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Doppler sonography of the prostate and seminal vesicles
Last reviewed: 06.07.2025
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With the advent of such techniques as color and power Doppler mapping, tissue harmonics, three-dimensional echography and three-dimensional angiography, echocontrast angiography, diagnostics of prostate diseases has moved to a new level. With the help of new ultrasound technologies for obtaining images of prostate tissue and its vascular structures, it has become possible to carry out highly accurate diagnostics of the earliest forms of diseases and monitor treatment.
The blood supply to the prostate comes from paired prostatic arteries, which are branches of the inferior vesical artery. They run anteriorly from the anterior fibromuscular zone and form a dense plexus on the surface of the gland. The urethral arteries branch off to the central part of the gland, and the capsular arteries branch off to the peripheral part. The blood supply to the gland also involves paired inferior genital arteries, which pass in the paraprostatic tissue posteriorly and laterally from the prostate gland as part of the neuromuscular bundle. They give off separate branches that participate in the blood supply to the posterior parts of the gland. The veins form plexuses in the surrounding paraprostatic tissue on the lateral surfaces of the gland.
In transrectal longitudinal scanning, the prostatic artery is defined above the anterior fibromuscular zone and follows it in the paraprostatic tissue. It is often difficult to visualize it along its entire length due to its tortuous course. The urethral arteries branch off from the prostatic artery to the central part of the gland, and the capsular arteries branch off to the peripheral part of the gland.
The energy mapping mode is widely used at present and is considered the most informative for visualizing the vessels of the prostate gland. It allows visualizing smaller vessels of the gland and locating capsular vessels of the peripheral zone, the course of which is perpendicular to the ultrasound beam. With three-dimensional volumetric reconstruction in the energy mapping mode, it is possible to volumetrically represent the course and mutual arrangement of vessels in the parenchyma of the gland. The distribution of vessels in the prostate gland is uniform, fan-shaped. When comparing the vascular pattern of the right and left lobes of the prostate gland on cross sections is symmetrical and uniformly distributed, which was demonstrated in a series of experimental works.
The results of the study of hemodynamics in the vessels of the prostate gland showed that the prostatic artery has a high, narrow, sharp systolic peak and a low-amplitude flat diastolic. The values of peak blood flow velocities in the prostatic artery average 20.4 cm/s (from 16.6 to 24.5 cm/s), IR - 0.92 (from 0.85 to 1.00).
Dopplerograms of the urethral and capsular arteries are comparable with each other, have a medium-amplitude wide, sharp systolic peak and a flat diastolic peak. The values of peak blood flow velocities and IR in the urethral and capsular arteries are similar and on average equal 8.19 ± 1.2 cm/s and 0.58 ± 0.09, respectively. Dopplerograms of the veins of the prostate gland do not have oscillatory phases, representing a medium-amplitude straight line. The average velocity in the veins of the prostate gland varies from 4 to 27 cm/s, averaging 7.9 cm/s.
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