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Knull E, Park CKS, Bax J, Tessier D, Fenster A. Toward mechatronic MRI-guided focal laser ablation of the prostate: Robust registration for improved needle delivery. Med Phys 2023; 50:1259-1273. [PMID: 36583505 DOI: 10.1002/mp.16190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 12/04/2022] [Accepted: 12/11/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Multiparametric MRI (mpMRI) is an effective tool for detecting and staging prostate cancer (PCa), guiding interventional therapy, and monitoring PCa treatment outcomes. MRI-guided focal laser ablation (FLA) therapy is an alternative, minimally invasive treatment method to conventional therapies, which has been demonstrated to control low-grade, localized PCa while preserving patient quality of life. The therapeutic success of FLA depends on the accurate placement of needles for adequate delivery of ablative energy to the target lesion. We previously developed an MR-compatible mechatronic system for prostate FLA needle guidance and validated its performance in open-air and clinical 3T in-bore experiments using virtual targets. PURPOSE To develop a robust MRI-to-mechatronic system registration method and evaluate its in-bore MR-guided needle delivery accuracy in tissue-mimicking prostate phantoms. METHODS The improved registration multifiducial assembly houses thirty-six aqueous gadolinium-filled spheres distributed over a 7.3 × 7.3 × 5.2 cm volume. MRI-guided needle guidance accuracy was quantified in agar-based tissue-mimicking prostate phantoms on trajectories (N = 44) to virtual targets covering the mechatronic system's range of motion. 3T gradient-echo recalled (GRE) MRI images were acquired after needle insertions to each target, and the air-filled needle tracks were segmented. Needle guidance error was measured as the shortest Euclidean distance between the target point and the segmented needle trajectory, and angular error was measured as the angle between the targeted trajectory and the segmented needle trajectory. These measurements were made using both the previously designed four-sphere registration fiducial assembly on trajectories (N = 7) and compared with the improved multifiducial assembly using a Mann-Whitney U test. RESULTS The median needle guidance error of the system using the improved registration fiducial assembly at a depth of 10 cm was 1.02 mm with an interquartile range (IQR) of 0.42-2.94 mm. The upper limit of the one-sided 95% prediction interval of needle guidance error was 4.13 mm. The median (IQR) angular error was 0.0097 rad (0.0057-0.015 rad) with a one-sided 95% prediction interval upper limit of 0.022 rad. The median (IQR) positioning error using the previous four-sphere registration fiducial assembly was 1.87 mm (1.77-2.14 mm). This was found to be significantly different (p = 0.0012) from the median (IQR) positioning error of 0.28 mm (0.14-0.95 mm) using the new registration fiducial assembly on the same trajectories. No significant difference was detected between the medians of the angular errors (p = 0.26). CONCLUSION This is the first study presenting an improved registration method and validation in tissue-mimicking phantoms of our remotely actuated MR-compatible mechatronic system for delivery of prostate FLA needles. Accounting for the effects of needle deflection, the system was demonstrated to be capable of needle delivery with an error of 4.13 mm or less in 95% of cases under ideal conditions, which is a statistically significant improvement over the previous method. The system will next be validated in a clinical setting.
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Affiliation(s)
- Eric Knull
- Faculty of Engineering, School of Biomedical Engineering, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Claire Keun Sun Park
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jeffrey Bax
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - David Tessier
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- Faculty of Engineering, School of Biomedical Engineering, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Knull E, Bax JS, Park CKS, Tessier D, Fenster A. Design and validation of an MRI-compatible mechatronic system for needle delivery to localized prostate cancer. Med Phys 2021; 48:5283-5299. [PMID: 34131933 DOI: 10.1002/mp.15050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/18/2021] [Accepted: 06/03/2021] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Prostate cancer is the most common non-cutaneous cancer among men in the United States and is the second leading cause of cancer death in American men. (Siegel et al. [2019] CA: A Cancer J Clin.69(1):7-34.) Focal laser ablation (FLA) has the potential to control small tumors while preserving urinary and erectile function by leaving the neurovascular bundles and urethral sphincters intact. Accurate needle guidance is critical to the success of FLA. Multiparametric magnetic resonance images (mpMRI) can be used to identify targets, guide needles, and assess treatment outcomes. The purpose of this work was to design and evaluate the accuracy of an MR-compatible mechatronic system for in-bore transperineal guidance of FLA ablation needles to localized lesions in the prostate. METHODS The mechatronic system was constructed entirely of non-ferromagnetic materials, with actuation controlled by piezoelectric motors and optical encoders. The needle guide hangs between independent front and rear two-link arms, which allows for horizontal and vertical translation as well as pitch and yaw rotation of the guide with a 6.0 cm range of motion in each direction. Needles are inserted manually through a chosen hole in the guide, which has been aligned with the target in the prostate. Open-air positioning error was evaluated using an optical tracking system (0.25 mm RMS accuracy) to measure 125 trajectories in free space. Correction of systematic bias in the system was performed using 85 of the trajectories, and the remaining 40 were used to estimate the residual error. The error was calculated as the horizontal and vertical displacement between the axis of the desired and measured trajectories at a typical needle insertion depth of 10 cm. MR-compatibility was evaluated using a grid phantom to assess image degradation due to the presence of the system, and induced force, heating, and electrical interference in the system were assessed qualitatively. In-bore positioning error was evaluated on 25 trajectories. RESULTS Open-air mean positioning error at the needle tip was 0.80 ± 0.36 mm with a one-sided 95% confidence interval of 1.40 mm. The mean deviation of needle trajectories from the planned direction was 0.14 ± 0.06∘ . In the MR bore, the mean positioning error at the needle tip was 2.11 ± 1.05 mm with a one-sided 95% prediction interval of 3.84 mm. The mean angular error was 0.49 ± 0.26∘ . The system was found to be compatible with the MR environment under the specified gradient-echo sequence parameters used in this study. CONCLUSION A complete system for delivering needles to localized prostate tumors was developed and described in this work, and its compatibility with the MR environment was demonstrated. In-bore MRI positioning error was sufficiently small for targeting small localized prostate tumors.
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Affiliation(s)
- Eric Knull
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada
| | - Jeffrey Scott Bax
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Claire Keun Sun Park
- Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - David Tessier
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, Canada.,Robarts Research Institute, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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Seetharam Bhat KR, Samavedi S, Moschovas MC, Onol FF, Roof S, Rogers T, Patel VR, Sivaraman A. Magnetic resonance imaging-guided prostate biopsy-A review of literature. Asian J Urol 2021; 8:105-116. [PMID: 33569277 PMCID: PMC7859420 DOI: 10.1016/j.ajur.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 04/22/2020] [Accepted: 06/01/2020] [Indexed: 12/14/2022] Open
Abstract
Objective Multiparametric magnetic resonance imaging (MP-MRI) helps to identify lesion of prostate with reasonable accuracy. We aim to describe the various uses of MP-MRI for prostate biopsy comparing different techniques of MP-MRI guided biopsy. Materials and methods A literature search was performed for "multiparametric MRI", "MRI fusion biopsy", "MRI guided biopsy", "prostate biopsy", "MRI cognitive biopsy", "MRI fusion biopsy systems", "prostate biopsy" and "cost analysis". The search operation was performed using the operator "OR" and "AND" with the above key words. All relevant systematic reviews, original articles, case series, and case reports were selected for this review. Results The sensitivity of MRI targeted biopsy (MRI-TB) is between 91%-93%, and the specificity is between 36%-41% in various studies. It also has a high negative predictive value (NPV) of 89%-92% and a positive predictive value (PPV) of 51%-52%. The yield of MRI fusion biopsy (MRI-FB) is similar, if not superior to MR cognitive biopsy. In-bore MRI-TB had better detection rates compared to MR cognitive biopsy, but were similar to MR fusion biopsy. Conclusions The use of MRI guidance in prostate biopsy is inevitable, subject to availability, cost, and experience. Any one of the three modalities (i.e. MRI cognitive, MRI fusion and MRI in-bore approach) can be used. MRI-FB has a fine balance with regards to accuracy, practicality and affordability.
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Affiliation(s)
| | - Srinivas Samavedi
- The Hays Medical Centre, University of Kansas Health System, Hays, KS, USA
| | - Marcio Covas Moschovas
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Fikret Fatih Onol
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Shannon Roof
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Travis Rogers
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
| | - Vipul R Patel
- Department of Urology, AdventHealth Global Robotics Institute, Celebration, FL, United States
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Velazco‐Garcia JD, Navkar NV, Balakrishnan S, Abi‐Nahed J, Al‐Rumaihi K, Darweesh A, Al‐Ansari A, Christoforou EG, Karkoub M, Leiss EL, Tsiamyrtzis P, Tsekos NV. End‐user evaluation of software‐generated intervention planning environment for transrectal magnetic resonance‐guided prostate biopsies. Int J Med Robot 2020; 17:1-12. [DOI: 10.1002/rcs.2179] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/25/2020] [Accepted: 09/30/2020] [Indexed: 01/20/2023]
Affiliation(s)
| | | | | | | | | | - Adham Darweesh
- Department of Clinical Imaging Hamad Medical Corporation Doha Qatar
| | | | | | - Mansour Karkoub
- Department of Mechanical Engineering Texas A&M University—Qatar Doha Qatar
| | - Ernst L. Leiss
- Department of Computer Science University of Houston Houston Texas USA
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Herz C, MacNeil K, Behringer PA, Tokuda J, Mehrtash A, Mousavi P, Kikinis R, Fennessy FM, Tempany CM, Tuncali K, Fedorov A. Open Source Platform for Transperineal In-Bore MRI-Guided Targeted Prostate Biopsy. IEEE Trans Biomed Eng 2020; 67:565-576. [PMID: 31135342 PMCID: PMC6874712 DOI: 10.1109/tbme.2019.2918731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Accurate biopsy sampling of the suspected lesions is critical for the diagnosis and clinical management of prostate cancer. Transperineal in-bore MRI-guided prostate biopsy (tpMRgBx) is a targeted biopsy technique that was shown to be safe, efficient, and accurate. Our goal was to develop an open source software platform to support evaluation, refinement, and translation of this biopsy approach. METHODS We developed SliceTracker, a 3D Slicer extension to support tpMRgBx. We followed modular design of the implementation to enable customization of the interface and interchange of image segmentation and registration components to assess their effect on the processing time, precision, and accuracy of the biopsy needle placement. The platform and supporting documentation were developed to enable the use of software by an operator with minimal technical training to facilitate translation. Retrospective evaluation studied registration accuracy, effect of the prostate segmentation approach, and re-identification time of biopsy targets. Prospective evaluation focused on the total procedure time and biopsy targeting error (BTE). RESULTS Evaluation utilized data from 73 retrospective and ten prospective tpMRgBx cases. Mean landmark registration error for retrospective evaluation was 1.88 ± 2.63 mm, and was not sensitive to the approach used for prostate gland segmentation. Prospectively, we observed target re-identification time of 4.60 ± 2.40 min and BTE of 2.40 ± 0.98 mm. CONCLUSION SliceTracker is modular and extensible open source platform for supporting image processing aspects of the tpMRgBx procedure. It has been successfully utilized to support clinical research procedures at our site.
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Martorana E, Pirola GM, Aisa MC, Scialpi P, Di Blasi A, Saredi G, D'Andrea A, Signore S, Grisanti R, Scialpi M. Prostate MRI and transperineal TRUS/MRI fusion biopsy for prostate cancer detection: clinical practice updates. Turk J Urol 2019; 45:237-244. [PMID: 31291186 DOI: 10.5152/tud.2019.19106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
Abstract
This narrative review summarizes the current knowledge about multiparametric and biparametric magnetic resonance imaging of the prostate. This is provided from both a radiological and a urological point of view analyzing the technical aspects of fusion-targeted biopsy using the transperineal approach. We report practical considerations concerning pure cognitive and software-assisted settings, discuss the principal transperineal fusion software now available, and debate the pros and cons of choosing one approach over the other.
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Affiliation(s)
| | | | - Maria Cristina Aisa
- Division of Obstetrics and Gynecology, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
| | - Pietro Scialpi
- Department of Urology, Portogruaro Hospital, Portogruaro, Italy
| | - Aldo Di Blasi
- Section of Radiology and Diagnostic Imaging, Tivoli Hospital, Lazio, Italy
| | | | | | | | | | - Michele Scialpi
- Division of Diagnostic Imaging, Department of Surgical and Biomedical Sciences, University of Perugia, Italy
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Li R, Xu S, Bakhutashvili I, Turkbey IB, Choyke P, Pinto P, Wood B, Tse ZTH. Template for MR Visualization and Needle Targeting. Ann Biomed Eng 2018; 47:524-536. [PMID: 30488309 DOI: 10.1007/s10439-018-02167-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/14/2018] [Indexed: 01/17/2023]
Abstract
To improve the targeting accuracy and reduce procedure time in magnetic resonance imaging (MRI)-guided procedures, a 3D-printed flexible template was developed. The template was printed using flexible photopolymer resin FLFLGR02 in Form 2 printer® (Formlabs, Inc., Somerville, MA). The flexible material gives the template a unique advantage by allowing it to make close contact with human skin and provide accurate insertion with the help of the newly developed OncoNav software. At the back of the template, there is a grid comprised of circular containers filled with contrast agent. At the front of the template, the guide holes between the containers provide space and angular flexibility for needle insertion. MRI scans are initially used to identify tumor position as well as the template location. The OncoNav software then pre-selects a best guide hole for targeting a specific lesion and suggests insertion depth for the physician A phantom study of 13 insertions in a CT scanner was carried out for assessing needle placement accuracy. The mean total distance error between planned and actual insertion is 2.7 mm, the maximum error was 4.78 mm and standard deviation was 1.1 mm. The accuracy of the OncoNav-assisted and template-guided needle targeting is comparable to the robot-assisted procedure. The proposed template is a low-cost, quickly-deployable and disposable medical device. The presented technology will be further evaluated in prostate cancer patients to quantify its accuracy in needle biopsy.
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Affiliation(s)
- Rui Li
- School of Electrical and Computer Engineering, University of Georgia, Athens, GA, USA
| | - Sheng Xu
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | - Ivane Bakhutashvili
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | - Ismail B Turkbey
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter Choyke
- Molecular Imaging Program, National Cancer Institute, Bethesda, MD, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, USA
| | - Bradford Wood
- Center for Interventional Oncology, National Institutes of Health, Bethesda, MD, USA
| | - Zion T H Tse
- School of Electrical and Computer Engineering, University of Georgia, Athens, GA, USA. .,3T Technologies, LLC, Marietta, GA, USA.
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Overduin CG, Heidkamp J, Rothgang E, Barentsz JO, de Lange F, Fütterer JJ. Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study. Eur Radiol 2018; 28:4824-4831. [PMID: 29789909 PMCID: PMC6182740 DOI: 10.1007/s00330-018-5497-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/07/2018] [Accepted: 04/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy. METHODS Twenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded. RESULTS Needle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min. CONCLUSIONS Use of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction. KEY POINTS • Performing MR-guided prostate biopsy using an in-room tablet device is feasible. • CSRs could be sampled after a single alignment step in 19/20 patients. • The mean procedure time for biopsy with the tablet device was 23.7 min.
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Affiliation(s)
- Christiaan G Overduin
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.
| | - Jan Heidkamp
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | | | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Frank de Lange
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, P.O. Box 9101 (767), 6500 HB, Nijmegen, The Netherlands.,MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, Enschede, The Netherlands
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Verma S, Choyke PL, Eberhardt SC, Oto A, Tempany CM, Turkbey B, Rosenkrantz AB. The Current State of MR Imaging-targeted Biopsy Techniques for Detection of Prostate Cancer. Radiology 2017; 285:343-356. [PMID: 29045233 DOI: 10.1148/radiol.2017161684] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Systematic transrectal ultrasonography (US)-guided biopsy is the standard approach for histopathologic diagnosis of prostate cancer. However, this technique has multiple limitations because of its inability to accurately visualize and target prostate lesions. Multiparametric magnetic resonance (MR) imaging of the prostate is more reliably able to localize significant prostate cancer. Targeted prostate biopsy by using MR imaging may thus help to reduce false-negative results and improve risk assessment. Several commercial devices are now available for targeted prostate biopsy, including in-gantry MR imaging-targeted biopsy and real-time transrectal US-MR imaging fusion biopsy systems. This article reviews the current status of MR imaging-targeted biopsy platforms, including technical considerations, as well as advantages and challenges of each technique. © RSNA, 2017.
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Affiliation(s)
- Sadhna Verma
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Peter L Choyke
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Steven C Eberhardt
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Aytekin Oto
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Clare M Tempany
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Baris Turkbey
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
| | - Andrew B Rosenkrantz
- From the Department of Radiology, University of Cincinnati Medical Center, 234 Goodman St, Cincinnati, OH 45267-0761 (S.V.); National Cancer Institute, National Institutes of Health, Bethesda, Md (P.L.C.); Department of Radiology, University of New Mexico, Albuquerque, NM (S.C.E.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (A.O.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (C.M.T.); Center for Cancer Research, National Cancer Institute, Bethesda, Md (B.T.); and Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, New York, NY (A.B.R.)
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Velez E, Fedorov A, Tuncali K, Olubiyi O, Allard CB, Kibel AS, Tempany CM. Pathologic correlation of transperineal in-bore 3-Tesla magnetic resonance imaging-guided prostate biopsy samples with radical prostatectomy specimen. Abdom Radiol (NY) 2017; 42:2154-2159. [PMID: 28293720 DOI: 10.1007/s00261-017-1102-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE To determine the accuracy of in-bore transperineal 3-Tesla (T) magnetic resonance (MR) imaging-guided prostate biopsies for predicting final Gleason grades in patients who subsequently underwent radical prostatectomy (RP). METHODS A retrospective review of men who underwent transperineal MR imaging-guided prostate biopsy (tpMRGB) with subsequent radical prostatectomy within 1 year was conducted from 2010 to 2015. All patients underwent a baseline 3-T multiparametric MRI (mpMRI) with endorectal coil and were selected for biopsy based on MR findings of a suspicious prostate lesion and high degree of clinical suspicion for cancer. Spearman correlation was performed to assess concordance between tpMRGB and final RP pathology among patients with and without previous transrectal ultrasound (TRUS)-guided biopsies. RESULTS A total of 24 men met all eligibility requirements, with a median age of 65 years (interquartile range [IQR] 11.7). The median time from biopsy to RP was 85 days (IQR 50.5). Final pathology revealed Gleason 3 + 4 = 7 in 12 patients, 4 + 3 = 7 in 10 patients, and 4 + 4 = 8 in 2 patients. A strong correlation (ρ: +0.75, p < 0.001) between tpMRGB and RP results was observed, with Gleason scores concordant in 17 cases (71%). 16 of the 24 patients underwent prior TRUS biopsies. Subsequent tpMRGB revealed Gleason upgrading in 88% of cases, which was concordant with RP Gleason scores in 69% of cases (ρ: +0.75, p < 0.001). CONCLUSION Final Gleason scores diagnosed by tpMRGB at 3-T correlate strongly with final RP surgical pathology. This may facilitate prostate cancer diagnosis, particularly in patients with negative or low-grade TRUS biopsy results in whom clinically significant cancer is suspected or detected on mpMRI.
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Affiliation(s)
- Clare Tempany
- Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- FA Jolesz Chair of Radiology Research Brigham & Women's Hospital, Boston, MA 02115, USA
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Martin PR, Cool DW, Romagnoli C, Fenster A, Ward AD. Magnetic resonance imaging-targeted, 3D transrectal ultrasound-guided fusion biopsy for prostate cancer: Quantifying the impact of needle delivery error on diagnosis. Med Phys 2015; 41:073504. [PMID: 24989418 DOI: 10.1118/1.4883838] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Magnetic resonance imaging (MRI)-targeted, 3D transrectal ultrasound (TRUS)-guided "fusion" prostate biopsy intends to reduce the ∼23% false negative rate of clinical two-dimensional TRUS-guided sextant biopsy. Although it has been reported to double the positive yield, MRI-targeted biopsies continue to yield false negatives. Therefore, the authors propose to investigate how biopsy system needle delivery error affects the probability of sampling each tumor, by accounting for uncertainties due to guidance system error, image registration error, and irregular tumor shapes. METHODS T2-weighted, dynamic contrast-enhanced T1-weighted, and diffusion-weighted prostate MRI and 3D TRUS images were obtained from 49 patients. A radiologist and radiology resident contoured 81 suspicious regions, yielding 3D tumor surfaces that were registered to the 3D TRUS images using an iterative closest point prostate surface-based method to yield 3D binary images of the suspicious regions in the TRUS context. The probabilityP of obtaining a sample of tumor tissue in one biopsy core was calculated by integrating a 3D Gaussian distribution over each suspicious region domain. Next, the authors performed an exhaustive search to determine the maximum root mean squared error (RMSE, in mm) of a biopsy system that gives P ≥ 95% for each tumor sample, and then repeated this procedure for equal-volume spheres corresponding to each tumor sample. Finally, the authors investigated the effect of probe-axis-direction error on measured tumor burden by studying the relationship between the error and estimated percentage of core involvement. RESULTS Given a 3.5 mm RMSE for contemporary fusion biopsy systems,P ≥ 95% for 21 out of 81 tumors. The authors determined that for a biopsy system with 3.5 mm RMSE, one cannot expect to sample tumors of approximately 1 cm(3) or smaller with 95% probability with only one biopsy core. The predicted maximum RMSE giving P ≥ 95% for each tumor was consistently greater when using spherical tumor shapes as opposed to no shape assumption. However, an assumption of spherical tumor shape for RMSE = 3.5 mm led to a mean overestimation of tumor sampling probabilities of 3%, implying that assuming spherical tumor shape may be reasonable for many prostate tumors. The authors also determined that a biopsy system would need to have a RMS needle delivery error of no more than 1.6 mm in order to sample 95% of tumors with one core. The authors' experiments also indicated that the effect of axial-direction error on the measured tumor burden was mitigated by the 18 mm core length at 3.5 mm RMSE. CONCLUSIONS For biopsy systems with RMSE ≥ 3.5 mm, more than one biopsy core must be taken from the majority of tumors to achieveP ≥ 95%. These observations support the authors' perspective that some tumors of clinically significant sizes may require more than one biopsy attempt in order to be sampled during the first biopsy session. This motivates the authors' ongoing development of an approach to optimize biopsy plans with the aim of achieving a desired probability of obtaining a sample from each tumor, while minimizing the number of biopsies. Optimized planning of within-tumor targets for MRI-3D TRUS fusion biopsy could support earlier diagnosis of prostate cancer while it remains localized to the gland and curable.
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Affiliation(s)
- Peter R Martin
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Derek W Cool
- Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada and Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Cesare Romagnoli
- Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada; Department of Medical Imaging, The University of Western Ontario, London, Ontario N6A 3K7, Canada; and Robarts Research Institute, The University of Western Ontario, London, Ontario N6A 3K7, Canada
| | - Aaron D Ward
- Department of Medical Biophysics, The University of Western Ontario, London, Ontario N6A 3K7, Canada and Department of Oncology, The University of Western Ontario, London, Ontario N6A 3K7, Canada
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Abstract
Nearly all prostate biopsies are performed via the transrectal ultrasound (TRUS)-guided technique which suffers from its inability to accurately visualize and target suspicious lesions. Advances in prostate MR imaging now allow for the detection of suspicious regions of the prostate gland, opening the door for lesion-directed biopsy techniques. The ability to obtain a definitive histologic grade has become increasingly important due to the rise of active surveillance as a popular method to approach low-grade cancer. Biopsies obtained with MR guidance or MR imaging/transrectal ultrasound fusion can accurately identify and characterize cancers and thus appropriately stratify patients for specific therapies.
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Marami B, Sirouspour S, Ghoul S, Cepek J, Davidson SRH, Capson DW, Trachtenberg J, Fenster A. Elastic registration of prostate MR images based on estimation of deformation states. Med Image Anal 2015; 21:87-103. [PMID: 25624044 DOI: 10.1016/j.media.2014.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 12/15/2014] [Accepted: 12/19/2014] [Indexed: 10/24/2022]
Abstract
Magnetic resonance imaging (MRI) is being used increasingly for image-guided targeted biopsy and focal therapy of prostate cancer. In this paper, a combined rigid and deformable registration technique is proposed to register pre-treatment diagnostic 3T magnetic resonance (MR) images of the prostate, with the identified target tumor(s), to intra-treatment 1.5T MR images. The pre-treatment T2-weighted MR images were acquired with patients in a supine position using an endorectal coil in a 3T scanner, while the intra-treatment T2-weighted MR images were acquired in a 1.5T scanner before insertion of the needle with patients in the semi-lithotomy position. Both the rigid and deformable registration algorithms employ an intensity-based distance metric defined based on the modality independent neighborhood descriptors (MIND) between images. The optimization routine for estimating the rigid transformation parameters is initialized using four pairs of manually selected approximate corresponding points on the boundaries of the prostate. In this paper, the problem of deformable image registration is approached from the perspective of state estimation for dynamical systems. The registration algorithm employs a rather generic dynamic linear elastic model of the tissue deformation discretized by the finite element method (FEM). We use the model in a classical state estimation framework to estimate the deformation of the prostate based on the distance metric between pre- and intra-treatment images. Our deformable registration results using 17 sets of prostate MR images showed that the proposed method yielded a target registration error (TRE) of 1.87 ± 0.94 mm,2.03 ± 0.94 mm, and 1.70 ± 0.93 mm for the whole gland (WG), central gland (CG), and peripheral zone (PZ), respectively, using 76 manually-identified fiducial points. This was an improvement over the 2.67 ± 1.31 mm, 2.95 ± 1.43 mm, and 2.34 ± 1.11 mm, respectively for the WG, CG, and PZ after rigid registration alone. Dice similarity coefficients (DSC) in the WG, CG and PZ were 88.2 ± 5.3, 85.6 ± 7.6 and 68.7 ± 6.9 percent, respectively. Furthermore, the mean absolute distances (MAD) between surfaces was 1.26 ± 0.56 mm and 1.27 ± 0.55 mm in the WG and CG, after deformable registration. These results indicate that the proposed registration technique has sufficient accuracy for localizing prostate tumors in MRI-guided targeted biopsy or focal therapy of clinically localized prostate cancer.
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Affiliation(s)
- Bahram Marami
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, Canada.
| | - Shahin Sirouspour
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada.
| | - Suha Ghoul
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Department of Medical Imaging, London Health Sciences Center, London, Ontario, Canada.
| | - Jeremy Cepek
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, Canada.
| | - Sean R H Davidson
- Ontario Cancer Institute, University Health Network, Toronto, Ontario, Canada.
| | - David W Capson
- Department of Electrical and Computer Engineering, University of Victoria, Victoria, British Columbia, Canada.
| | - John Trachtenberg
- Department of Surgical Oncology, University Health Network, Toronto, Ontario, Canada.
| | - Aaron Fenster
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada; Biomedical Engineering Graduate Program, The University of Western Ontario, London, Ontario, Canada; Department of Medical Biophysics, The University of Western Ontario, London, Ontario, Canada.
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Hyodoh H, Shimizu J, Mizuo K, Okazaki S, Watanabe S, Inoue H. CT-guided percutaneous needle placement in forensic medicine. Leg Med (Tokyo) 2014; 17:79-81. [PMID: 25454535 DOI: 10.1016/j.legalmed.2014.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 12/01/2022]
Abstract
We have developed a technique of CT-guided needle placement in the destructed human body in forensic practice. A sixty-year-old male was found in a burned car and he was also destructed severely. Although blood was needed for the external examination, it was difficult to approach the vessels because of the severely burned condition of the cadaver. Thus, we attempted to obtain a blood sample from a vessel using a CT-guided technique. Postmortem CT demonstrated the presence of blood-containing vessels in the pelvis. Indeed, CT-guided needle placement had no difficulty with surface markers, table location, or depth measurement from the surface. CT-guide needle placement is a feasible and reliable technique, so that when the tissue/blood sample is at risk of being spoiled, CT-guided needle placement could be a substitute for conventional sampling techniques.
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Affiliation(s)
- Hideki Hyodoh
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan.
| | - Jyunya Shimizu
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan
| | - Keisuke Mizuo
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan
| | - Shunichiro Okazaki
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan
| | - Satoshi Watanabe
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan
| | - Hiromasa Inoue
- Department of Legal Medicine, Sapporo Medical University, School of Medicine, Japan
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Penzkofer T, Tuncali K, Fedorov A, Song SE, Tokuda J, Fennessy FM, Vangel MG, Kibel AS, Mulkern RV, Wells WM, Hata N, Tempany CMC. Transperineal in-bore 3-T MR imaging-guided prostate biopsy: a prospective clinical observational study. Radiology 2014; 274:170-80. [PMID: 25222067 DOI: 10.1148/radiol.14140221] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To determine the detection rate, clinical relevance, Gleason grade, and location of prostate cancer ( PCa prostate cancer ) diagnosed with and the safety of an in-bore transperineal 3-T magnetic resonance (MR) imaging-guided prostate biopsy in a clinically heterogeneous patient population. MATERIALS AND METHODS This prospective retrospectively analyzed study was HIPAA compliant and institutional review board approved, and informed consent was obtained. Eighty-seven men (mean age, 66.2 years ± 6.9) underwent multiparametric endorectal prostate MR imaging at 3 T and transperineal MR imaging-guided biopsy. Three subgroups of patients with at least one lesion suspicious for cancer were included: men with no prior PCa prostate cancer diagnosis, men with PCa prostate cancer who were undergoing active surveillance, and men with treated PCa prostate cancer and suspected recurrence. Exclusion criteria were prior prostatectomy and/or contraindication to 3-T MR imaging. The transperineal MR imaging-guided biopsy was performed in a 70-cm wide-bore 3-T device. Overall patient biopsy outcomes, cancer detection rates, Gleason grade, and location for each subgroup were evaluated and statistically compared by using χ(2) and one-way analysis of variance followed by Tukey honestly significant difference post hoc comparisons. RESULTS Ninety biopsy procedures were performed with no serious adverse events, with a mean of 3.7 targets sampled per gland. Cancer was detected in 51 (56.7%) men: 48.1% (25 of 52) with no prior PCa prostate cancer , 61.5% (eight of 13) under active surveillance, and 72.0% (18 of 25) in whom recurrence was suspected. Gleason pattern 4 or higher was diagnosed in 78.1% (25 of 32) in the no prior PCa prostate cancer and active surveillance groups. Gleason scores were not assigned in the suspected recurrence group. MR targets located in the anterior prostate had the highest cancer yield (40 of 64, 62.5%) compared with those for the other parts of the prostate (P < .001). CONCLUSION In-bore 3-T transperineal MR imaging-guided biopsy, with a mean of 3.7 targets per gland, allowed detection of many clinically relevant cancers, many of which were located anteriorly.
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Affiliation(s)
- Tobias Penzkofer
- From the Division of MRI in the Department of Radiology (T.P., K.T., A.F., S.S., J.T., F.M.F., R.V.M., W.M.W., N.H., C.M.C.T.) and the Division of Urology (A.S.K.), Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115; Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen, Germany (T.P.). Department of Radiology, Massachusetts General Hospital, Boston, Mass (M.G.V.); Department of Radiology, Dana-Farber Cancer Institute, Boston, Mass (F.M.F.); and Department of Radiology, Children's Hospital, Boston, Mass (R.V.M.)
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Tempany CMC, Jayender J, Kapur T, Bueno R, Golby A, Agar N, Jolesz FA. Multimodal imaging for improved diagnosis and treatment of cancers. Cancer 2014; 121:817-27. [PMID: 25204551 DOI: 10.1002/cncr.29012] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 12/17/2022]
Abstract
The authors review methods for image-guided diagnosis and therapy that increase precision in the detection, characterization, and localization of many forms of cancer to achieve optimal target definition and complete resection or ablation. A new model of translational, clinical, image-guided therapy research is presented, and the Advanced Multimodality Image-Guided Operating (AMIGO) suite is described. AMIGO was conceived and designed to allow for the full integration of imaging in cancer diagnosis and treatment. Examples are drawn from over 500 procedures performed on brain, neck, spine, thorax (breast, lung), and pelvis (prostate and gynecologic) areas and are used to describe how they address some of the many challenges of treating brain, prostate, and lung tumors. Cancer 2015;121:817-827. © 2014 American Cancer Society.
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Affiliation(s)
- Clare M C Tempany
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Xu H, Lasso A, Fedorov A, Tuncali K, Tempany C, Fichtinger G. Multi-slice-to-volume registration for MRI-guided transperineal prostate biopsy. Int J Comput Assist Radiol Surg 2014; 10:563-72. [PMID: 25193145 DOI: 10.1007/s11548-014-1108-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 08/10/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Prostate needle biopsy is a commonly performed procedure since it is the most definitive form of cancer diagnosis. Magnetic resonance imaging (MRI) allows target-specific biopsies to be performed. However, needle placements are often inaccurate due to intra-operative prostate motion and the lack of motion compensation techniques. This paper detects and determines the extent of tissue displacement during an MRI-guided biopsy so that the needle insertion plan can be adjusted accordingly. METHODS A multi-slice-to-volume registration algorithm was developed to align the pre-operative planning image volume with three intra-operative orthogonal image slices of the prostate acquired immediately before needle insertion. The algorithm consists of an initial rigid transformation followed by a deformable step. RESULTS A total of 14 image sets from 10 patients were studied. Based on prostate contour alignment, the registrations were accurate to within 2 mm. CONCLUSION This algorithm can be used to increase the needle targeting accuracy by alerting the clinician if the biopsy target has moved significantly prior to needle insertion. The proposed method demonstrated feasibility of intra-operative target localization and motion compensation for MRI-guided prostate biopsy.
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Affiliation(s)
- Helen Xu
- School of Computing, Queen's University, Kingston, Canada,
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Bodelle B, Naguib NN, Schulz B, Eichler K, Müller C, Hansmann ML, Hammerstingl R, Hübner F, Vogl TJ, Zangos S. 1.5-T magnetic resonance-guided transgluteal biopsies of the prostate in patients with clinically suspected prostate cancer: technique and feasibility. Invest Radiol 2013; 48:458-63. [PMID: 23385402 DOI: 10.1097/RLI.0b013e31827c394b] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the feasibility and safety of magnetic resonance-guided prostate biopsy (MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic lesions. MATERIALS AND METHODS This study was approved by the ethical committee. A total of 25 men with clinically suspected prostate cancer with increased prostate-specific antigen levels and at least 1 previous negative transrectal ultrasound-guided prostatic biopsy (TRUSBx) underwent diagnostic magnetic resonance (MR) imaging of the prostate. Cancer suspicious regions (CSR) were identified, and MRGBx with a transgluteal approach in a large closed-bore 1.5-T MR system was manually performed in coaxial technique, using transversal fat-suppressed T2-weighted true fast imaging with steady-state free precession sequences. Success rate, biopsy findings, side effects, procedure time, number of acquisitions for the repositioning of the needle guide, and length of the biopsy channel were documented. Follow-up was performed 24 months after the procedure. RESULTS In diagnostic MR imaging of the prostate, a total of 40 CSRs were detected in 25 patients. All MRGBx procedures were technically successful and all CSRs were biopsied. The mean number of core biopsies per CSR was 3.3 ± 1.5 (range, 1-7). Histopathological analysis revealed adenocarcinoma in 35% (14/40), acute or chronic prostatitis in 30% (12/40), adenofibromyomatous changes in 22.5% (9/40), and no identifiable pathology in 17.5% (7/40) of CSRs, with a pathological overlap for chronic prostatitis and adenofibromyomatous changes in 1 patient with biopsies in 2 CSRs. No missed prostate cancer after MR-guided biopsy in clinical follow-up was detected. Mean procedure time was 31 ± 7 minutes (range, 21-46 minutes). Side effects were hematuria (n = 7), hematospermia (n = 3), combined hematuria/hematospermia (n = 2), and infection (n=1). CONCLUSION Magnetic resonance-guided prostate biopsy of the prostate gland with a transgluteal approach is feasible, safe, and a promising technique for histological clarification of cancer suspicious lesions in patients with increased prostate-specific antigen levels after negative TRUSBx. Magnetic resonance-guided prostate biopsy offers a reasonable alternative to repeated TRUSBx for histological clarification of prostate cancer.
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Penzkofer T, Tempany-Afdhal CM. Prostate cancer detection and diagnosis: the role of MR and its comparison with other diagnostic modalities--a radiologist's perspective. NMR Biomed 2014; 27:3-15. [PMID: 24000133 PMCID: PMC3851933 DOI: 10.1002/nbm.3002] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Revised: 06/16/2013] [Accepted: 06/18/2013] [Indexed: 05/07/2023]
Abstract
It is now universally recognized that many prostate cancers are over-diagnosed and over-treated. The European Randomized Study of Screening for Prostate Cancer from 2009 evidenced that, to save one man from death from prostate cancer, over 1400 men need to be screened, and 48 need to undergo treatment. The detection of prostate cancer is traditionally based on digital rectal examination (DRE) and the measurement of serum prostate-specific antigen (PSA), followed by ultrasound-guided biopsy. The primary role of imaging for the detection and diagnosis of prostate cancer has been transrectal ultrasound (TRUS) guidance during biopsy. Traditionally, MRI has been used primarily for the staging of disease in men with biopsy-proven cancer. It has a well-established role in the detection of T3 disease, planning of radiation therapy, especially three-dimensional conformal or intensity-modulated external beam radiation therapy, and planning and guiding of interstitial seed implant or brachytherapy. New advances have now established that prostate MRI can accurately characterize focal lesions within the gland, an ability that has led to new opportunities for improved cancer detection and guidance for biopsy. Two new approaches to prostate biopsy are under investigation. Both use pre-biopsy MRI to define potential targets for sampling, and the biopsy is performed either with direct real-time MR guidance (in-bore) or MR fusion/registration with TRUS images (out-of-bore). In-bore and out-of-bore MRI-guided prostate biopsies have the advantage of using the MR target definition for the accurate localization and sampling of targets or suspicious lesions. The out-of-bore method uses combined MRI/TRUS with fusion software that provides target localization and increases the sampling accuracy of TRUS-guided biopsies by integrating prostate MRI information with TRUS. Newer parameters for each imaging modality, such as sonoelastography or shear wave elastography, contrast-enhanced ultrasound and MRI elastography, show promise to further enrich datasets.
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Affiliation(s)
- Tobias Penzkofer
- Division of MRI and Surgical Planning Laboratory, Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA; Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen, Germany
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Seifabadi R, Cho NBJ, Song SE, Tokuda J, Hata N, Tempany CM, Fichtinger G, Iordachita I. Accuracy study of a robotic system for MRI-guided prostate needle placement. Int J Med Robot 2013; 9:305-16. [PMID: 22678990 PMCID: PMC3772968 DOI: 10.1002/rcs.1440] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Accurate needle placement is the first concern in percutaneous MRI-guided prostate interventions. In this phantom study, different sources contributing to the overall needle placement error of a MRI-guided robot for prostate biopsy have been identified, quantified and minimized to the possible extent. METHODS The overall needle placement error of the system was evaluated in a prostate phantom. This error was broken into two parts: the error associated with the robotic system (called 'before-insertion error') and the error associated with needle-tissue interaction (called 'due-to-insertion error'). Before-insertion error was measured directly in a soft phantom and different sources contributing into this part were identified and quantified. A calibration methodology was developed to minimize the 4-DOF manipulator's error. The due-to-insertion error was indirectly approximated by comparing the overall error and the before-insertion error. The effect of sterilization on the manipulator's accuracy and repeatability was also studied. RESULTS The average overall system error in the phantom study was 2.5 mm (STD = 1.1 mm). The average robotic system error in the Super Soft plastic phantom was 1.3 mm (STD = 0.7 mm). Assuming orthogonal error components, the needle-tissue interaction error was found to be approximately 2.13 mm, thus making a larger contribution to the overall error. The average susceptibility artifact shift was 0.2 mm. The manipulator's targeting accuracy was 0.71 mm (STD = 0.21 mm) after robot calibration. The robot's repeatability was 0.13 mm. Sterilization had no noticeable influence on the robot's accuracy and repeatability. CONCLUSIONS The experimental methodology presented in this paper may help researchers to identify, quantify and minimize different sources contributing into the overall needle placement error of an MRI-guided robotic system for prostate needle placement. In the robotic system analysed here, the overall error of the studied system remained within the acceptable range.
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Affiliation(s)
- Reza Seifabadi
- Laboratory for Percutaneous Surgery (Perk Lab), Queen's University, Kingston, ON, Canada
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Eslami S, Fischer GS, Song SE, Tokuda J, Hata N, Tempany CM, Iordachita I. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design. IEEE Int Conf Robot Autom 2013; 20132:1228-1233. [PMID: 24683502 DOI: 10.1109/icra.2013.6630728] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications.
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Affiliation(s)
- Sohrab Eslami
- Laboratory for Computational Sensing and Robotics (LCSR) at the Johns Hopkins University, Baltimore, MD, USA
| | - Gregory S Fischer
- Automation and Interventional Medicine (AIM) Laboratory in the Department of Mechanical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Sang-Eun Song
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Junichi Tokuda
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nobuhiko Hata
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Clare M Tempany
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Iulian Iordachita
- Laboratory for Computational Sensing and Robotics (LCSR) at the Johns Hopkins University, Baltimore, MD, USA
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Sainani NI, Arellano RS, Shyn PB, Gervais DA, Mueller PR, Silverman SG. The challenging image-guided abdominal mass biopsy: established and emerging techniques ‘if you can see it, you can biopsy it’. ACTA ACUST UNITED AC 2013; 38:672-96. [DOI: 10.1007/s00261-013-9980-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Song SE, Tokuda J, Tuncali K, Tempany CM, Zhang E, Hata N. Development and preliminary evaluation of a motorized needle guide template for MRI-guided targeted prostate biopsy. IEEE Trans Biomed Eng 2013; 60:3019-27. [PMID: 23335658 DOI: 10.1109/tbme.2013.2240301] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To overcome the problems of limited needle insertion accuracy and human error in the use of a conventional needle guide template in magnetic resonance imaging (MRI)-guided prostate intervention, we developed a motorized MRI-compatible needle guide template that resembles a transrectal ultrasound-guided prostate template. The motorized template allows automated, gapless needle guidance in a 3T MRI scanner with minimal changes in the current clinical procedure. To evaluate the impact of the motorized template on MRI, signal-to-noise ratio and distortion were measured under various system configurations. A maximum of 44% signal-to-noise ratio decrease was found when the ultrasonic motors were running, and a maximum of 0.4% image distortion was observed due to the presence of the motorized template. To measure needle insertion accuracy, we performed four sets of five random target needle insertions mimicking four biopsy procedures, which resulted in an average in-plane targeting error of 0.94 mm with a standard deviation of 0.34 mm. The evaluation studies indicated that the presence and operation of the motorized template in the MRI bore create insignificant image degradation, and provide submillimeter targeting accuracy. The automated needle guide that is directly controlled by navigation software eliminates human error so that the safety of the procedure can be improved.
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Schwab SA, Kuefner MA, Adamietz B, Engelhard K, Keck B, Kunath F, Wach S, Wullich B, Uder M, Engehausen DG. MRI-guided core biopsy of the prostate in the supine position--introduction of a simplified technique using large-bore magnet systems. Eur Radiol 2012. [PMID: 23179522 DOI: 10.1007/s00330-012-2698-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To introduce a simplified technique for MRI-guided core biopsies (MRGB) of the prostate in the supine position using large-bore magnet systems. METHODS Fifty men with a history of negative transrectal ultrasound-guided biopsies underwent MRGB in either a 1.5-T (13/50) or 3.0-T (37/50) wide-bore MRI unit. MRGBs were conducted with the patients in a supine position using a dedicated MR-compatible biopsy device. RESULTS We developed a dedicated positioning device for the supine position. Using this device, the biopsies were performed successfully in all patients. Apart from minor rectal bleeding, only one patient developed a major side effect (urosepsis). Histology revealed prostate cancer in 25/50 (50 %) patients. CONCLUSIONS The new technique appears feasible. Its major advantage is the more comfortable and patient-friendly supine position during the biopsy without the need to modify the MRI system's patient table. KEY POINTS • A novel positioning device for MRI-guided prostate biopsies has been developed. • Biopsies can be performed in the patient-friendly supine position. • The positioning device can be utilised without modifying the MRI's patient table.
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Affiliation(s)
- Siegfried A Schwab
- Department of Radiology, University Hospital Erlangen-Nuremberg, Maximiliansplatz 1, 91054 Erlangen, Germany.
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Fedorov A, Tuncali K, Fennessy FM, Tokuda J, Hata N, Wells WM, Kikinis R, Tempany CM. Image registration for targeted MRI-guided transperineal prostate biopsy. J Magn Reson Imaging 2012; 36:987-92. [PMID: 22645031 PMCID: PMC3434292 DOI: 10.1002/jmri.23688] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Accepted: 03/28/2012] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To develop and evaluate image registration methodology for automated re-identification of tumor-suspicious foci from preprocedural MR exams during MR-guided transperineal prostate core biopsy. MATERIALS AND METHODS A hierarchical approach for automated registration between planning and intra-procedural T2-weighted prostate MRI was developed and evaluated on the images acquired during 10 consecutive MR-guided biopsies. Registration accuracy was quantified at image-based landmarks and by evaluating spatial overlap for the manually segmented prostate and sub-structures. Registration reliability was evaluated by simulating initial mis-registration and analyzing the convergence behavior. Registration precision was characterized at the planned biopsy targets. RESULTS The total computation time was compatible with a clinical setting, being at most 2 min. Deformable registration led to a significant improvement in spatial overlap of the prostate and peripheral zone contours compared with both rigid and affine registration. Average in-slice landmark registration error was 1.3 ± 0.5 mm. Experiments simulating initial mis-registration resulted in an estimated average capture range of 6 mm and an average in-slice registration precision of ±0.3 mm. CONCLUSION Our registration approach requires minimum user interaction and is compatible with the time constraints of our interventional clinical workflow. The initial evaluation shows acceptable accuracy, reliability and consistency of the method.
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Affiliation(s)
- Andriy Fedorov
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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28
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Abstract
Transrectal ultrasonography (US)-guided biopsy is the standard approach for histopathologic diagnosis of prostate cancer. However, this technique has multiple limitations owing to the operator's inability in most cases to directly visualize and target prostate lesions. Magnetic resonance (MR) imaging of the prostate overcomes many of these limitations by directly depicting areas of abnormality and allowing targeted biopsies. Accuracy in the detection of prostate cancer is improved by the combined use of standard T2-weighted MR imaging and advanced MR imaging techniques such as diffusion-weighted imaging, dynamic contrast-enhanced imaging, and MR spectroscopy. Suspicious-appearing regions of the prostate seen on MR images can be targeted at real-time transrectal US-guided biopsy to improve the diagnostic yield. MR imaging also can be performed for real-time guidance of transrectal prostate biopsy. Studies among patients who underwent at least one transrectal US-guided biopsy with a negative result before undergoing an MR imaging-guided biopsy showed improved detection rates with MR imaging-guided biopsy in comparison with the detection rates achieved with a repeat transrectal US-guided biopsy; however, MR imaging-guided biopsy is a more time-consuming procedure. A technique known as fused MR imaging- and transrectal US-guided biopsy, which relies on the coregistration of previously acquired MR images with real-time transrectal US images acquired during the procedure, shows promise but is limited by deformation of the prostate; this limitation is the subject of ongoing investigation. Another technique that is currently under investigation, MR imaging-guided prostate biopsy with robotic assistance, may one day help improve the accuracy of biopsy needle placement.
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Affiliation(s)
- Joseph H Yacoub
- Department of Radiology, University of Chicago, 5841 S Maryland Ave, MC 2026, Chicago, IL 60637, USA
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Tokuda J, Tuncali K, Iordachita I, Song SE, Fedorov A, Oguro S, Lasso A, Fennessy FM, Tempany CM, Hata N. In-bore setup and software for 3T MRI-guided transperineal prostate biopsy. Phys Med Biol 2012; 57:5823-40. [PMID: 22951350 DOI: 10.1088/0031-9155/57/18/5823] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
MRI-guided prostate biopsy in conventional closed-bore scanners requires transferring the patient outside the bore during needle insertion due to the constrained in-bore space, causing a safety hazard and limiting image feedback. To address this issue, we present our custom-made in-bore setup and software to support MRI-guided transperineal prostate biopsy in a wide-bore 3 T MRI scanner. The setup consists of a specially designed tabletop and a needle-guiding template with a Z-frame that gives a physician access to the perineum of the patient at the imaging position and allows the physician to perform MRI-guided transperineal biopsy without moving the patient out of the scanner. The software and Z-frame allow registration of the template, target planning and biopsy guidance. Initially, we performed phantom experiments to assess the accuracy of template registration and needle placement in a controlled environment. Subsequently, we embarked on our clinical trial (N = 10). The phantom experiments showed that the translational errors of the template registration along the right-left (RP) and anterior-posterior (AP) axes were 1.1 ± 0.8 and 1.4 ± 1.1 mm, respectively, while the rotational errors around the RL, AP and superior-inferior axes were (0.8 ± 1.0)°, (1.7 ± 1.6)° and (0.0 ± 0.0)°, respectively. The 2D root-mean-square (RMS) needle-placement error was 3 mm. The clinical biopsy procedures were safely carried out in all ten clinical cases with a needle-placement error of 5.4 mm (2D RMS). In conclusion, transperineal prostate biopsy in a wide-bore 3T scanner is feasible using our custom-made tabletop setup and software, which supports manual needle placement without moving the patient out of the magnet.
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Affiliation(s)
- Junichi Tokuda
- Department of Radiology, Brigham and Womens Hospital and Harvard Medical School, Boston, MA, USA.
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Abstract
PURPOSE OF REVIEW The ability to accurately localize and target prostate cancer, whether for staging or future interventions, is an important concept in prostate cancer management. In this review, we describe the emerging technologies that allow for enhanced visualization and precise targeting of the prostate cancer. RECENT FINDINGS Uses of prostate-specific antigen and conventional prostate biopsy with image-blinded random systematic techniques have led to overdiagnosis of insignificant cancer and underdiagnosis of significant cancer. Active surveillance and focal therapy have become hot topics in prostate cancer management as the incidence of low-risk prostate cancer rises. For either management, it is essential to localize, characterize, and target the clinically important cancer in the prostate. Emerging techniques in ultrasound as well as MRI modalities allow for enhancement of tumor visualization, and characterization. Digital mapping technique of biopsy trajectory is an emerging technique that allows for three-dimensional mapping of biopsy-proven cancer lesions as well as potential future delivery of focal therapy. Molecular or cancer-specific targeting is promising for specific imaging and therapeutic approach at the cell level. SUMMARY Emerging technologies improve clinically relevant prostate cancer identification using digitalized multiparametric anatomical and functional imaging and enhance the ability to precisely target the known-cancer.
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31
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Baumann M, Mozer P, Daanen V, Troccaz J. Prostate biopsy tracking with deformation estimation. Med Image Anal 2012; 16:562-76. [DOI: 10.1016/j.media.2011.01.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 01/24/2011] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
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Tadayyon H, Lasso A, Kaushal A, Guion P, Fichtinger G. Target Motion Tracking in MRI-guided Transrectal Robotic Prostate Biopsy. IEEE Trans Biomed Eng 2011; 58:3135-42. [DOI: 10.1109/tbme.2011.2163633] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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33
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Schernthaner M, Helbich TH, Fueger BJ, Margreiter M, Memarsadeghi M, Stiglbauer A, Linhart HG, Doan A, Pinker K, Brader P. [Magnetic resonance tomography-guided interventional procedure for diagnosis of prostate cancer]. Radiologe 2011; 51:962-8. [PMID: 22012569 DOI: 10.1007/s00117-011-2180-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy.
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Abstract
Over the past 30 years, continuous progress in the application of nuclear magnetic resonance (NMR) spectroscopy and magnetic resonance spectroscopic imaging (MRSI) to the detection, diagnosis and characterization of human prostate cancer has turned what began as scientific curiosity into a useful clinical option. In vivo MRSI technology has been integrated into the daily care of prostate cancer patients, and innovations in ex vivo methods have helped to establish NMR-based prostate cancer metabolomics. Metabolomic and multimodality imaging could be the future of the prostate cancer clinic--particularly given the rationale that more accurate interrogation of a disease as complex as human prostate cancer is most likely to be achieved through paradigms involving multiple, instead of single and isolated, parameters. The research and clinical results achieved through in vivo MRSI and ex vivo NMR investigations during the first 11 years of the 21st century illustrate areas where these technologies can be best translated into clinical practice.
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Affiliation(s)
- Elita M DeFeo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Zangos S, Melzer A, Eichler K, Sadighi C, Thalhammer A, Bodelle B, Wolf R, Gruber-Rouh T, Proschek D, Hammerstingl R, Müller C, Mack MG, Vogl TJ. MR-compatible assistance system for biopsy in a high-field-strength system: initial results in patients with suspicious prostate lesions. Radiology 2011; 259:903-10. [PMID: 21364080 DOI: 10.1148/radiol.11101559] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system. MATERIALS AND METHODS The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented. RESULTS The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed. CONCLUSION Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.
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Affiliation(s)
- Stephan Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
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Dominguez-Escrig JL, McCracken SR, Greene D. Beyond diagnosis: evolving prostate biopsy in the era of focal therapy. Prostate Cancer 2011; 2011:386207. [PMID: 22110983 DOI: 10.1155/2011/386207] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Accepted: 10/14/2010] [Indexed: 11/23/2022] Open
Abstract
Despite decades of use as the “gold standard” in the detection of prostate cancer, the optimal biopsy regimen is still not universally agreed upon. While important aspects such as the need for laterally placed biopsies and the importance of apical cancer are known, repeated studies have shown significant patients with cancer on subsequent biopsy when the original biopsy was negative and an ongoing suspicion of cancer remained. Attempts to maximise the effectiveness of repeat biopsies have given rise to the alternate approaches of saturation biopsy and the transperineal approach. Recent interest in focal treatment of prostate cancer has further highlighted the need for accurate detection of prostate cancer, and in response, the introduction of transperineal template-guided biopsy. While the saturation biopsy approach and the transperineal template approach increase the detection rate of cancer in men with a previous negative biopsy and appear to have acceptable morbidity, there is a lack of clinical trials evaluating the different biopsy strategies. This paper reviews the evolution of prostatic biopsy and current controversies.
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Mitterberger MJ, Aigner F, Horninger W, Ulmer H, Cavuto S, Halpern EJ, Frauscher F. Comparative efficiency of contrast-enhanced colour Doppler ultrasound targeted versus systematic biopsy for prostate cancer detection. Eur Radiol 2010; 20:2791-6. [DOI: 10.1007/s00330-010-1860-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 05/07/2010] [Accepted: 05/31/2010] [Indexed: 11/25/2022]
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Fennessy FM, Tuncali K, Morrison PR, Tempany CM. MR imaging-guided interventions in the genitourinary tract: an evolving concept. Magn Reson Imaging Clin N Am 2010; 18:11-28. [PMID: 19962090 DOI: 10.1016/j.mric.2009.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Harvard Medical School/Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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39
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Tokuda J, Fischer GS, DiMaio SP, Gobbi DG, Csoma C, Mewes PW, Fichtinger G, Tempany CM, Hata N. Integrated navigation and control software system for MRI-guided robotic prostate interventions. Comput Med Imaging Graph 2010; 34:3-8. [PMID: 19699057 DOI: 10.1016/j.compmedimag.2009.07.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 07/17/2009] [Indexed: 11/24/2022]
Abstract
A software system to provide intuitive navigation for MRI-guided robotic transperineal prostate therapy is presented. In the system, the robot control unit, the MRI scanner, and the open-source navigation software are connected together via Ethernet to exchange commands, coordinates, and images using an open network communication protocol, OpenIGTLink. The system has six states called "workphases" that provide the necessary synchronization of all components during each stage of the clinical workflow, and the user interface guides the operator linearly through these workphases. On top of this framework, the software provides the following features for needle guidance: interactive target planning; 3D image visualization with current needle position; treatment monitoring through real-time MR images of needle trajectories in the prostate. These features are supported by calibration of robot and image coordinates by fiducial-based registration. Performance tests show that the registration error of the system was 2.6mm within the prostate volume. Registered real-time 2D images were displayed 1.97 s after the image location is specified.
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40
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Abstract
This paper introduces some of the authors' recent attempts to enhance image-guided treatment in intraoperative magnetic resonance imaging (MRI). These include the deformable registration of preoperative images obtained by 1.5 Tesla MRI to the intraoperative images, and a needle-holding robotic system that is MR-compatible and optimized to work with intraoperative MRI. The role of deformable registration is to enhance intraoperative planning and simulation, and the robotic system is to systematically link the result of such planning and simulation to active surgical assistance. The former was retrospectively examined in prostate cancer biopsy cases and statistically suggested that deformable registration significantly improved the quality of registration. The latter, which is planned to be applied to prostate brachytherapy, was found to have good MR compatibility and its maneuvering had no adverse effect on the imaging and <I>vice versa</I>.
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41
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Abstract
Magnetic resonance imaging (MRI) provides more detailed anatomical images of the prostate compared with the transrectal ultrasound imaging. Therefore, for the purpose of intervention in the prostate gland, diagnostic or therapeutic, MRI guidance offers a possibility of more precise targeting that may be crucial to the success of prostate interventions. However, access within the scanner is limited for manual instrument handling and the MR environment is most demanding among all imaging equipment with respect to the instrumentation used. A solution to this problem is the use of MR-compatible robots purposely designed to operate in the space and environmental restrictions inside the MR scanner allowing real-time interventions. Building an MRI-compatible robot is a very challenging engineering task because, in addition to the material restrictions that MRI instruments have, the robot requires actuators and sensors that limit the type of energies that can be used. Several important design problems have to be overcome before a successful MR-compatible robot application can be built. A number of MR-compatible robots, ranging from a simple manipulator to a fully automated system, have been developed, proposing ingenious solutions to the design challenge. Several systems have been already tested clinically for prostate biopsy and brachytherapy. As technology matures, precise image guidance for prostate interventions performed or assisted by specialized MR-compatible robotic devices may provide a uniquely accurate solution for guiding the intervention directly based on MR findings and feedback. Such an instrument would become a valuable clinical tool for biopsies directly targeting imaged tumor foci and delivering tumor-centered focal therapy.
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Affiliation(s)
- Katarzyna J Macura
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Brady Urological Institute, School of Medicine, Johns Hopkins University, Baltimore, MD 21287-0750, USA.
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Pondman KM, Fütterer JJ, ten Haken B, Schultze Kool LJ, Witjes JA, Hambrock T, Macura KJ, Barentsz JO. MR-Guided Biopsy of the Prostate: An Overview of Techniques and a Systematic Review. Eur Urol 2008; 54:517-27. [PMID: 18571309 DOI: 10.1016/j.eururo.2008.06.001] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 06/03/2008] [Indexed: 10/22/2022]
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43
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Sciarra A. Editorial comment on: MR-guided biopsy of the prostate: an overview of techniques and a systematic review. Eur Urol 2008; 54:526-7. [PMID: 18571308 DOI: 10.1016/j.eururo.2008.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
In this article the current issues of diagnosis and detection of prostate cancer are reviewed. The limitations for current techniques are highlighted and some possible solutions with MR imaging and MR-guided biopsy approaches are reviewed. There are several different biopsy approaches under investigation. These include transperineal open magnet approaches to closed-bore 1.5T transrectal biopsies. The imaging, image processing, and tracking methods are also discussed. In the arena of therapy, MR guidance has been used in conjunction with radiation methods, either brachytherapy or external delivery. The principles of the radiation treatment, the toxicities, and use of images are outlined. The future role of imaging and image-guided interventions lie with providing a noninvasive surrogate for cancer surveillance or monitoring treatment response. The shift to minimally invasive focal therapies has already begun and will be very exciting when MR-guided focused ultrasound surgery reaches its full potential.
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Affiliation(s)
- Clare Tempany
- Department of Radiology, Brigham & Women's Hospital, Boston, MA 02115, USA.
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45
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Abstract
The paper reports an important achievement in MRI instrumentation, a pneumatic, fully actuated robot located within the scanner alongside the patient and operating under remote control based on the images. Previous MRI robots commonly used piezoelectric actuation limiting their compatibility. Pneumatics is an ideal choice for MRI compatibility because it is decoupled from electromagnetism, but pneumatic actuators were hardly controllable. This achievement was possible due to a recent technology breakthrough, the invention of a new type of pneumatic motor, PneuStep 1, designed for the robot reported here with uncompromised MRI compatibility, high-precision, and medical safety. MrBot is one of the "MRI stealth" robots today (the second is described in this issue by Zangos et al.). Both of these systems are also multi-imager compatible, being able to operate with the imager of choice or cross-imaging modalities. For MRI compatibility the robot is exclusively constructed of nonmagnetic and dielectric materials such as plastics, ceramics, crystals, rubbers and is electricity free. Light-based encoding is used for feedback, so that all electric components are distally located outside the imager's room. MRI robots are modern, digital medical instruments in line with advanced imaging equipment and methods. These allow for accessing patients within closed bore scanners and performing interventions under direct (in scanner) imaging feedback. MRI robots could allow e.g. to biopsy small lesions imaged with cutting edge cancer imaging methods, or precisely deploy localized therapy at cancer foci. Our robot is the first to show the feasibility of fully automated in-scanner interventions. It is customized for the prostate and operates transperineally for needle interventions. It can accommodate various needle drivers for different percutaneous procedures such as biopsy, thermal ablations, or brachytherapy. The first needle driver is customized for fully automated low-dose radiation seed brachytherapy. This paper gives an introduction to the challenges of MRI robot compatibility and presents the solutions adopted in making the MrBot. Its multi-imager compatibility and other preclinical tests are included. The robot shows the technical feasibility of MRI-guided prostate interventions, yet its clinical utility is still to be determined.
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Affiliation(s)
- Dan Stoianovici
- Urology Robotics, Johns Hopkins Medicine, Baltimore, MD 21224, USA.
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46
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Abstract
In recent years MR imaging has played an increasingly important role in the diagnosis and treatment of prostate cancer. MR imaging of the prostate allows a clear delineation of the anatomic structures and prostate tumors when performing interventions such as biopsies, brachytherapy or thermal therapy of the prostate gland. MRI robotic assistance will improve the accuracy of the interventions. Due to the advantages of MR imaging MR-guided prostate interventions will play an increasing role in future.
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Affiliation(s)
- S Zangos
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Frankfurt/Main, Germany.
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47
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de Oliveira A, Rauschenberg J, Beyersdorff D, Semmler W, Bock M. Automatic passive tracking of an endorectal prostate biopsy device using phase-only cross-correlation. Magn Reson Med 2008; 59:1043-50. [DOI: 10.1002/mrm.21430] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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48
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Abstract
MR imaging-guided interventions are well established in routine patient care in many parts of the world. There are many approaches, depending on magnet design and clinical need, based on MR imaging providing excellent inherent tissue contrast without ionizing radiation risk for patients. MR imaging-guided minimally invasive therapeutic procedures have advantages over conventional surgical procedures. In the genitourinary tract, MR imaging guidance has a role in tumor detection, localization, and staging and can provide accurate image guidance for minimally invasive procedures. The advent of molecular and metabolic imaging and use of higher strength magnets likely will improve diagnostic accuracy and allow targeted therapy to maximize disease control and minimize side effects.
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Affiliation(s)
- Fiona M Fennessy
- Department of Radiology, Harvard Medical School/Brigham and Women's Hospital, Boston, MA 02115, USA.
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49
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Kawamoto S, Pannu HK, Bluemke DA, Fishman EK. Genitourinary Imaging. Oncology. [DOI: 10.1007/0-387-31056-8_31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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50
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Blumenfeld P, Hata N, DiMaio S, Zou K, Haker S, Fichtinger G, Tempany CMC. Transperineal prostate biopsy under magnetic resonance image guidance: a needle placement accuracy study. J Magn Reson Imaging 2007; 26:688-94. [PMID: 17729363 DOI: 10.1002/jmri.21067] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To quantify needle placement accuracy of magnetic resonance image (MRI)-guided core needle biopsy of the prostate. MATERIALS AND METHODS A total of 10 biopsies were performed with 18-gauge (G) core biopsy needle via a percutaneous transperineal approach. Needle placement error was assessed by comparing the coordinates of preplanned targets with the needle tip measured from the intraprocedural coherent gradient echo images. The source of these errors was subsequently investigated by measuring displacement caused by needle deflection and needle susceptibility artifact shift in controlled phantom studies. Needle placement error due to misalignment of the needle template guide was also evaluated. RESULTS The mean and standard deviation (SD) of errors in targeted biopsies was 6.5 +/- 3.5 mm. Phantom experiments showed significant placement error due to needle deflection with a needle with an asymmetrically beveled tip (3.2-8.7 mm depending on tissue type) but significantly smaller error with a symmetrical bevel (0.6-1.1 mm). Needle susceptibility artifacts observed a shift of 1.6 +/- 0.4 mm from the true needle axis. Misalignment of the needle template guide contributed an error of 1.5 +/- 0.3 mm. CONCLUSION Needle placement error was clinically significant in MRI-guided biopsy for diagnosis of prostate cancer. Needle placement error due to needle deflection was the most significant cause of error, especially for needles with an asymmetrical bevel.
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Affiliation(s)
- Philip Blumenfeld
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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