ECR_2016

EUROPEAN HOSPITAL  Vol 25 Issue 1/16 28 EH @ ECR European Hospital Booth 615 First Level Expo Gallery We are here! Meet our EUROPEAN HOSPITAL team on site at ECR 2016. At the booth we present not only our congress magazine but an overview of our other publica- tions and online offers. Come and say ‘Hello’ – visit us! Volumetric ShearWave Elastography Imaging A 3-D Endocavity probe knocks for targeted prostate procedures The prostate remains the only organ where random biopsies are per- formed to find cancer, notes Jean- Michel Correas MD PhD, from the Necker University Hospital in Paris. If we proposed this approach to a woman to search for breast cancer, it would be outrageous, he said. This is mainly due to the limita- tions of prostate TRUS (Trans-Rectal Ultrasonography) using convention- al ultrasound imaging (B-mode and Colour Flow), which detects less than 30% of cancer. While system- atic biopsy techniques improve the detection rate, more than 20% of the cancers are still missed. Multi- parametric MRI (mpMRI) is helpful for the detection of significant high- grade prostate cancer, but the vast majority of biopsies are performed under ultrasound guidance. MpMRI with fusion to ultrasound imaging allows targeting of suspi- cious prostate lesion and should improve the biopsy detection rates; however, the overall cost of the procedure (mpMRI + TRUS + pathol- ogy) is high, and the availability of MRI is low in many countries. Moreover ultrasound-MR fusion guided biopsy increases by a factor of two the examination time. At the European Congress of Radiology in Vienna, Professor Correas will present his recent expe- riences using a new probe from SuperSonic Imagine, which he says brings a significant improvement to prostate imaging with ultrasound and provides a true alternative to mpMRI imaging targeting for pros- tate cancer (SuperSonic Imagine’s symposium, March 2nd, 12.30). The SEV12-3 3-D Endocavity Transducer allows volumetric acqui- sitions of the whole prostate, and reconstructions of transversal, sagit- tal and coronal views not only in B-mode but also in colour Doppler and in ShearWave Elastography. Volumetric ShearWave Elastography enables measuring stiffness every- where in the prostate in a very rapid manner (full volumetric SWE acqui- sition of the prostate obtained in a minute or less). In a recent study performed by Correas with 2-D ShearWave Elastography on a population of 184 patients with biopsy proven cancers, it was shown that prostate tissue with higher stiffness (>35kPa) meas- ured with ShearWave Elastography are at higher risk of malignancy*. Another improvement with the new transducer is that ShearWave is now possible across the entire transversal view of the prostate, allowing the visualisation of tissue stiffness on both lobes and therefore enabling the comparison of stiffness of both lobes in 2-D or 3-D. ‘With 3-D ShearWave Elastography, for the first time, we can clear- ly identify and target suspicious regions of the prostate with an ultra- ment to the index prostate cancer (lesion with highest grade) with- out removing the entire prostate because it would reduce side effects significantly by leaving untouched sensible structures, such as the neu- rovascular bundle or the urinary sphincter. The limitations of partial therapy for prostate cancer are the multifo- cal nature of the disease, as well as the problem of correct identification and localisation of the prostate can- cer lesions by prostate biopsy and/ or imaging. 3-D ShearWave may help detect this index lesion and would enable partial focal treat- ment of cancers with, for example, RFA, HIFU or cryo-ablation, Correas concluded. * Correas JM, Tissier AM, Khairoune A, Vassiliu V, Mejean A, Helenon O, et al. Prostate Cancer: Diagnostic Performance of Real-time Shear-Wave Elastography. Radiology. 2015 Apr;275(1):280-9. PubMed PMID: 25599156. Jean-Michel Correas is Professor of Radiology at the Paris-Descartes University and vice-chairman of the Department of Adult Radiology in Necker University Hospital, Paris. He gained MD PhD degrees from the University of Tours and was Visiting Professor of Radiology at the University of Toronto department of Imaging Research. There he was headed several research projects on ultrasound contrast agents as part of his science doctorate on ultrasound contrast agents. He is deeply involved with the development of interventional uroradiology, and particularly biopsy procedures and guidance as well as minimally invasive treatment of renal tumours. 72 year-old patient with elevated PSA (42.3 ng/ml) with previous negative TRUS. Coronal views in Bmode (top image) and ShearWave™ Elastography of the prostate, reconstructed from one single 3D TRUS acquisition with the SEV12-3 probe, is showing one 45 mm single lesion at the left base with extra prostatic soft tissue extension into the seminal glands on both the Bmode and SWE with elevated stiffness greater than 70kPa. Targeted biopsies confirmed the presence of a large Gleason 9 adenocarcinoma. CEUS at adifferent time in the same suspicious area after the bolus injection (1.2 ml of SonoVue). 3 targeted biopsies in the suspicious area showed 22 mm adenocarcinoma with Gleason 8 score while systematic biopsies came back with no cancer. Patient was referred for radical prostatectomy. 72 year-old patient with elevated PSA (6.3 ng/ml) stable for 1 year (no previous data). MRI not possible due to non-compatible PaceMaker. Previous TRUS examination was performed but no suspicious area was found. Suspicious area found with ShearWave™ Elastograophy in the transition zone (isoechoic lesion on Bmode) with a stiffness of 68kPa. 62 year-old patient with 3.0 ng/ml PSA. Coronal views in Bmode (top image) and ShearWave™ Elastography of the prostate, reconstructed from one single 3D TRUS acquisition with the SEV12-3 probe, is showing one 10mm single lesion at the right lobe on ShearWave™ Elastography only with elevated stiffness greater than 70kPa. Targeted biopsies confirmed the presence of a 10 mm Gleason 7 (3+4) adenocarcinoma. sound based technique and perform targeted and systematic biopsies with the same imaging modality and probe,’ Correas said. The professor also emphasised that the SEV12-3 3D probe works equally as well as a 2-D transduc- er with excellent B-mode imaging, which remains a very important modality to guide systematically randomised biopsies, as well as the capability to detect low-flow perfusion with a very sensitive Directional Colour Power Imaging and with contrast enhanced ultra- sound (CEUS). Therefore, prostate lesion detec- tion with TRUS, like for MRI, has become a multiparametric imaging technique combining several TRUS data to identify suspicious lesions. 3-D ShearWave Elastography (com- bined with B-mode) may be used for detection of lesion because of its high sensitivity (>95%)* while CEUS could be used to further char- acterise and biopsy the suspicious lesions. ‘In recent years, the concept of focal therapy has gained more and more interest. The aim of partial prostate ablation is to provide treat- SuperSonic Endocavity Transducer reveals, for first time, true volume of prostate cancer lesions The SEV12-33-D Endocavity

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