Ultrasound signs of diseases of the prostate and seminal vesicles

Ultrasonic evaluation of diseases of the prostate and seminal vesicles

In acute prostatitis, both strengthened and reduced vascularization can be noted in equal measure, depending on the stage of the inflammatory process. With the predominance of the phase of hyperemia, there is an increase in vascularization and a decrease in the IR in the gland vessels, whereas in the edema phase, a decrease in vascularization and an increase in IR prevail. The importance of transrectal ultrasound with new technologies in monitoring the treatment of patients with prostatitis was clearly demonstrated in a number of works. With acute prostatitis, it is recommended that the treatment be monitored after 2-3 days using a comprehensive vascular study to determine the effectiveness of the therapy. The dynamics of changes in vascularity is an indicator of the effect of treatment. With a positive effect, there is a restoration of the symmetry of the vascular pattern, enrichment of the vascular pattern and enhancement of the perfusion of the gland (in areas with previously decreased blood flow) or a decrease in the degree of vascularization in areas with previously increased blood flow. When analyzing the changes in venous blood flow, a significant increase in the linear velocity of venous blood flow in the periprostatic venous plexus is observed, on average, by 5.3 ± 2.1 cm / s (15%), indicating an improvement in venous outflow and, consequently, a decrease in stagnant phenomena. Similar changes are noted in intraprostatic veins (periurethral and capsular).

The technique of ultrasound angiography allows one to suspect at an early stage the formation of an abscess of the prostate and to reveal the ineffectiveness of the treatment. In gray scale mode, even with the use of tissue harmonic mode, it is impossible to immediately suspect the formation of an abscess. In ultrasound angiography, this zone is usually avascular or hypovascular. Reducing the degree of vascularization of the gland or reducing vascularization in the focal focus in a control study also indicates a worsening of the blood supply to the inflammation zone and further, in the absence of correction of treatment, leads to the formation of an abscess. When ultrasound angiography for an abscess, blood flow is typical of the "flaming ring" type.

Vesiculitis is determined echographically with a sharp expansion of seminal vesicles with thickened walls filled with anechogenous contents. In ultrasound angiography in the walls of seminal vesicles, the amplified blood flow is lucid.

In chronic prostatitis, vascularization analysis using ultrasound angiography in all patients with a predominance of fibrotic changes showed a local decrease in vascularization in fibrosis zones. In some cases, with a long-term chronic prostatitis, there was a general decrease in vascularization of the gland. The parameters of peak LSC and IR in the intraprostatic arteries in patients with chronic prostatitis did not practically differ from those in the norm group.

With benign prostatic hyperplasia, the vascular pattern changes significantly, mainly due to hyperplasia of the urethral group of arteries, which has been described in a number of scientific papers. It is characterized by a hyperplastic type of vascularization. The ratio of the degree of vascularization of the central and peripheral parts of the gland is violated by reducing the vascularization of the peripheral zone and strengthening the vascularization of the central part.

Benign hyperplasia

The prostate gland is accompanied not only by qualitative, but also by quantitative changes in hemodynamics. It is characterized by an increase in peak blood flow velocities to an average of 14.8 ± 5.2 cm / s in the urethral arteries and to 16.8 + 4.3 cm / s in the capsular arteries, IR to 0.71 ± 0.08 and 0, 72 + 0.09, respectively, regardless of the form of adenoma growth.

Prostate cancer, according to many researchers, is characterized by hypervascularization in the affected area. However, it was found that hypervascularization is not a decisive factor in its diagnosis. In prostate cancer, both hypervascular and hypovascular tumors are equally common. The degree of vascularization of the tumor is closely related to its ability to rapidly grow and metastasize. The study of angioarchitectonics and the nature of the vascular pattern is more important than determining the degree of vascularization of the tumor. Tumor vessels differ from normal ones. For tumor vessels is characterized by pathological branching, a different caliber, a convoluted course, blind pockets instead of terminal arterioles. This type of vascular pattern was called "disorganized". Determination of the nature of the vascular pattern is most possible when using the technique of three-dimensional angiography. With the three-dimensional reconstruction of the vessels, the vascular pattern of the gland can be more accurately estimated as a whole, it is possible to detect not only the zones of asymmetry of the vascular pattern, but also to identify the zones of neovascularization, to talk about the spatial distribution of the vessels in the tumor. In this mode, it is more accurate to perform differential diagnostics of various hypoechoic sites in the prostate gland. This allows us to distinguish at the first stage hypoechoic sites in acute prostatitis and cancer in elderly patients. The study of the symmetry of vascularization raises the positive predictive value of TRUS in revealing infiltrating isoechogenic tumors and tumors with fuzzy contours. In the absence of local changes in the gray scale, the asymmetry of the vascular pattern, local reduction or increase in the degree of vascularization can provide some help in the search for isoechogenic tumors and infiltrative prostate cancer.

Prostate adenoma on scans - a uniform formation, different in shape and size, but always with clear, even contours and a well-traced capsule. Adenomatous tissue of the gland can develop unevenly evenly and look asymmetric in frontal echoscanization. With the predominance of glandular elements, edema of the stroma due to adenoma and the associated inflammatory process, the echogenicity of the gland can be diffusively reduced: in the parenchyma, small anehogenous rounded formations are sometimes found. In the case of chronic inflammation in the parenchyma, hyperechoic inclusions (sometimes with an acoustic path) occur, usually located in the transit zone and in the course of the surgical capsule or on the border of the central and peripheral zones.

To determine the causes of obstruction of the lower urinary tract and to assess the structural changes in the urethra, micture ultrasound cystourethroscopy (echrodynamic examination) is used. The essence of the method is in the TRUSI prostate performed during urination. Passage of urine through the urethra allows you to see the latter during echography, which can not be done when it is asleep. On transrectal echograms at the time of urination, determine the neck of the bladder in the form of a funnel with a clear and even inner contour, the prostatic and? Partially, membranous parts of the urethra, about 5 mm thick. If the cause of obstruction is prostate adenoma, the urethra at this site is visualized as a thin anehogenous strip less than 5 mm wide. Deviation of the urethra by adenomatous tissue depends on the form of its growth. Mikational ultrasound cystourethroscopy acquires great importance in the recognition of urethral stricture, especially if the patient has prostate adenoma. It allows to determine the state of the urethra proximal to the site of constriction, localization and, in some cases, the extent of the stricture. During urination, if his impairment is not associated with prostate adenoma, with a stricture, dilatation of the urethra is noted above stenosis (including the prostatic part). With inflammatory narrowing, the outline of the urethra is distinct, straight, the diameter of the healthy part of the urethra is not changed.

In addition to diagnosing the structural changes in the urethra, mucous ultrasound cystourethroscopy in combination with a UFM or dopplerography of the urine flow allows us to detect functional changes in the urethra and bladder.

IVO in prostate adenoma leads to structural and functional changes in the urinary tract (for example, the bladder). Determining the volume of residual urine by ultrasound is an important method for diagnosing and establishing the stage of prostate adenoma.

Prostate cancer is characterized by echographic features in the form of formation of heterogeneous hypoechoic nodes in the peripheral zone.

Depending on the stage, symmetry breaking, contour irregularity and thinning of the capsule are observed. With ultrasound in 13% of observations, cancer nodes have more pronounced echogenicity than the gland tissue, and in 9% they are isoechoic or not detected at all.

Echographic changes in prostatitis depend on the form of inflammation and are extremely diverse. Thus, with acute prostatitis, an increase in the size of the gland and a decrease in its echomodality are noted in both individual sites and in all of the gland. Abscess of the organ is easily diagnosed with the help of TRUS. The echographic pattern has characteristic features. The abscess looks like the formation of a rounded or irregular shape of a significantly reduced echogenicity, almost approaching that of a liquid structure (anechogenous character). The structure of the abscess of the prostate is not homogeneous due to the content of purulent-necrotic masses in it; often observed anehogennye (fluid) inclusions. With color Doppler mapping in the abscess area, there is no circulation, and around it a pronounced vasculature is found.

In the chronic inflammatory process in the prostate, without exacerbation, the changes in the structure of the organ, associated with sclerotic changes, come to the forefront, which, when echography, have the form of hyperechoic regions without an acoustic effect. Stones in the prostate look like hyperechoic, often multiple formations with a clear acoustic path. Echodoplurography of the prostate allows you to explore the features of the circulation in it for various diseases, which increases the diagnostic value of the method.