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Purpose: The purpose of this study is to see if changes in patient positioning result in significant changes in Doppler findings., Materials and Methods: 30 consecutive patients with jumper's knee in the proximal portion of the patellar tendon formed the study group. The patellar tendon was scanned in the longitudinal plane with colour and spectral Doppler with the knee fully extended as well as, flexed at 15 degrees and 20 degrees . All subjects were randomised to either extension or 20 degrees flexion as the initial position. The amount of colour Doppler activity inside the tendon was expressed with the colour fraction (colour pixels/total pixels) in the proximal portion of the tendon. With spectral Doppler, the resistive index was measured ((peak systolic velocity--end-diastolic velocity)/ peak systolic velocity)., Results: The mean (+/- SE) colour fraction in the fully extended position and 20 degrees flexion was 36.7 +/- 3.4% and 13.3 +/- 3.4%, respectively (p<0.0001). The mean resistive index was 0.607 +/- 0.036 with full extension and 0.914 +/- 0.036 with 20 degrees flexion (p<0.0001). On an individual patient basis, a decrease in colour fraction was observed in all 30 patients (100%), whereas an increase in resistive index was observed in 29 patients (97%). Maximum perfusion was seen in all positions when flexion was the initial position., Conclusion: We advocate that for the examination of the patellar tendon by Doppler sonography, the patients should have fully extended and relaxed knees. Otherwise, the colour Doppler findings will underestimate the flow, and the spectral Doppler will overestimate peripheral vascular resistance.

Rationale and Objectives: Radiofrequency (RF) tissue ablation with a cooled needle electrode (probe) can produce large lesions. By using this technique on ex vivo calf livers, the authors evaluated the role of ultrasound (US), dose response, and temperature course with time., Methods: RF ablation was produced with a 14-gauge probe with a 2-cm exposed tip. The lesions were examined with US and macroscopically after various treatment durations. Tissue temperature was measured with thermosensors inserted 1, 2, and 3 cm from the probe., Results: Before treatment the tip of the probe was easy to visualize with US, but treatment microbubbles obscured the lesion and probe. After treatment, the lesions appeared hypoechoic. Lesion size was underestimated based on US findings. Lesion size was logarithmically correlated to treatment duration. Lesion temperature increased at an increased rate with higher wattage applied and with decreased distance from the probe., Conclusion: US is useful for probe placement before treatment and might be of value after treatment. Lesion size increases reproducibility with treatment duration.

To investigate, in a population of women suspected of an ovarian mass, whether pelvic ultrasound (US) and US combined with US-guided fine needle biopsy (FNB) increased the detection rate and whether tumor specific diagnoses could be obtained, a cohort of 307 patients suspected of an ovarian mass underwent US examination as part of routine gynecologic work-up. In cases of solid or solid/cystic lesions a US guided FNB for histology as well as cytology was proposed. All 35 primary ovarian cancers, 6 of 7 secondary ovarian cancers, and 3 of 4 non-ovarian cancers were demonstrated on US. Among 17 cases with normal palpation and an ovarian mass on US, operation disclosed 3 ovarian cancers. FNB identified 24 of 27 primary ovarian cancers and 7 of 7 cancers of extra-ovarian origin. The use of US, in this study, increased the detection of masses in the pelvis and FNB provided a reliable verification.

A literature review was undertaken to investigate whether transrectal ultrasound can predict the local stage of prostate cancer. Twelve papers were found which correlated ultrasound findings with surgical findings and another paper reported on strategic staging biopsies guided by transrectal ultrasound. Eleven of these papers reported on ultrasound findings in patients in whom digital rectal examination had defined localized disease. One paper compared ultrasound findings and digital rectal findings. One paper indicated that transrectal ultrasound, though not suited to patients with clinically localized disease defined by digital rectal examination, may be superior as the initial staging tool. We conclude that transrectal ultrasound has too low a specificity to upgrade the diagnostic results of digital rectal examination, but that it may be more useful as the primary staging tool and for guidance in strategic staging biopsies.

A study was conducted to compare results of transrectal ultrasound with pathologic findings on 116 patients who underwent radical prostatectomy for treatment of prostate cancer. In 96% (111 of 116), transrectal ultrasound guided biopsies of a hypoechoic lesion proved cancer; seven patients had known Stage A cancer; one patient had cancer detected by palpation and not detected by ultrasound. Cancers in the outer gland (peripheral and central zones) were compared with cancers in the inner gland (transition zone) by both ultrasound and pathology. Forty-eight percent (52 of 108) of cancers originating in the outer gland showed extraprostatic extension (Stage C disease). The primary sites of tumor escape from the outer gland were the prostatic capsule (38%), anterior fibromuscular stroma (5%), seminal vesicle (18%), the base of the gland at the neurovascular bundle (21%), and the apex (31%). Twenty-two percent (17 of 54) of cancers originating in the inner gland (transition zone) showed extraprostatic extension (Stage C disease). The primary sites of tumor escape from the inner gland were the anterior fibromuscular stroma (6%) and apex (11%). Both histologic and biologic differences between outer and inner gland cancers were found when tumor size was controlled. Gleason scores were significantly different for inner and outer gland cancers, with mean scores of 6.2 +/- 1.6 and 7.4 +/- 0.9, respectively. An odds ratio of 8.6 confirmed the increased risk of extraprostatic extension for outer gland cancer. Outer gland cancers showed increased aggressive behavior of both histologic and biologic nature. The difference in biologic aggressiveness of outer and inner gland cancers has definite implications for treatment options. Use of other diagnostic parameters, such as DNA ploidy, may help to determine which cancers to treat and when to treat them; this may have more relevance for cancers originating in the inner gland. Strategic transrectal ultrasound guided biopsy affords accurate tumor mapping and staging when modes of internal spread and escape of cancer from both outer and inner gland are known. Thus, transrectal ultrasound may be our "window of observation" through which additional research may explain the histologic and biologic discrepancies between outer and inner gland cancers.

The comprehensive description of the zonal anatomy of the prostate as developed by McNeal has identified the likely sites of cancer within the gland and provided further understanding of the way in which prostate tumors spread. Two areas where the capsule is deficient have been described: the invaginated extraprostatic space and the apex of the prostate, both of which are easy avenues along which tumor may escape the confines of the prostate. Cancer of the prostate is hypoechoic in comparison with the normal peripheral zone tissue in all cases and can be diagnosed with great accuracy by the use of ultrasound-guided biopsies. The sensitivity of transrectal ultrasound in the diagnosis of prostate cancer is twice that of digital rectal examination. In our clinical study, the overall positive predictive value of a hypoechoic lesion was 41 per cent, and it increased to 61 per cent when combined with the finding of a positive digital rectal examination and to 52 per cent if the prostate-specific antigen level was elevated. Thirty-two per cent of the cancers diagnosed with transrectal ultrasound were not detectable by digital rectal examinations.

1. PIN can present as a hypoechoic lesion on ultrasound. 2. Biopsy results prove a close relationship between PIN and cancer. 3. Measurements of age, lesion size, and PSA for diagnoses of PIN were intermediate values between non-cancer and cancer. 4. Sequential, precise transrectal ultrasound-guided biopsies of hypoechoic lesions are now possible, and close follow-up of patients with diagnoses of PIN is therefore possible.

The use of transrectal ultrasound in combination with the Biopty System provides a high accurate, efficient, and safe method for the diagnosis and staging of prostate cancer. Because both diagnosis and staging may be attained easily using one comprehensive procedure, we recommend ultrasound guidance be used for all initial biopsies of the prostate. When transrectal ultrasound-guided biopsy of a palpable hypoechoic abnormality is negative for cancer, digitally guided biopsy must subsequently be performed. In some cases, palpable abnormality may not be seen on ultrasound. We advocate the use of our biopsy procedure as an integral extension of transrectal ultrasound of the prostate. In an outpatient setting, biopsy may be performed immediately after finding a suspect lesion on ultrasound. In this way, patients are spared time and anxiety, and society is spared medical costs.

TRUS allows visualization of the internal anatomy of the prostate gland. Knowledge of zonal prostate anatomy allows more accurate staging of prostate cancer by use of strategic TRUS-guided biopsy of sites of possible tumor extension. These biopsies may be facilitated via the transrectal route using an automatic Biopsy system. TRUS is twice as sensitive as DRE and is capable of detecting nonpalpable prostate cancer. TRUS can detect nonpalpable tumors with average dimensions as small as 1.0 cm. This size is considered to be clinically significant.

Percutaneous ultrasound-guided interstitial radiotherapy is an attractive and elegant technique for the administration of high-dose local radiotherapy to the prostate. The complications of seed implantation are those associated with the radiation rather than with the technique of implantation. However, radiotherapy has not provided impressive local control of the disease or prolonged survival. The poor disease control was not attributed to poor seed placement, but rather to the inadequacy of 125I in controlling the cancer. The essence of nonsurgical treatment for prostate cancer is the use of effective imaging. Experience in the field of minimally invasive surgery has shown that ultrasound is the ideal imaging system for targeting treatments because of its ease of use and the absence of adverse effects. As the newer techniques of implantation come to be accepted, it is hoped that the complications of rectal and bladder radiation injury will decrease and the therapeutic benefits increase. The clinical trials required to define the precise role of each of the modalities of treatment must take nodal staging into account and must be compared with the gold standard of radical prostatectomy in the treatment of early confined disease.