Transrectal ultrasonography (TRUS) of the prostate has been used for screening and staging of prostate cancer since the first practical tomogram of the prostate was obtained in Japan. Systematic biopsy of the prostate in men with elevated prostate specific antigen (PSA) has been a gold standard method for the detection of prostate cancer while the ability of conventional gray-scale imaging was limited to differentiating malignant from benign lesions. In this review, we discuss recent developments in TRUS. Contrast-enhanced Doppler imaging as well as elastography are new ultrasound technological modalities that improve cancer detection and may lead to new diagnostic approaches for prostate cancer. Furthermore, real-time TRUS navigation and augmented reality have been developed for minimally invasive surgery such as minilaparotomy and laparoscopic radical prostatectomy. Intra-operative TRUS visualizes the surgical anatomy and cancer lesion and may help surgeons perform precise operations. Recent advances in TRUS potentially improve the diagnostic performance and therapeutic outcome for prostate cancer.

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From 1983 through 2003, 1,403 cases of malignant neoplasm were detected among 1,375,565 examinees who underwent abdominal US screening. In these cases, 545 cases (38.8%) were detected from kidney and urinary organs, such as 337 renal cell carcinoma (RCC), 18 ureteropelvic cancer, 123 bladder carcinoma, 62 prostate cancer, and so on. The resected cases of RCC, ureteropelvic cancer, bladder carcinoma, and prostate cancer were 332 (98.5%), 16 (88.9%), 121 (98.4%), and 10 (16.1%), respectively. The cumulative survival rate of these cases was 96.8% at 10 y, 52.0% at 10 y, 99.1% at 7 y, and 100% at 10 y, respectively. The percentage of cases with stage I disease was 86% in RCC and 98.3% in bladder carcinoma. On the other hand, in ureteropelvic cancer, the percentage of cases with stage I disease was 33.3%, and the percentage with stage III or IV disease were 60%. In bladder carcinoma, 98.3% of the cases were treated by TUR-Bt. US screening was extremely useful for early detection of RCC and bladder carcinoma. The internal echo pattern of many small RCCs was hyperechoic and homogeneous, and it was very important to distinguish it from angiomyolipoma. Moreover, the heterogeneous type increased with the size of the tumor. In cystic type RCCs, the US features of thickened wall and solid component in the tumor were important for early detection. In ureteropelvic cancer, solid echo in CEC, change of CEC echo with the passage of time, and hydronephrosis and/or hydroureter should be evaluated very carefully. Bladder carcinoma is frequently detected at the triangle of the bladder, and it is very important to detect elevated lesions.

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High-intensity ultrasound can selectively destroy tissue if delivered in a focused manner without damage to the surrounding tissue. High-intensity focused ultrasound (HIFU) in the treatment of localized prostate cancer can deliver a minimally invasive treatment with effective cancer control. Of particular note, HIFU has the ability to deliver focal therapy of only the malignant lesions within the prostate. One of the advantages of HIFU has been purported to be its repeatability in men who have residual prostate cancer. Patients on anticoagulant therapy, such as warfarin or aspirin, can be kept on their anticoagulant regimens. Recent improvements to the device allow the monitoring of changes in the estimated tissue temperature at the point where HIFU is delivered during HIFU therapy, supporting its authenticity. The idea of treating only the cancer within the prostate and sparing the non-cancerous tissue in the prostate is quite appealing. Some evidence prompted us to use HIFU for focal therapy of a limited area of the prostate in low-risk patients. Consequently, HIFU has been considered to be a forerunner in minimally invasive and focal treatment of localized prostate cancer.

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Approximately 30 years have passed since ultrasonography came to be used for health check-ups and mass surveys of the upper abdomen. However, its efficacy has not yet been adequately evaluated. The most important purpose for introducing abdominal ultrasonography into screening is considered to be the early detection of cancers. This presentation outlines enforcement of cancer screening, conditions for performing cancer screening, evaluation methods of cancer screening, accuracy of the screening test, accuracy of the screening system, and communication with the examinee.

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Although tissue Doppler echocardiography is useful in assessing regional myocardial function, Doppler-angle dependency greatly limits its clinical application. By contrast, speckle tracking echocardiography automatically tracks myocardial ultrasound speckle, making it possible to assess myocardial velocity and strain and strain rate irrespective of direction of myocardial motion. Speckle tracking echocardiography is thus useful in assessing myocardial function in all ventricular walls, providing information that is especially important in assessing ventricular dyssynchrony and myocardial ischemia associated with postsystolic shortening. Ventricular dyssynchrony is assessed by measuring the time difference of peak myocardial strain among the walls and is reported to be robust than that between peak systolic myocardial velocities. Moreover, recent advances enable estimation of subendocardial and subepicardial myocardial function separately. One interesting application of speckle tracking echocardiography is the ability to assess ventricular rotation and wringing motion. Twist and untwist are assessed based on the difference between basal and apical rotation. Untwisting is mainly seen during isovolumic relaxation and may be related to diastolic relaxation, suggesting that untwist could prove useful in assessing grade of diastolic dysfunction. Speckle tracking echocardiography has been applied in two-dimensional echocardiography, where it can assess myocardial motion in a more physiological manner and is likely to open new avenues for research and clinical application, Note, however, that three-dimensional speckle tracking echocardiography has just become available.

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A 63-year-old man was admitted to our hospital complaining of strong chest pain in the early morning. His medical history included percutaneous coronary intervention (PCI) resulting from anterior myocardial infarction. The electrocardiogram showed significant change only in the right bundle branch block. No troponin T or enzymes derived from the myocardium were detected. The echocardiogram showed anteroseptal akinesis. Wall motion abnormality improved 4 minutes after the initial scan, but appeared again 14 minutes later. Diastolic stunning and postsystolic shortening were detected by two-dimensional speckle tracking analysis at 4 and 14 minutes, respectively. Percutaneous coronary intervention was performed immediately when coronary angiography indicated 90% stenosis in a stent implanted in the left anterior descending artery. We report this as a rare case of acute coronary syndrome with myocardial wall motion which changed remarkably under echocardiographic observation.

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