S20 Ultrasound in Medicine and Biology Volume 35, Number 8S, 2009

moderate vascularity of peripheral or combined pattern. Homogenousstructure of the surrounding tissue allows faster nodule volume de-crease ending with a smaller “scar” achieved by fewer PLA sessions.Treatment of hypervascular nodules is less effective and needs morePLA sessions. PLA is not proved to be effective in calcificated nodulesand nodules with avascular regions of extremely high or low USdensity. Approximately 30-40% patients with nodular goiter have in-dications to PLA. Among them 72% nodules reduce their volume twoor more times and 24% disappear. The nodules appearing hypoechoicand partly or completely avascular in 4 weeks time after PLA sessionshow further volume regression. The nodules with persisting vascular-ization do not decrease and should be subject to a second PLA session.Conclusion: US-guided PLA is an effective treatment modality fordecreasing benign thyroid nodules volume. Gray scale sonography andcolor Doppler imaging should be used to achieve the best results.

0213

Groin and Scrotal PainSimon Elliott, Freeman Hospital, United Kingdom

Chronic groin pain is a common symptom in men, which can have asignificant effect upon daily life of the patient. Chronic scrotal painaccounts for approximately 3% of male urological referrals. Manycases are related to previous groin or scrotal surgery, with around 30%of men reporting chronic pain after hernia repair or vasectomy. Thispresentation will outline the possible causes of this condition, discussthe role of high-resolution ultrasound in its investigation, and describea range of ultrasound findings.

0214

Prostate 3D and DopplerRoberto Moncayo, Ecomedica, Ecuador

Ultrasound is probably today the best method of diagnostic in prostatepathology. New ultrasound techniques let us improve and diagnosis.We will talk about 3D and Doppler study applied to the prostate.3D technique improves the knowledge of normal anatomy and pathol-ogy of the prostate and in the coronal plane (only seen in 3D) we canvisualize the path of the urethra. The volume rendering let us visualizethe contours of the prostate and also calculate the volume more accu-rately.When we do 3D reconstructions with full bladder can visualize andunderstand how big is the prostate and how important the protrusionthat enlarged prostate (BPH) made on the floor of the bladder. Also ispossible to see the bladder neck, and confirm if it is compressed or notby the BPH.The multislice feature allows us to examine the gland in multipleimages performing only a single scan.Another feature is the electronic scalp that let us take out (virtually) asegment of the prostate in order to know if a possible cancer noduleproduces infiltration to neighboring tissues or to identify the rupture ofthe capsule or infiltration into the bladder or periprostatic tissues forexample.We can also consider the type of vascularization of a lesion, the shape,number, shunts A-V path of intranodular vessels, in order to despite ifit is benign or malignant.On the other hand we will mention the utility of Doppler in the variouspathologies of the prostate. For example, the increased vascularizationparticularly in acute prostatitis. With Doppler Color we can identifyabnormal neovascular blood vessels, especially in suspicious nodulesor even more in areas without nodules, but with increase of vascularity.

It is known increased focal vascularity in neoplasic nodules or areas

without nodules, which will be considered highly suspicious in whichwe must take several biopsies.According to the literature the Spectral Doppler waveform has notspecific value in cancer diagnosis, but rather to the presence or absenceof blood vessels and the number and characteristics of blood vessels,are important signs better analyzed and visualized by 3D.Conclusions: 3D ultrasound and Doppler techniques in prostate pa-thology improve our knowledge of the characteristics of a lesion and inparticular we can identify smaller cancerous lesions and allows theearlier diagnosis of prostate Ca.

0215

Acute ScrotumSimon Elliott, Freeman Hospital, United Kingdom

Acute scrotal pain or swelling is a common referral for ultrasoundinvestigation in pre-pubertal, adolescent and adult males. Clinical mis-diagnosis of torsion and testicular malignancy is also a frequent causeof medical litigation in the United Kingdom and across the world. Thispresentation will describe the causes of acute scrotal conditions and thelikely findings on ultrasound examination. The role of ultrasound in thediagnosis and management of acute scrotal pain will be discussed.

0216

Contrast US-Guided RF Ablation of Prostate: Laboratory andClinical ExperiencesJi-Bin Liu, Thomas Jefferson University, United StatesEdouard J Trabulsi, Thomas Jefferson University, United StatesRongqin Zheng, Sun Yat-Sen University, ChinaKai Li, Sun Yat-Sen University, ChinaDaniel A Merton, United StatesFlemming Forsberg, Thomas Jefferson University, United StatesEthan J Halpern, Thomas Jefferson University, United StatesBarry B Goldberg, Thomas Jefferson University, United States

Objective: To investigate the use of contrast-enhanced ultrasound(CEUS) for monitoring radiofrequency (RF) ablation of the prostate ina canine model and in humans.Methods: A Cool-Tip™ RF electrode was used to ablate the entireprostate in 15 canines and 4 patients with prostate cancer. TransrectalCEUS with intravenous injections of microbubble-based contrast wasused to monitor the ablation procedure. Two groups of canines wereused to test cooling techniques for protection of urethra and neurovas-cular bundles (NVB) and compare to non-cooling control group usingpathology as a gold standard and Fisher exact test fro statistical anal-ysis. Four patients with prostate cancer were treated with similartechnique to test the feasibility of prostate ablation.Results: Average volumes of prostate ablation achieved in 15 caninesranged from 91.9% to 96.6%. CEUS allowed visualization of coagu-lated areas and monitoring of urethral and NVB blood flow during theablation. Infusion of cold saline in the urethra and iliac artery reduceddamage to the urethra and NVB from ablation. Damage to the urethrawas 13 times more likely to occur if the urethra was not cooled(p�0.0001), while the difference in NVB damage between the coolingand non-cooling protection of the NVB was not statistically significant(p�0.093). Thermal ablation of the entire prostate was successfullyachieved in all 4 patients without complications.Conclusions: CEUS is feasible to guide and monitor RF ablation of theentire prostate. The use of cold saline infusion provides effective

protection for the urethra and partial protection for the NVB.