Contrast-enhanced ultrasonographic characteristics of the diseased canine prostate gland

Contrast-Enhanced Ultrasound (CEUS) Evaluation of Canine Prostatic Hyperplasia before and after Osaterone Acetate Therapy: Preliminary Results

The prostate is the only sexual gland of the male dog, and dihydrotestosterone (DHT) regulates its growth. In intact dogs, constant DHT stimulation results in benign prostatic hyperplasia (BPH) that can be treated with osaterone acetate (OSA). This study describes the effects of OSA treatment, detected by contrast-enhanced ultrasonography (CEUS), highlighting prostatic vascularization with a contrast agent composed of gas microbubbles. Fifteen dogs (2-8 years) of different sizes and breeds (4-30 kg) diagnosed with BPH are involved in the study. Before treatment (D0), CPSE is measured (294.05 ± 115.97 ng/mL), and a B-mode ultrasound is performed (Vratio = 2.80 ± 1.85), confirming BPH. CEUS highlights the length of the wash-in (11.93 ± 2.08 s) and wash-out (42.20 ± 6.99 s) phases of the contrast agent in the prostate and the presence of cysts and parenchymal alteration. Dogs are treated with OSA (0.5 mg/kg for 7 days) and reassessed after 21 days (D1): CPSE and prostate volume are significantly (p < 0.001) reduced. The length of the wash-in (14.73 ± 2.54 s) and wash-out (51.13 ± 6.03 s) phases are significantly (p < 0.001) increased. The results confirm the effectiveness of the treatment, particularly the reduction in prostatic perfusion, confirmed by the increase in diffusion times of the contrast. Although preliminary, these findings are promising for the use of CEUS in monitoring dogs with BPH.

Digital postprocessing analysis of prostatic perfusion in neutered dogs

B-mode ultrasound is routinely performed to evaluate the prostate gland in neutered dogs, although, the detection of malignancies may be challenging. Contrast-enhanced ultrasound (CEUS) has shown to be useful for the assessment of prostatic perfusion in normal and diseased dogs, although the interpretation of contrast ultrasonographic features may still be subjective. A quantitative tool for evaluating prostatic perfusion might improve the reliability of the results in terms of early detection of prostate neoplasia in neutered dogs. The present study aimed to evaluate the applicability of a postprocessing analysis tool to CEUS of the prostate in healthy neutered dogs, to provide quantitative measurements, and to study the influence of individual characteristics on prostatic regression. Twenty-three neutered dogs underwent a B-mode and CEUS examination of the prostate to acquire data about prostatic morphology and microcirculation. The prostate was imaged using a 5-7.5 MHz linear transducer and contrast was administered intravenously. Videoclips were analyzed by using Qontrast software and a postprocessing digital analysis tool (ImageJ) to measure perfusion peak intensity, time to peak, and vascularization ratio at the moment of the peak, which were then related to body weight, age, and time elapsed since orchiectomy. Correlation tests revealed higher vascularization in younger compared with older dogs (P < .05) and in smaller compared with larger dogs (P < .05). Time elapsed since orchiectomy (P > .05) did not affect prostatic perfusion. Contrast-enhanced ultrasound and the postprocessing analysis tool ImageJ allowed analysis of vascular perfusion in all dogs and have the potential to improve the diagnostic possibilities for andrological examination.

Diagnostic value of enhanced-contrast ultrasound for cesarean scar pregnancy: A systematic review

BACKGROUND

Cesarean scar pregnancy, an uncommon ectopic pregnancy in which the embryo is implanted in the cesarean scar, poses significant risks without prompt diagnosis and treatment. Its prevalence has risen alongside increased cesarean section rates. Despite various treatment approaches, consensus remains elusive. Ultrasonography, particularly contrast-enhanced ultrasonography, shows promise in cesarean scar pregnancy diagnosis.

MAIN BODY

This systematic review, following PRISMA guidelines, explores contrast-enhanced ultrasound's diagnostic potential in cesarean scar pregnancy. We searched PubMed, Scopus, Web of Science, and Google Scholar up to August 2023. Selection involved two stages: title/abstract screening and full-text assessment. The included studies investigated contrast-enhanced ultrasound's diagnostic value in cesarean scar pregnancy, provided adequate data, and were peer-reviewed in English. Quality assessment followed the QUADAS-2 criteria. We extracted the diagnostic accuracy metrics: sensitivity, specificity, and accuracy. Out of 193 records, five studies met the inclusion criteria (2016-2020, China). Contrast-enhanced ultrasound displayed sensitivities of 77%-100% and specificities of 95%-100%. Two studies reported accuracy of 96.9%-97.8%. Compared with conventional ultrasound, contrast-enhanced ultrasound exhibited superior sensitivity, specificity, and accuracy. It also outperformed transvaginal ultrasound.

CONCLUSION

Enhanced-contrast ultrasound holds promise for diagnosing and managing cesarean scar pregnancy by visualizing scar vascularization in real-time, thereby reducing severe complication risks. This review highlights contrast-enhanced ultrasound as a transformative diagnostic tool for cesarean scar pregnancy management, despite existing evidence limitations.

Ultrasound-Based Technologies for the Evaluation of Testicles in the Dog: Keystones and Breakthroughs

Ultrasonography is a valuable diagnostic tool extensively used in the andrology of human and domestic animals, including dogs. This review aims to provide an overview of various technologies based on ultrasound, from the basic B-Mode ultrasonography to the more recent advancements, such as contrast-enhanced ultrasonography (CEUS) and ultrasound elastography (UEl), all of which are utilized in the evaluation of canine testicles. The review outlines the principles behind each of these technologies and discusses their application in assessing normal and abnormal testicular conditions. B-mode canine testicular ultrasonography primarily focuses on detecting focal lesions but has limitations in terms of objectivity. Other technologies, including Doppler ultrasonography, B-Flow, and CEUS, allow for the characterization of vascular patterns, which could be further measured using specific applications like spectral Doppler or quantitative CEUS. Additionally, ultrasound elastography enables the assessment of parenchyma stiffness both qualitatively and quantitatively. These ultrasound-based technologies play a crucial role in andrology by providing valuable information for evaluating testicular function and integrity, aiding in the identification of pathological conditions that may impact the health and quality of life of male dogs.

New approaches to selecting a scan-sampling method for chicken behavioral observations and their practical implications

The use of the scan-sampling method, especially when a large amount of data is collected, has become widespread in behavioral studies. However, there are no specific guidelines regarding the choice of the sampling interval in different conditions. Thus, establishing a standard approach for video analysis represents an important step forward within the scientific community. In the present work, we hypothesized that the length of the sampling interval could influence the results of chicken behavioral study, for which we evaluated the reliability, accuracy, and validity of three different sampling intervals (10, 15 and 30 min). The Bland-Altman test was proposed as an innovative approach to compare sampling intervals and support researcher choices. Moreover, these sampling intervals were applied to compare the behavior of 4 chicken genotypes kept under free-range conditions. The Bland-Altman plots suggested that sampling intervals greater than 10 min lead to biases in the estimation of rare behaviors, such as "Attacking". In contrast, the 30-min sampling interval was able to detect differences among genotypes in high-occurrence behaviors, such as those associated with locomotory activity. Thus, from a practical viewpoint, when a broad characterization of chicken genotypes is required, the 30-min scan-sampling interval might be suggested as a good compromise between resources and results.

Contrast-Enhanced Ultrasonography (CEUS) in Imaging of the Reproductive System in Dogs: A Literature Review

The use of contrast-enhanced ultrasound (CEUS) has been widely reported for reproductive imaging in humans and animals. This review aims to analyze the utility of CEUS in characterizing canine reproductive physiology and pathologies. In September 2022, a search for articles about CEUS in canine testicles, prostate, uterus, placenta, and mammary glands was conducted on PubMed and Scopus from 1990 to 2022, showing 36 total results. CEUS differentiated testicular abnormalities and neoplastic lesions, but it could not characterize tumors. In prostatic diseases, CEUS in dogs was widely studied in animal models for prostatic cancer treatment. In veterinary medicine, this diagnostic tool could distinguish prostatic adenocarcinomas. In ovaries, CEUS differentiated the follicular phases. In CEH-pyometra syndrome, it showed a different enhancement between endometrium and cysts, and highlighted angiogenesis. CEUS was shown to be safe in pregnant dogs and was able to assess normal and abnormal fetal-maternal blood flow and placental dysfunction. In normal mammary glands, CEUS showed vascularization only in diestrus, with differences between mammary glands. CEUS was not specific for neoplastic versus non-neoplastic masses and for benign tumors, except for complex carcinomas and neoplastic vascularization. Works on CEUS showed its usefulness in a wide spectrum of pathologies of this non-invasive, reliable diagnostic procedure.

Ultrasonographic measurements of the prostate gland in castrated adult dogs

Background

The dimensions of the prostatic gland in castrated adult dogs, as assessed by ultrasonography, is currently not yet reported in veterinary literature. The current study was aimed at reporting the prostatic dimensions in castrated dogs and investigate the relationship between the dogs’ body weight and prostate size. A second aim of the study was to investigate whether there was a relationship between the dogs’ age and prostate dimensions. A prospective, single-centre, observational study was conducted and 72 privately owned, adult, male castrated dogs with a range of breeds and ages met the final inclusion criteria. The subjects were divided into three categories based on body weight.

Results

A Kruskal–Wallis test found prostatic length and prostatic depth in the longitudinal orientation to be significantly different among the 3 categories (P < 0.005), with an increase in both prostatic length and prostatic depth with increasing body weight. Linear regression of the data set provided comprehensive formulas calculating prostatic length and depth based on the body weight of the dog (r² of 0.69 and 0.53 for prostatic length and depth respectively). Kendall’s Tau rank test showed no correlation between dogs’ age and prostate dimensions (P > 0.100).

Conclusions

The current study is the first to provide a comprehensive, weight-based reference for the canine prostate gland of castrated dogs when assessed on ultrasonography.

Characterization of Testicular Tumor Lesions in Dogs by Different Ultrasound Techniques

In this retrospective study, we assessed the accuracy of different blood flow imaging in diagnosing testicular tumor types in dogs. We recruited 27 dogs with leydigomas (14), seminomas (eight), sertoliomas (six), and mixed cells (five) confirmed histopathologically. In intact dogs, Pampiniform plexus and marginal arteries were scanned through pulsed Doppler. Blood flow and presence of intralesional/perilesional arteries were assessed by color and power Doppler, B-flow, and contrast-enhanced ultrasound. Tumor types did not differ by B-Mode ultrasonography characters. Pampiniform and testicular arteries of sertoliomas had higher (p < 0.05) pulsatility and resistive indexes. The proportion of leydigomas with a perilesional and/or perilesional/intralesional blood flow pattern detected by color and pulsed Doppler and B-flow was higher (p < 0.05) than that of the other tumors counted together. This resulted in a sensitivity of 81.8%, 83.3%, and 85.7%, a specificity of 76.5%, 56.3%, and 73.7%, and a correct classification rate of 78.6%, 67.9%, and 78.8%, respectively. While contrast enhanced ultrasound was highly effective in detecting all tumors, qualitative and quantitative parameters did not contribute to their differential diagnosis. In conclusion, results indicate that different testicular tumor types of dogs have subtly different vascular patterns, a condition that could help in identifying leydigomas.

Perfusion change in benign prostatic hyperplasia before and after castration in a canine model: Contrast enhanced ultrasonography and CT perfusion study

Hormonal and vascular changes affecting the canine prostate after castration were investigated to identify the effects of hormones and perfusion on the development of benign prostatic hyperplasia (BPH). Concentrations of serum testosterone and estrogen and intraprostatic dihydrotestosterone (DHT) were compared between 5 normal dogs, 6 dogs with mild BPH, and 6 dogs with marked BPH. In addition, prostatic perfusion using contrast-enhanced ultrasonography (CEUS) and CT perfusion (CTP), as well as CT volumes of the prostates were compared. The changes in these values following castration were assessed in 6 dogs with marked BPH. CEUS revealed significantly slower prostatic arterial inflow and relatively faster venous outflow in BPH versus normal prostate. Permeability and blood volume were not significantly different between the groups via CTP. Intraprostatic DHT level was higher in BPH than in normal prostate and decreased significantly following castration, which was accompanied by a rapid decrease in prostatic volume. On CEUS, arterial inflow to the prostate significantly decreased following castration. Blood volume within the prostate decreased significantly by day 60 following castration. Permeability increased significantly during the early phase after castration; however, by day 60 post-castration, all perfusion parameters decreased significantly. Perfusion changes including venous parameters measured by CEUS and blood volume changes measured by CTP, however, did not support the backflow theory postulating that BPH is induced by vascular changes from congested testes. The major etiology for the development of BPH is attributed to be increased levels of DHT rather than vascular changes.

Less enhancement and low apparent diffusion coefficient value on magnetic resonance imaging may be helpful to detect canine prostate adenocarcinoma in case series

In dogs, diagnosis of prostate cancer is often delayed because clinical signs are not pathognomonic. Although ultrasonography is mainly performed to detect prostate cancer, the ultrasonographic appearance is not specific. In humans, magnetic resonance imaging (MRI), including diffusion-weighted imaging (DWI) is used to localize the prostate tumour. To our knowledge, there are no studies of MRI findings for detecting or localizing prostate cancer. The purpose of this study was to assess MRI findings of prostate cancer. As a control, three prostate hyperplasia cases were included. MRI data were analysed, and the following parameters were noted: signal intensity (SI) of prostate lesion on T2-weighted imaging, T1-weighted imaging and DWI, enhancement pattern of prostate lesion, and relative contrast enhancement indices (RCEI) and apparent diffusion coefficient (ADC) value of prostate lesion. For MRI examination, the mean RCEI of the adenocarcinoma was significantly lower than that of hyperplasia (P = .01, r = .8). The SI of the DWI of adenocarcinoma was significantly higher compared to hyperplasia (P = .03, φ = 1). The mean ADC values of the adenocarcinoma were significantly lower than that of hyperplasia (P = .03, r = .82). Thus, less enhancement on MRI, and low ADC value on MRI may help to detect prostate adenocarcinoma.

Rhodesian Ridgebacks have an increased risk to develop benign prostatic hyperplasia

Benign prostatic hyperplasia (BPH) is an age-dependent primarily non-inflammatory enlargement of the accessory gland in the intact dog. The aim of the present study was to control a previously raised suspicion of a breed-related higher incidence of BPH in dogs of the Rhodesian Ridgeback breed. For this, 18 Labrador Retrievers/LR and 20 Rhodesian Ridgebacks/RR were assigned to the age groups 18-24 months (n = 12), 25-48 months (n = 13) and 49-72 months (n = 13). Prostate gland status was determined by rectal palpation, B-mode ultrasound, calculation of the prostate gland volume and semen analysis regarding haemospermia and was classified according to blood plasma concentrations of canine prostate-specific arginine esterase (CPSE) (normal ≤ 60 ng/ml, increased ≥ 61 ng/ml; Pinheiro et al., 2017). Concentrations of testosterone, 5α-dihydrotestosterone and estradiol were analysed in peripheral blood serum or plasma for detecting breed-specific conditions regarding the endocrine metabolism. Prostatic volume was significantly larger in RR irrespective of the CPSE status. In RR, BPH occurred more frequently and started at an earlier age compared with the LR. Breed-related specificities in steroid metabolism in the RR were indicated by correlations of 5α-dihydrotestosterone and estradiol with age and of testosterone with prostate gland volume. Although the incidence of sonographic signs of BPH and haemospermia did not fit with normal and increased CPSE concentrations, a breed-specific higher incidence of BPH in the RR breed could be clearly verified.

Advanced ultrasound techniques in small animal reproduction imaging

Ultrasonography is the imaging technology of choice for the evaluation of the reproduction system and of pregnancy in both humans and animals. Over the past 10 years, there have been significant technological improvements of the equipment, while new technologies have been developed. Doppler, contrast-enhanced ultrasonography, elastography, and 3D/4D ultrasonography are advanced ultrasound techniques that have been designed as methods to increase the diagnostic sensitivity of two-dimensional (b-mode) ultrasound, and not as stand-alone tests. The basic physics as well as the advantages and limitations of these advanced ultrasound methods are briefly described. In the reproductive diagnostics of small animals, these techniques have gained an increased popularity as proved by the increased publication of several reports that are also briefly summarized in this review. Clinical applicability is to date limited because of a lack of research on the diagnostic value in concrete situations. Future research projects should focus also on standardization of the used techniques, on determination of thresholds to discriminate between healthy or diseases or fertile versus infertile and on the predictive value of advanced ultrasound findings. Continuing development and optimization of different ultrasound techniques as well as the increase of related scientific interest and worldwide research promises that the clinical interest on the use of advanced ultrasound techniques will increase in future.

Prostatic Neoplasia in the Intact and Castrated Dog: How Dangerous is Castration?

Elective gonadectomy in the dog is a topic of interest for clinicians, pet-owners, and society. Although canine prostatic neoplasia (CPN) has a low incidence (0.35%), reports of an increased risk for castrated dogs attract attention and cause concern in pet-owners. Our aim is to provide professionals and non-professionals with a detailed description of this possible side effect of gonadectomy in the dog. The mean age at diagnosis of CPN ranges from 8.5 to 11.2 years. Medium to large size breeds are more frequently affected. Symptoms and findings of non-invasive examinations are not pathognomonic, therefore, cytological or histological examinations are needed for diagnosis. Overall, the incidence of metastasis reaches up to 80%, yet lung metastasis reportedly has no negative impact on median survival time (MST). It has been reported that castrated males have a significantly higher MST than intact males. Differences in inclusion criteria for studied populations make a comparison of studies difficult. Citation of odds ratios without consideration of the context of the reference may result in premature conclusions. We conclude that elective gonadectomy of adult male dogs under six years of age cannot be excluded from the veterinary practice due to concern of causing CPN until clear and strong evidence is available.

Plasmid DNA vaccine coding eight repeats of gonadotrophin-releasing hormone induced atrophy of prostate in male mice

Background

Prostate hyperplasia and neoplasia are major illness of men and elderly dogs. Treatment of prostate cancer requires androgen deprivation surgery or therapy to prevent metastases and alleviate pain. Recently, six DNA vaccines have entered clinical trials against prostate cancer in humans with limited success. There is a need for new therapies that delay the establishment of malignancy and prolong survival.

Materials and methods

A plasmid DNA vaccine coding for eight gonadotrophin-releasing hormone (GnRH-I) interspersed in eight T-helper epitopes was used. Sexually mature male mice were immunized with the vaccine in hemagglutinating virus of Japanese envelope vector and boosted in nonionized surfactant vesicles in study weeks 0, 3, 6, 9, and 12. Plasma anti-GnRH-I antibody response, serum testosterone concentration, and effect on prostate were evaluated.

Results

Results of an indirect enzyme linked immunosorbent assay (ELISA) showed anti-GnRH-I antibody response (OD value) detected in the study week 3 (0.613 ± 0.179) with a highest response in the week 12 (1.205 ± 0.219). Serum testosterone concentration (ng/ml) in vaccinated mice was significantly reduced (P > 0.000, 0.761 ± 0.531) in the study week 24 in contrast to control serum (7.583 ± 1.251). Group average gross combined weight of prostate and seminal vesicles of vaccinated mice was significantly (P < 0.000) reduced in the study week 24 (319.75 ± 89.19 mg) in contrast to control weight (563.25 ± 108.60 mg). Sections of prostate stained with Goldner's trichrome showed profuse pink color secretion in control tubules, which however was absent in the vaccinated prostate. The lining epithelium of the vaccinated prostate was atrophied and did not enfold in its lumen.

Conclusions

Immunization strategy designed with the plasmid DNA vaccine in hemagglutinating virus of Japanese envelope and nonionized surfactant vesicles can be the genetic immunization platform. This vaccine bears potentials in terms of reducing serum testosterone concentration and induction of atrophy of prostate. Targeted ablation of native GnRH-I by genetic immunization could offer leverage to vaccinologists, seeking therapeutic target to control and prevent malignancy of prostate.

Contrast-enhanced ultrasonography of maternal and fetal blood flows in pregnant bitches

We evaluated the potential usefulness of CEUS to assess fetal-maternal circulation during pregnancy in dogs. Nine bitches were examined at 23, 30, and 45 days of gestation using an ultrasound machine (LOGIQ E9) and SonoVue^® contrast media as echo-signal enhancer. Qualitative and quantitative evaluation of contrast enhancement patterns of uterine artery and utero/placental vessels were performed on recorded images. Independently of the gestational periods, the qualitative evaluation showed the initial wash-in phase from the first appearance of the uterine artery to the rapid distribution in embryonic vesicles or placenta to the progressive washout, whilst there was no enhancement of either embryos or fetuses in any bitch. Independent of gestational age, parameters derived from quantitative analysis of time intensity-curves of contrast enhancement (peak intensity, time to peak, rise time, washout) did not vary between proximal placenta, distal placenta, and uterine artery. With the progression of gestation, AUC values did not change in both proximal and distal placenta, but in the uterine artery it was lower (P ≤ 0.05) at day 30 than at day 23 (464.8 ± 16.1 vs.596.4 ± 28.1, respectively). In conclusion, CEUS appears to safely permit evaluation of the maternal and fetal vessels in the first two third of gestation, without any clinically relevant adverse effects. Further studies in a larger number of bitches in different stages of pregnancy are needed to establish standard parameters for normal pregnancies that can be used to detect abnormalities of pregnancy.

Canine prostate specific esterase (CPSE) as an useful biomarker in preventive screening programme of canine prostate: CPSE threshold value assessment and its correlation with ultrasonographic prostatic abnormalities in asymptomatic dogs

Due to the increased attention that pet-owners devote to their animals and to the improved veterinary care, investigations regarding methods to early detect prostatic disorders that might affect canine life quality have been performed. Canine prostate specific esterase (CPSE) concentration was reported to be higher in dogs suffering from prostatic diseases. This study aimed to estimate the CPSE threshold as a biomarker to early identify prostatic diseases in asymptomatic dogs. The ultrasonographic examination of the prostate was performed in 19 dogs (6-40 kg; 1-5 years) with no symptoms of prostatic diseases. Dogs were grouped according to the presence (Group A) or absence (Group B) of prostatic disorders at the ultrasound (altered appearance, the presence of cysts or irregular borders). For each dog, a venous blood sample was collected to measure serum CPSE and the ratio between calculated and normal expected prostatic volume was assessed for each dog. The CPSE data were statistically analysed (t test, p < .05), and the CPSE threshold in blood serum between groups was calculated by ROC. In 11 dogs, ultrasonography showed signs of prostatic abnormalities (Group A, 2-5 years), while no signs were detected in eight dogs (Group B, 1-3 years). The calculated/estimated volume ratio resulted greater than 1.5 in Group A dogs. The CPSE was statistically different between groups (p < .0001): higher in Group A (mean = 184.9, SD = 126 ng/ml) than in Group B (38.9 ± 22.1 ng/ml). The cut-off CPSE threshold was 52.3 ng/ml (ROC, AUC = 0.974, SE 95.6%, SP 89.2%). This study suggests that CPSE serum concentration higher than 50 ng/ml in asymptomatic dogs is associated with ultrasonographic alterations and increased the prostatic size (volume by 1.5 times greater than the normal size). As the onset of prostatic disorders often remains asymptomatic, the rapid assessment of CPSE could be suitable for selecting preventively those animals that would require further accurate evaluation.

The Value of Contrast-Enhanced Ultrasound in the Diagnosis of Cesarean Scar Pregnancy

Objective. To evaluate the value of contrast-enhanced ultrasound (CEUS) in the cesarean scar pregnancy (CSP). Methods. Clinical data from 92 patients with lower uterine segment pregnancy, who underwent conventional ultrasound and CEUS examination in the Department of Obstetrics and Gynecology, were collected by Xinqiao Hospital Third Military Medical University from March 2014 to March 2015. The parameters of ultrasound contrast time-intensity curve (TIC), including arrival time, time to peak, time from peak to one half, basic intensity, peak intensity, and wash-in slope, were analyzed. Results. Of the 92 cases of patients with pregnancy in the lower uterine segment, 52 cases were CSP, and 40 cases were intrauterine pregnancy. CEUS was significantly better than conventional ultrasound in terms of sensitivity, negative predictive value, Youden index, and diagnostic accuracy (P < 0.05). There was no significant difference in specificity and positive predictive value (P > 0.05). Conclusion. CEUS has a higher accuracy than conventional ultrasound in diagnosis of CSP.