found in the apex region. Sonoelastography seems to offer a new approach for differentiation of tissue stiffness of the prostate and may therefore improve PCa detection Figs.
Transverse transrectal grey-scale US image of prostate with no clear evidence for prostate cancer. Corresponding elastographic image of prostate. Elastogram shows a clearly visible stiffer area blue colour with suspicion of a prostate cancer on the left side of the prostate white dot. Contrast-specific US imaging techniques need specific three-dimensional acquisition for exact assessment of flow asymmetries, which would allow optimized PCa detection on the one hand, and may further allow minimal invasive therapies, or enable active surveillance in patients with diagnosis of PCa.
New PCa-specific microbubbles are under development for exact detection and differentiation of PCa and benign prostatic tissue. Ultrasound assessment with contrast agent dynamics such as time—intensity curves may allow an objective assessment of tumour vascularity and therefore improve PCa diagnosis.
Real-time elastography is limited because the compression is performed manually and is therefore not standardized. New techniques may allow for standardized compression and reduction in false-positive findings on elastography. Three-dimensional reconstructions will allow for a better assessment of the tissue stiffness difference within the prostate. Transrectal US-guided biopsy of the prostate with a minimum number of 10 biopsy cores of the peripheral zone remain the gold standard for PCa detection in the case of an elevated PSA or an abnormal DRE [ 9 ].
Contrast-enhanced targeted or real-time elastographically targeted biopsy can significantly increase PCa detection, especially the per core biopsy rate compared with SB [ 17 ]. Contrast-enhanced targeted US allows for detection of significantly higher Gleason score, which is important for PCa grading. However, both methods, contrast US and elastography, are still under clinical investigation and currently not used in standard clinical practice.
National Center for Biotechnology Information , U. Journal List Cancer Imaging v. Cancer Imaging. Published online Mar 3. Germar M. Author information Article notes Copyright and License information Disclaimer. Email: ta. Accepted Dec This article has been cited by other articles in PMC.
Abstract Ultrasound is a widely used imaging modality for evaluation of the prostate. Keywords: Prostate cancer, biopsy, contrast enhanced, imaging, ultrasound. Introduction Ultrasound US is a widely used and well-tolerated imaging modality for evaluation of the prostate. Prostate The prostate gland produces and secretes an alkaline fluid, which energizes and protects the sperm during ejaculation. Prostate anatomy The prostate gland lies between the bladder neck and the urogenital diaphragm, just anterior to the rectum, an ideal position to be imaged via TRUS.
Open in a separate window. Figure 1. Transrectal grey-scale imaging Since its introduction in transrectal grey-scale imaging has improved by application of higher frequency probes and new signal reception techniques.
Transrectal colour Doppler imaging Colour Doppler imaging is well established to illustrate macrovascularity and therefore perfusion. Figure 2. Transrectal contrast-enhanced colour Doppler imaging Contrast-enhanced US can be used for illustration of macrovascularity and microvascularity [ 17 ].
Figure 3. Figure 4. Transrectal contrast-specific US techniques The development of contrast agent-specific US techniques have offered new potential for US in the detection of microvascularity, as found in the case of tumour vessels. Figure 5. Real-time sonoelastography Another newly implemented technique is real-time sonoelastography RTE , which enables the illustration of distribution of tissue elasticity in one US slice [ 26 ].
Figure 6. Figure 7. Future developments Contrast-specific US imaging techniques need specific three-dimensional acquisition for exact assessment of flow asymmetries, which would allow optimized PCa detection on the one hand, and may further allow minimal invasive therapies, or enable active surveillance in patients with diagnosis of PCa. Conclusion Transrectal US-guided biopsy of the prostate with a minimum number of 10 biopsy cores of the peripheral zone remain the gold standard for PCa detection in the case of an elevated PSA or an abnormal DRE [ 9 ].
References 1. Cancer statistics, CA Cancer J Clin. Ismail M, Gomella LG. Ultrasound for prostate imaging and biopsy. Curr Opin Urol. Epidemiology of prostatitis.
Int J Antimicrob Agents. Guidelines on urological infections. Imaging the male reproductive tract: current trends and future directions. Radiol Clin North Am. Ultrasound of prostate cancer: recent advances. Eur Radiol. Accuracy and repeatability of prostate volume measurements by transrectal ultrasound. Prostate Cancer Prostatic Dis. Contrast-enhanced ultrasound for diagnosis of prostate cancer and kidney lesions. Eur J Radiol. EAU guidelines on prostate cancer. Eur Urol.
BJU Int. Correlation between prostate cancer grade and vascularity on colour Doppler imaging: preliminary findings. J Clin Ultrasound. Contrast-enhanced versus systematic transrectal ultrasound-guided prostate cancer detection: an overview of techniques and a systematic review. The potential value of power Doppler ultrasound imaging compared with grey-scale ultrasound findings in the diagnosis of local recurrence after radical prostatectomy. Clin Radiol. Value of contrast-enhanced ultrasound and elastography in imaging of prostate cancer.
Comparison of contrast enhanced colour Doppler targeted biopsy with conventional systematic biopsy: impact on prostate cancer detection. J Urol. Comparison of contrast enhanced colour Doppler targeted biopsy to conventional systematic biopsy: impact on Gleason score.
A prospective randomized trial comparing contrast-enhanced targeted versus systematic ultrasound guided biopsies: impact on prostate cancer detection. Halpern EJ. Contrast-enhanced ultrasound imaging of prostate cancer. Rev Urol. Detection of prostate carcinoma with contrast-enhanced sonography using intermittent harmonic imaging. Imaging of angiogenesis using cadence contrast pulse sequencing and targeted contrast agents.
Contrast Media Mol Imaging. Urol Oncol. This is why BK Medical created triplane imaging and developed the simultaneous biplane technique. Simultaneous Biplane: Real-time images of the prostate in both the sagittal and transverse planes.
Endfire: For biopsies close to the apex of the prostate, an endfire view and a biopsy guide designed for use in endfire view are ideal for precise, safe biopsies. With the Prostate Triplane Transducer E14C4t or , you can easily switch between imaging views and choose the biopsy imaging technique you need. The Prostate Triplane transducer supports simultaneous biplane and endfire imaging.
Transperineal biopsies TPUS Bx offer a systematic and targeted method for diagnosing prostate cancer in some patients. Blog Social Media Community Guidelines. Sales Offices Denmark Germany Sweden.
Prostate/Rectal Ultrasound | Johns Hopkins Medicine
Abstract: Rationale and Objectives : This study aims to investigate the feasibility and performance of a two-step scoring system of ultrasound imaging in the diagnosis of prostate cancer. Material and Methods : 75 patients with consecutive histopathologically verified lesions were included in this study. Step 1, an initial 5-point scoring system was developed based on conventional transrectal ultrasound TRUS. However, 96 cases were improperly upgraded after step 2 and 48 malignant lesions were still missed after step 2 as score For the two-step scoring system, the sensitivity, specificity, and accuracy were The application of the two-step scoring system for prostate cancer is promising.
Ultrasound imaging has been established as an effective clinical tool for the detection of prostate cancer in China. The conventional transrectal ultrasound TRUS imaging can delineate lesion morphology such as margin, echo, and blood flow. However, prostate TRUS imaging can be challenging: prostate cancer usually has multiple not an isolated lesion.
The microvessel density is increased in prostate cancer Kay et al. However, only the larger feeding vessels in prostate cancer could be detected by conventional color Doppler ultrasound imaging.
The problem of imaging the smaller vessels or slower speed vessels in the prostate can be resolved by microbubble ultrasound contrast agents Goldberg et al. Several studies have found that contrast-enhanced transrectal ultrasound CE-TRUS could improve significantly color Doppler signals in the detection of prostate cancer Bogers et al.
Consequently, the diagnostic accuracy of prostate cancer is highly variable due to different diagnostic criteria and the experience of the examiner. A scoring system could provide information suggestive of malignancy and improve agreement between radiologists. In this study, conventional TRUS was the basis of prostate cancer diagnosis. Our aim was to evaluate the diagnostic performance of a two-step scoring system and compare the diagnostic accuracy with conventional TRUS.
Patient age ranged from years, with a mean age of The study was approved by the Institutional Review Board. Informed consent was obtained from each patient. Grey-scale imaging was used to achieve an optimal prostate image.
Color Doppler gain was adjusted to maximize signal while minimizing color noise from the tissue of the prostate. The mechanical index was set at 0. The transverse plane of the sonographic abnormality was chosen. However, for those with no suspicious findings on conventional ultrasonography , the maximum transverse image of the prostate was chosen.
Consensus was reached through discussion if there was any controversy. Before this study, a training session was held to demonstrate the application of the two-step scoring system. We attempted to set up a two-step scoring system for prostate cancer diagnosis criteria. This system is based on our previous and current studies, and a literature review Trabulsi et al.
In step 1, all lesions in this study were classified using an initial 5-point scoring system according to the conventional TRUS images. Conventional TRUS images were analyzed and the following images were assessed with respect to suspicious lesions Trabulsi et al.
In step 2, all lesions in this study, which were classified by step 1, were corrected according to the CE-TRUS enhancement. The patient who presented one of the following enhanced patterns would be corrected as Score 1 lesions with a rapid-intensive enhancement s after contrast injection and a rapid washout compared with normal tissue; 2 lesions that were generally larger detected by contrast enhancement than grey ultrasound imaging. The patient who presented the following enhanced pattern would be corrected as Score lesions in the outer glands with moderately increased enhancement and moderate washout compared with inner glands.
However, the lesion in step 1 without the presence of the above enhanced pattern would be corrected as Score The two-step scoring system for the assessment of prostate cancer was summarized in Table 1. Table 1. The two-step scoring system assessment for prostate cancer.
MG automatic biopsy gun MG C. Targeted biopsy samples up to four needle cores; mean, 2. Additional biopsies, when necessary, were performed including from the lateral and medial outer glands as well as from the inner gland.
Specimens were marked based on the site of biopsy. For prostate cancer, Gleason scores were assessed and recorded. Table 2. Distribution of lesions by the two-step scoring system and conventional TRUS.
Statistical analyses were performed using MedCalc software version 9. The accuracy, sensitivity, specificity, negative predictive value, and positive predictive value were calculated.
The diagnostic value of this scoring system was evaluated by receiver operating characteristic ROC and the area under the curve AUC according to histopathology of each marked specimen. Table 3. The variation score of lesions by the two-step scoring system. Our study cohort consisted of 75 patients and the mean serum PSA was A total of lesions were verified histologically, with of them having prostate cancer from 46 patients and having benign prostatic hypertrophy BPH from 29 patients.
On the contrast image plane, outer gland and 12 inner gland malignant lesions were identified. Because contrast-enhanced detection of cancers in the inner gland was limited by intense enhancement in areas of BPH Jiang et al. In lesions with cancer, the Gleason scores ranged from , with 84 lesions being 7 or higher. Table 4. According to the two-step scoring system, lesions were upgraded and lesions were degraded from step 1 to step 2 Table 3. There were 68 lesions with score-1 in step 1 upgraded correctly in step 2.
Of the lesions with score-2 in step 1, there were 15 lesions upgraded correctly in step 2. There were 85 lesions with score-3 in step 1 upgraded correctly in step 2. There were 12 lesions with score-4 in step 1 upgraded correctly in step 2. However, a total of 96 cases were incorrectly upgraded by the two-step score system in this study after step 2. They were all confirmed by histopathology as benign.
In the meantime, 48 malignant lesions were still missed after step 2 as score Figure 1. AUC for lesion diagnosis was 0. When radiologists choose different ultrasound imaging interpretations for prostate cancer, the diagnosis could be quite variable, especially for diffused diseases.
Figure 2. A lesion was categorized as Score-3 by conventional TRUS, but upgraded correctly as Score-5 by the two-step scoring system in a year-old patient. The pathological result was prostate cancer. Conventional TRUS shows unclear borders between the inner and outer glands. This two-step scoring system could offer radiologists a step-by-step methodology toward the final diagnosis of a prostate lesion detected on ultrasonography, which is straightforward to follow.
Based on conventional TRUS, an initial scoring system was proposed. In this study, we compared the diagnostic efficacy of this two-step scoring system with that of conventional TRUS. As shown in Table 4, compared with step 1 conventional TRUS , the diagnostic sensitivity and accuracy were elevated after step 2 the two-step scoring system , while specificity declined.
The AUC for lesion diagnosis was 0. This two-step scoring system could help radiologists in their diagnosis by using a small number of diagnostically relevant criteria. This could be very useful especially for less experienced radiologists. Figure 3. A lesion with Score-5 by conventional TRUS, and also as Score-5 by the two-step scoring system in an year-old patient.
Color TRUS shows prominent flow signals around and within the focal area arrow. However, there were 68 lesions with score-1 in step 1 upgraded correctly in step 2. They were all confirmed by histopathology as malignant. In these cases, they presented as normal in step 1. In general, score-1 or score-2 lesions are usually considered as being benign. However, they were only mistaken as benign by conventional TRUS step 1. In addition, the proliferated microvessels cannot be easily detected by color Doppler imaging.
The proliferation of neovessels will produce an increased microvessel density in prostate cancer tissue Aigner et al. In the meanwhile, the peak intensity values are different between benign and malignant lesions Jiang et al. Some of these upgraded lesions displayed rapid-intensive enhancement and rapid washout. Some displayed moderate enhancement and moderate washout.
If clinicians rely only on conventional TRUS, some malignant lesions would be missed. Figure 4. A lesion was categorized as Score-3 by conventional TRUS, but downgraded correctly as Score-1 by the two-step scoring system in a year-old patient. The pathological result was prostatitis.
Of the prostate lesions with score-3 in step 1, there were 25 lesions upgraded correctly to be score-4 and 60 lesions upgraded correctly to be score-5 after step 2. Some of these under-diagnosed cases involved diffuse multicenter carcinoma, some involved tumors in the medial outer glands, and some were low-grade tumors.
A rapid-intensive enhancement and rapid washout pattern was regarded as a typical pattern of malignant lesions. Besides the typical enhancement pattern, lesions in the medial outer glands with a moderate enhancement pattern should also be treated as suspicious, especially for diffuse prostate cancer Trabulsi et al.