***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Shear wave imaging ( SWI ) is a new ultrasound technique whose application facilitates quantitative tissue elasticity assessment during transrectal ultrasound biopsies of the prostate gl and . The aim of this study was to determine whether SWI quantitative data can differentiate between benign and malignant areas within prostate gl and s in men suspected of prostate cancer ( PCa ) . Methods We conducted a protocol -based , prospect i ve , prebiopsy quantitative SWI of prostate gl and s in 50 unscreened men suspected of prostate cancer between July 2011 and May 2012 . The ultrasound image of whole prostate gl and was arbitrarily divided into 12 zones for sampling biopsies , as is carried out in routine clinical practice . Each region was imaged by grey scale and SWI imaging techniques . Each region was further biopsied irrespective of findings of grey scale or SWI on ultrasound . Additional biopsies were taken if SWI abnormal area was felt to be outside of these 12 zones . Quantitative assessment of SWI abnormal areas was obtained in kilopascals ( kPa ) from abnormal regions shown by SWI and compared with histopathology . Sensitivity , specificity , positive and negative predictive values , and likelihood ratios were calculated for SWI ( histopathology was a reference st and ard ) . Results Fifty patients , with a mean age of 69 ± 6.2 years , were recruited into the study . Thirty-three ( 66 % ) patients were diagnosed with PCa , while an additional 4 ( 8 % ) had atypia in at least one of the 12 prostate biopsies . Thirteen ( 26 % ) patients had a benign biopsy . Data analysed per core for SWI findings showed that for patients with PSA < 20 μg/L , the sensitivity and specificity of SWI for PCa detection were 0.9 and 0.88 , respectively , while in patients with PSA > 20 μg/L , the sensitivity and specificity were 0.93 and 0.93 , respectively . In addition , PCa had significantly higher stiffness values compared to benign tissues ( p < 0.05 ) , with a trend toward stiffness differences in different Gleason grade s. ConclusionS WI provides quantitative assessment of the prostatic tissues and , in our preliminary observation , provides better diagnostic accuracy than grey-scale ultrasound imaging PURPOSE We determined the prostate cancer detection rate of multiparametric magnetic resonance imaging at 3 T . Precise one-to-one histopathological correlation with magnetic resonance imaging was possible using prostate magnetic resonance imaging based custom printed specimen molds after radical prostatectomy . MATERIAL S AND METHODS This institutional review board approved prospect i ve study included 45 patients ( mean age 60.2 years , range 49 to 75 ) with a mean prostate specific antigen of 6.37 ng/ml ( range 2.3 to 23.7 ) who had biopsy proven prostate cancer ( mean Gleason score of 6.7 , range 6 to 9 ) . Before prostatectomy all patients underwent prostate magnetic resonance imaging using endorectal and surface coils on a 3 T scanner , which included triplane T2-weighted magnetic resonance imaging , apparent diffusion coefficient maps of diffusion weighted magnetic resonance imaging , dynamic contrast enhanced magnetic resonance imaging and spectroscopy . The prostate specimen was whole mount sectioned in a customized mold , allowing geometric alignment to magnetic resonance imaging . Tumors were mapped on magnetic resonance imaging and histopathology . Sensitivity , specificity , positive predictive value and negative predictive value of magnetic resonance imaging for cancer detection were calculated . In addition , the effects of tumor size and Gleason score on the sensitivity of multiparametric magnetic resonance imaging were evaluated . RESULTS The positive predictive value of multiparametric magnetic resonance imaging to detect prostate cancer was 98 % , 98 % and 100 % in the overall prostate , peripheral zone and central gl and , respectively . The sensitivity of magnetic resonance imaging sequences was higher for tumors larger than 5 mm in diameter as well as for those with higher Gleason scores ( greater than 7 , p < 0.05 ) . CONCLUSIONS Prostate magnetic resonance imaging at 3 T allows for the detection of prostate cancer . A multiparametric approach increases the predictive power of magnetic resonance imaging for diagnosis . In this study accurate correlation between multiparametric magnetic resonance imaging and histopathology was obtained by the patient specific , magnetic resonance imaging based mold technique Purpose The role of HistoScanning ™ ( HS ) in prostate biopsy is still indeterminate . Existing literature is sparse and controversial . To provide more evidence according to that important clinical topic , we analyzed institutional data from the Martini-Clinic , Prostate Cancer Center , Hamburg . Methods Patients who received prostate biopsy and who also received HS were included in the study cohort . A single examiner , blinded to pathological results , re-analyzed all HS data in accordance with sextants of the prostate . Each sextant was considered as an individual case . Corresponding results from biopsy and HS were analyzed . The area under the receiver-operating characteristic curve ( AUC ) for the prediction of a positive biopsy by HS was calculated . Furthermore , sensitivity , specificity , positive predictive value ( PPV ) and negative predictive value ( NPV ) were assessed according to different HS signal volume cutoffs ( > 0 , > 0.2 and > 0.5 ml ) . Results Overall , 198 men were identified and 1,188 sextants were analyzed .  The AUC to predict positive biopsy results by HS was 0.58 . Sensitivity , specificity , PPV and NPV  for HS to predict positive biopsy results per sextant , depending on different HS signal volume cutoffs ( > 0 , > 0.2 and > 0.5 ml ) were 84.1 , 27.7 , 29.5 and 82.9 % , 60.9 , 50.6 , 28.8 and 79.7 % , and 40.1 , 73.3 , 33.1 and 78.8 % , respectively . Conclusions Positive HS signals do not accurately predict positive prostate biopsy results according to sextant analysis . We can not recommend a variation of well-established r and om biopsy patterns or reduction of biopsy cores in accordance with HS signals at the moment PURPOSE To prospect ively evaluate multiparametric magnetic resonance imaging ( MRI ) for accurate localization of intraprostatic tumor nodules , with whole-mount histopathology as the gold st and ard . MATERIAL S AND METHODS Seventy-five patients with biopsy-proven , intermediate , and high-risk prostate cancer underwent preoperative T2-weighted ( T2w ) , dynamic contrast-enhanced ( DCE ) and diffusion-weighted ( DW ) MRI at 1.5 T . Localization of suspicious lesions was recorded for each of 24 st and ardized regions of interest on the different MR images and correlated with the pathologic findings . Generalized estimating equations ( GEE ) were used to estimate the sensitivity , specificity , accuracy , positive , and negative predictive value for every MRI modality , as well as to evaluate the influence of Gleason score and pT-stage . Tumor volume measurements on histopathological specimens were correlated with those on the different MR modalities ( Pearson correlation ) . RESULTS DW MRI had the highest sensitivity for tumor localization ( 31.1 % vs. 27.4 % vs. 44.5 % for T2w , DCE , and DW MRI , respectively ; P < 0.005 ) , with more aggressive or more advanced tumors being more easily detected with this imaging modality . Significantly higher sensitivity values were obtained for the combination of T2w , DCE , and DW MRI ( 58.8 % ) as compared to each modality alone or any combination of two modalities ( P < 0.0001 ) . Tumor volume can most accurately be assessed by means of DW MRI ( r = 0.75 ; P < 0.0001 ) . CONCLUSION Combining T2w , DCE , and DW imaging significantly improves prostate cancer localization OBJECTIVES Various imaging modalities , such as magnetic resonance imaging ( MRI ) , have been assessed with regard to their value in the detection of prostate cancer ( CaP ) . However , there is a need for less time-consuming and more cost effective procedures in urology . In order to determine the ability of contrast-enhanced transrectal ultrasound ( CE-TRUS ) to identify CaP , we investigated patients scheduled for radical prostatectomy for CaP and radical cystoprostatectomy for bladder cancer . MATERIAL AND METHODS Between May and August 2008 , 35 consecutive patients with CaP and muscle-invasive bladder carcinoma were prospect ively enrolled in this single center study . All patients underwent B-mode TRUS and CE-TRUS ( Sequoia 512 unit with an endocavity probe EV8C4 , 8 MHz ; Siemens , Erlangen , Germany ) by one investigator blinded to any clinical data before radical surgery . Contrast-enhanced images were obtained after intravenous infusion of a bolus ( 2.4 ml ) of the contrast agent SonoVue ( Bracco , Milan , Italy ) . Ultrasound findings ( CE-TRUS and B-mode TRUS ) were correlated with step-section histology . RESULTS On a per-patient basis , sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) for detecting CaP with CE-TRUS were 71.0 % , 50.0 % , 91.7 % , and 18.2 % , respectively . In comparison with B-mode TRUS ( sensitivity 45.2 % , specificity 75.0 % , PPV 93.3 % , and NPV 18.0 % ) , CE-TRUS performed significantly better ( P=0.004 , McNemar test ) . On a per-prostate-lobe basis sensitivity , specificity , PPV , and NPV were 69.0 % , 33.3 % , 83.3 % , and 18.2 % . CONCLUSION CE-TRUS detected prostate cancer with a modest sensitivity and a high PPV in a selected patient cohort . Future r and omized-controlled multicenter studies are needed to further vali date the value of CE-TRUS in the detection of CaP. Based on our results , CE-TRUS may not be recommended as a routine procedure in the diagnosis of CaP at present BACKGROUND We quantified changes in prostate carcinoma vascularity treated with anti- and rogens using color Doppler and power transrectal ultrasound in combination with microbubble contrast agent Levovist . METHODS Thirty-six men with prostate carcinoma were studied at baseline and at intervals during treatment . At each attendance , Levovist((R ) ) ( 10 ml , 300 mg/ml ) was given as an iv bolus . Using quantitative analysis , we calculated the pre-enhancement scores , arrival time , time to peak , peak value , and area under the time-enhancement curve ( AUC ) . These were compared to pre-treatment values and serial PSA measurements . RESULTS The pre-enhancement , peak value , and AUC each showed a marked response with reductions within one week . The average AUC declined to 68 % + /- 9 % ( mean + /- st and ard error ) by week 1 , 56 % + /- 9 % by week 3 , and 20 % + /- 4 % by week 6 . A strong correlation with changes in the mean PSA ( r = 0.95 , P < 0.001 ) was also measured . In four patients , Doppler indices did not fall with PSA : two patients with the most marked discrepancy relapsed at 6 months . CONCLUSION The vascular enhancement declined with therapy , similar to PSA . Microbubble enhanced ultrasound can show early response to treatment PURPOSE To compare areas of contrast material enhancement in the prostate at ultrasonography ( US ) with whole-mount radical prostatectomy specimens to determine if the use of contrast material improves the detection rate of prostate cancer . MATERIAL S AND METHODS Transrectal US was performed in 12 subjects with cancer of the prostate prior to radical prostatectomy .  Each gl and was evaluated with conventional gray-scale and wide-b and harmonic US at baseline and again during intravenous infusion of a microbubble contrast agent . Focal areas of contrast enhancement were identified prospect ively in the transverse plane at the base , midgl and , and apex of the prostate . US findings were then compared with whole-mount prostatectomy specimens . Baseline and contrast-enhanced findings were compared by using the Wilcoxon signed rank test . RESULTS Thirty-one foci of prostate cancer were present at pathologic evaluation , with multiple foci of cancer in 11 of the 12 gl and s. Three of 10 inner-gl and cancers and five of 21 outer-gl and cancers were detected at baseline imaging . Diffuse inner-gl and enhancement was identified in all subjects during contrast agent infusion . Contrast-enhanced imaging demonstrated an additional five cancer foci in the outer gl and ( P = .025 ) , for an overall sensitivity of 42 % ( 13 of 31 foci ) . Seven additional sites of focal contrast enhancement were identified . Five of these sites corresponded to foci of hyperplasia . Two sites were false-positive with no pathologic abnormality . Increased flow was not demonstrated posteriorly in the midline , even when a tumor was present . CONCLUSION Contrast-enhanced US of the prostate with Sonazoid can improve sensitivity for 
    Output:
    
Results Limited research available on combining ultrasound modalities has presented improvement in diagnostic performance .
Conclusion Available evidence confirms that combining different ultrasound modalities significantly improves diagnostic performance