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Endorectal Color Doppler Sonography and Endorectal MR Imaging Features of Nonpalpable Prostate Cancer

Correlation with Radical Prostatectomy Findings

F. Cornud1, K. Hamida1, T. Flam2, O. Hélénon1, Y. Chrétien2,3, N. Thiounn2, J. M. Correas1, J. M. Casanova4 and J. F. Moreau1

1 Service de Radiologie, Hôpital Necker, 149 rue de Sèvres, 75015 Paris, France.
2 Service d'Urologie, Hôpital Cochin, 24 Rue du Faubourg saint Jacques, 75014 Paris, France.
3 Service d'Urologie, Hôpital Necker, 75015 Paris, France.
4 Service d'Uro-Gynécologie, Hôpital Notre Dame de Bon Secours, 14 rue des volontaires, 75014 Paris, France.



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  		Fig. 1A. —68-year-old man with hypervascular nonpalpable cancerous tumor having Gleason score of 7. Endorectal sonogram (axial view) shows hypoechoic nodule in peripheral zone (arrows).

 


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  		Fig. 1B. —68-year-old man with hypervascular nonpalpable cancerous tumor having Gleason score of 7. Color Doppler sonogram reveals increased flow.

 


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  		Fig. 2A. —64-year-old man with hypervascular nonpalpable cancerous tumor having Gleason score of 8. Endorectal sonogram (axial view) shows subtle hypoechoic area in peripheral zone (PZ) that is visible only during real-time scanning. TZ = transition zone.

 


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  		Fig. 2B. —64-year-old man with hypervascular nonpalpable cancerous tumor having Gleason score of 8. Color Doppler sonogram shows intense peripheral zone hypervascularization.

 


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  		Fig. 3A. —57-year-old man with hypovascular nonpalpable cancerous tumor having Gleason score of 5. Endorectal sonogram (axial view) shows discrete hypoechoic area (arrows).

 


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  		Fig. 3B. —57-year-old man with hypovascular nonpalpable cancerous tumor having Gleason score of 5. Color Doppler sonogram reveals no increased flow compared with adjacent peripheral zone.

 


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  		Fig. 4A. —69-year-old man with stage pT3 nonpalpable cancer. Axial fast spin-echo T2-weighted MR image shows tumor hyposignal in periprostatic fat (arrows), indicating established capsular penetration.

 


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  		Fig. 4B. —69-year-old man with stage pT3 nonpalpable cancer. Axial fast spin-echo T2-weighted MR image contiguous to A reveals extensive tumor hyposignal in periprostatic fat (arrows).

 


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  		Fig. 5A. —59-year-old man with stage pT3 nonpalpable cancerous tumor. Axial fast spin-echo T2-weighted MR image shows obliteration of prostatorectal angle (arrowhead), indicating established capsular penetration.

 


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  		Fig. 5B. —59-year-old man with stage pT3 nonpalpable cancerous tumor. Axial fast spin-echo T2-weighted MR image contiguous to A shows tumor hyposignal in periprostatic fat (arrow), confirming established capsular penetration.

 


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  		Fig. 6. —71-year-old man with stage pT3 nonpalpable cancerous tumor. Axial fast spin-echo T2- weighted MR image shows asymmetry of neurovascular bundles. Left side has normal appearance (black arrows). Bundle on right side shows hypointensity (white arrows), indicating established capsular penetration with invasion of right neurovascular bundle.

 


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  		Fig. 7A. —67-year-old man with combined capsular penetration and seminal vesicle invasion. Axial fast spin-echo T2-weighted MR image shows tumor hyposignal in left base and in periprostatic fat (arrowheads), indicating established capsular penetration.

 


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  		Fig. 7B. —67-year-old man with combined capsular penetration and seminal vesicle invasion. Axial fast spin-echo T2-weighted MR image reveals focal wall thickening in left seminal vesicle, indicating extensive seminal vesicle invasion (arrows).

 

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