PurposeProstate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images.Materials and MethodsA ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies.ResultsThe addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy.ConclusionReal-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies. PurposeProstate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images. Prostate biopsy is performed blindly without focal imaging guidance other than ultrasound to aim the needle towards the peripheral zone or a specific sextant region of the prostate organ. This conventional technique is both blind and random, and does not use MRI imaging information that might localize tumors. A multimodality fusion navigation system for prostate biopsy allows for real-time mapping and referencing to pre-procedural MRI images. Materials and MethodsA ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies. A ultrasound + MRI fusion platform for prostate biopsy guidance was custom fabricated and demonstrated in phantoms, animals, and 360 patients. Patients underwent multiparametric prostate MRI, and identified lesions were assigned a suspicion for cancer as low, moderate or high. Patients underwent standard 12 sextant US biopsies, followed by fusion guided US biopsy of targets defined by pre-procedural MRI. Tissue was correlated with imaging features by mapping the biopsy location to the image. Standard blind sextant biopsies were analyzed with and without the addition of targeted fusion biopsies. ResultsThe addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy. The addition of fusion targeted prostate biopsy to conventional random biopsy in patients with focal targets on MRI yielded marked increase in cancer detection rates. Targeted prostate biopsies added clinical value to standard blind prostate biopsies in the setting of previous negative biopsy and anterior or central gland lesions visible on MRI, that might not otherwise be sampled by conventional ultrasound guided biopsy. Imaging suspicion levels correlated with Gleason scores. Prior biopsy location was used to map subsequent biopsy location in the setting of patients with low Gleason scores undergoing surveillance biopsy. ConclusionReal-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies. Real-time multimodality feedback with fusion guidance for prostate biopsy using prior MRI images is feasible and does not require the presence of the MRI itself. Cancer detection rates are markedly improved with the addition of targeted fusion biopsy to conventional blind random biopsies.

From the Urologic Oncology Branch (PAP, PHC, ARR, AAB, CJB, CC, GB, WML) and Molecular Imaging Program (BT, PLC), Center for Cancer Research, and Center for Interventional Oncology, Department of Radiology and Imaging Sciences (JKL, SPG, CB, BJW), Clinical Center & National Cancer Institute, National Institutes of Health, Bethesda, and Biometric Research Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute, National Institutes of Health, Rockville, Maryland, Philips Healthcare, Toronto, Canada (NDG), and Philips Research North America, Briarcliff Manor, New York (JK, SX, PY, SK, JHS)

During transrectal ultrasound (TRUS)-guided prostate biopsies, the actual location of the biopsy site is rarely documented. Here, we demonstrate the capability of TRUS-magnetic resonance imaging (MRI) image fusion to document the biopsy site and correlate biopsy results with multi-parametric MRI findings. Fifty consecutive patients (median age 61 years) with a median prostate-specific antigen (PSA) level of 5.8 ng/ml underwent 12-core TRUS-guided biopsy of the prostate. Pre-procedural T2-weighted magnetic resonance images were fused to TRUS. A disposable needle guide with miniature tracking sensors was attached to the TRUS probe to enable fusion with MRI. Real-time TRUS images during biopsy and the corresponding tracking information were recorded. Each biopsy site was superimposed onto the MRI. Each biopsy site was classified as positive or negative for cancer based on the results of each MRI sequence. Sensitivity, specificity, and receiver operating curve (ROC) area under the curve (AUC) values were calculated for multi-parametric MRI. Gleason scores for each multi-parametric MRI pattern were also evaluated. Six hundred and 5 systemic biopsy cores were analyzed in 50 patients, of whom 20 patients had 56 positive cores. MRI identified 34 of 56 positive cores. Overall, sensitivity, specificity, and ROC area values for multi-parametric MRI were 0.607, 0.727, 0.667, respectively. TRUS-MRI fusion after biopsy can be used to document the location of each biopsy site, which can then be correlated with MRI findings. Based on correlation with tracked biopsies, T2-weighted MRI and apparent diffusion coefficient maps derived from diffusion-weighted MRI are the most sensitive sequences, whereas the addition of delayed contrast enhancement MRI and three-dimensional magnetic resonance spectroscopy demonstrated higher specificity consistent with results obtained using radical prostatectomy specimens.

PURPOSE:A phase I dose escalation study was performed with systemically delivered lyso-thermosensitive liposomal doxorubicin (LTLD). The primary objectives were to determine the safe maximum tolerated dose (MTD), pharmacokinetic properties, and dose-limiting toxicity (DLT) of LTLD during this combination therapy.MATERIALS AND METHODS:Subjects eligible for percutaneous or surgical radiofrequency (RF) ablation with primary (n = 9) or metastatic (n = 15) tumors of the liver, with four or fewer lesions as large as 7 cm in diameter, were included. RF ablation was initiated 15 minutes after starting a 30-minute intravenous LTLD infusion. Dose levels between 20 mg/m(2) and 60 mg/m(2) were evaluated. Magnetic resonance imaging, positron emission tomography, and computed tomography were performed at predetermined intervals before and after treatment until evidence of recurrence was seen, administration of additional antitumor treatment was performed, or a total of 3 years had elapsed.RESULTS:DLT criteria were met at 60 mg/m(2), and the MTD was defined as 50 mg/m(2). RF ablation was performed during the peak of the plasma concentration-time curve in an effort to yield maximal drug deposition. LTLD produced reversible, dose-dependent neutropenia and leukopenia.CONCLUSIONS:LTLD can be safely administered systemically at the MTD (50 mg/m(2)) in combination with RF ablation, with limited and manageable toxicity. Further evaluation of this agent combined with RF ablation is warranted to determine its role in the management of liver tumors.

Purpose: We determined whether there is a correlation between D'Amico risk stratification and the degree of suspicion of prostate cancer on multiparametric magnetic resonance imaging based on targeted biopsies done with our electromagnetically tracked magnetic resonance imaging/ultrasound fusion platform.Materials and Methods: A total of 101 patients underwent 3 Tesla multiparametric magnetic resonance imaging of the prostate, consisting of T2, dynamic contrast enhanced, diffusion weighted and spectroscopy images in cases suspicious for or with a diagnosis of prostate cancer. All prostate magnetic resonance imaging lesions were then identified and graded by the number of positive modalities, including low-2 or fewer, moderate-3 and high-4 showing suspicion on multiparametric magnetic resonance imaging. The biopsy protocol included standard 12-core biopsy, followed by real-time magnetic resonance imaging/ultrasound fusion targeted biopsies of the suspicious magnetic resonance lesions. Cases and lesions were stratified by the D'Amico risk stratification.Results: In this screening population 90.1% of men had a negative digital rectal examination. Mean +/- SD age was 62.7 +/- 8.3 years and median prostate specific antigen was 5.8 ng/ml. Of the cases 54.5% were positive for cancer on protocol biopsy. Chi-square analysis revealed a statistically significant correlation between magnetic resonance suspicion and D'Amico risk stratification (p <0.0001). Within cluster resampling demonstrated a statistically significant correlation between magnetic resonance suspicion and D'Amico risk stratification for magnetic resonance targeted core biopsies and magnetic resonance lesions (p <0.01)Conclusions: Our data support the notion that using multiparametric magnetic resonance prostate imaging one may assess the degree of risk associated with magnetic resonance visible lesions in the prostate.

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Currently, systematic prostate biopsies are obtained with minimal information about their actual location. This study demonstrates that a electromagnetically tracked ultrasound probe can be used to guide biopsies into specific areas of the prostate. By registering the ultrasound to an MRI scan of the prostate, obtained prior to biopsy, it is possible to accurately map the location of biopsies. Thus, if a patient requires a repeat biopsy, or there is a question about whether a specific area of the prostate was sampled, this system can be used to more accurately guide biopsies in the future. OBJECTIVE To develop a system that documents the location of transrectal ultrasonography (TRUS)‐guided prostate biopsies by fusing them to MRI scans obtained prior to biopsy, as the actual location of prostate biopsies is rarely known. PATIENTS AND METHODS Fifty patients (median age 61) with a median prostate‐specific antigen (PSA) of 5.8 ng/ml underwent 3T endorectal coil MRI prior to biopsy. 3D TRUS images were obtained just prior to standard TRUS‐guided 12‐core sextant biopsies wherein an electromagnetic positioning device was attached to the needle guide and TRUS probe in order to track the position of each needle pass. The 3D‐TRUS image documenting the location of each biopsy was fused electronically to the T2‐weighted MRI. Each biopsy needle track was marked on the TRUS images and these were then transposed onto the MRI. Each biopsy site was classified pathologically as positive or negative for cancer and the Gleason score was determined. RESULTS The location of all ( n = 605) needle biopsy tracks was successfully documented on the T2‐weighted (T2W) MRI. Among 50 patients, 20 had 56 positive cores. At the sites of biopsy, T2W signal was considered ‘positive’ for cancer (i.e. low in signal intensity) in 34 of 56 sites. CONCLUSION It is feasible to document the location of TRUS‐guided prostate biopsies on pre‐procedure MRI by fusing the pre‐procedure TRUS to an endorectal coil MRI using electromagnetic needle tracking. This procedure may be useful in documenting the location of prior biopsies, improving quality control and thereby avoiding under‐sampling of the prostate as well as directing subsequent biopsies to regions of the prostate not previously sampled.

PURPOSE To investigate whether apparent diffusion coefficients (ADCs) derived from diffusion-weighted (DW) magnetic resonance (MR) imaging at 3 T correlate with the clinical risk of prostate cancer in patients with tumors that are visible on MR images, with MR imaging/transrectal ultrasonography (US) fusion-guided biopsy as a reference. MATERIALS AND METHODS Forty-eight consecutive patients (median age, 60 years; median serum prostate-specific antigen value, 6.3 ng/mL) who underwent DW imaging during 3-T MR imaging with an endorectal coil were included in this retrospective institutional review board-approved study, and informed consent was obtained from each patient. Patients underwent targeted MR imaging/transrectal US fusion-guided prostate biopsy. Mean ADCs of cancerous target tumors were correlated with Gleason and D'Amico clinical risk scores. The true risk group rate and predictive value of the mean ADC for classifying a tumor by its D'Amico clinical risk score was determined by using linear discriminant and receiver operating characteristic analyses. RESULTS A significant negative correlation was found between mean ADCs of tumors in the peripheral zone and their Gleason scores (P = .003; Spearman ρ = -0.60) and D'Amico clinical risk scores (P < .0001; Spearman ρ = -0.69). ADC was found to distinguish tumors in the peripheral zone with intermediate to high clinical risk from those with low clinical risk with a correct classification rate of 0.73. CONCLUSION There is a significant negative correlation between ADCs and Gleason and D'Amico clinical risk scores. ADCs may therefore be useful in predicting the aggressiveness of prostate cancer. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10100667/-/DC1.

Purpose: To show utility, accuracy, and clinical outcomes of electromagnetic tracking and multimodality image fusion for guidance of biopsy and radiofreguency (R:F) ablation procedures.Materials and Methods: A combination of conventional image guidance (ultrasound[US]/computed tomography [CT]) and a research navigation system was used in 40 patients undergoing biopsy or RF ablation to assist in target localization and needle and electrode placement. The navigation system displays electromagnetically tracked needles and US images relative to a preprocedural CT scan. Additional images (prior positron emission tomography [PET] or magnetic resonance [MR] imaging) can be fused with CT as needed. Needle aiming with and without tracking were compared, the utility of navigation for each procedure was assessed, the system's off-target tracking error for two different registration methods was evaluated, and setup time was recorded.Results: The tracking error could be evaluated in 35 of 40 patients. A basic tracking error of 3.8 mm +/- 2.3 was shown using skin fiducial markers for registration. The error improved to 2.7 mm +/- 1.6 when using prior internal needle positions as additional fiducial markers. Real-time fusion of US with CT and registration with prior PET and MR imaging were successful and provided clinically relevant guidance information, enabling 19 of the 40 procedures.Conclusions: The spatial accuracy of the navigation system is sufficient to display clinically relevant image guidance information during biopsy and RF ablation. Breath holding and respiratory gating are effective in minimizing the error associated with tissue motion. In 48% of cases, the navigation system provided information crucial for successful execution of the procedure. Fusion of real-time US with CT or prior diagnostic images may enable procedures that are not feasible with standard, single-modality image guidance.

PURPOSE:A novel platform was developed that fuses pre-biopsy magnetic resonance imaging with real-time transrectal ultrasound imaging to identify and biopsy lesions suspicious for prostate cancer. The cancer detection rates for the first 101 patients are reported.MATERIALS AND METHODS:This prospective, single institution study was approved by the institutional review board. Patients underwent 3.0 T multiparametric magnetic resonance imaging with endorectal coil, which included T2-weighted, spectroscopic, dynamic contrast enhanced and diffusion weighted magnetic resonance imaging sequences. Lesions suspicious for cancer were graded according to the number of sequences suspicious for cancer as low (2 or less), moderate (3) and high (4) suspicion. Patients underwent standard 12-core transrectal ultrasound biopsy and magnetic resonance imaging/ultrasound fusion guided biopsy with electromagnetic tracking of magnetic resonance imaging lesions. Chi-square and within cluster resampling analyses were used to correlate suspicion on magnetic resonance imaging and the incidence of cancer detected on biopsy.RESULTS:Mean patient age was 63 years old. Median prostate specific antigen at biopsy was 5.8 ng/ml and 90.1% of patients had a negative digital rectal examination. Of patients with low, moderate and high suspicion on magnetic resonance imaging 27.9%, 66.7% and 89.5% were diagnosed with cancer, respectively (p <0.0001). Magnetic resonance imaging/ultrasound fusion guided biopsy detected more cancer per core than standard 12-core transrectal ultrasound biopsy for all levels of suspicion on magnetic resonance imaging.CONCLUSIONS:Prostate cancer localized on magnetic resonance imaging may be targeted using this novel magnetic resonance imaging/ultrasound fusion guided biopsy platform. Further research is needed to determine the role of this platform in cancer detection, active surveillance and focal therapy, and to determine which patients may benefit.

You have accessJournal of UrologyProstate Cancer: Detection and Screening1 Apr 2011846 MRI/US FUSION PROSTATE BIOPSIES: CANCER DETECTION RATES Ardeshir Rastinehad, Jochen Kruecker, Compton Benjamin, Paul Chung, Baris Turkbey, Sheng Xu, Julia Locklin, Stacey Gates, Carey Buckner, Marston Linehan, Gennady Bratslavsky, Neil Glossop, Peter Choyke, Bradford Wood, and Peter Pinto Ardeshir RastinehadArdeshir Rastinehad Bethesda, MD More articles by this author , Jochen KrueckerJochen Kruecker Bethesda, MD More articles by this author , Compton BenjaminCompton Benjamin Bethesda, MD More articles by this author , Paul ChungPaul Chung Bethesda, MD More articles by this author , Baris TurkbeyBaris Turkbey Bethesda, MD More articles by this author , Sheng XuSheng Xu Bethesda, MD More articles by this author , Julia LocklinJulia Locklin Bethesda, MD More articles by this author , Stacey GatesStacey Gates Bethesda, MD More articles by this author , Carey BucknerCarey Buckner Bethesda, MD More articles by this author , Marston LinehanMarston Linehan Bethesda, MD More articles by this author , Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author , Neil GlossopNeil Glossop Bethesda, MD More articles by this author , Peter ChoykePeter Choyke Bethesda, MD More articles by this author , Bradford WoodBradford Wood Bethesda, MD More articles by this author , and Peter PintoPeter Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.667AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The fusion platform combines the benefits of MRI and real time TRUS imaging to perform image guided biopsies. We report the cancer detection rates for the system. METHODS Two radiologists reviewed multiparametric MRI in patients with suspicion or diagnosis of prostate cancer (CaP), 193 patient encounters were evaluated. The MRI of the prostate included T2, DCE, DWI, and spectroscopy images. All lesions were identified and graded by number of sequences positive: low (<2), moderate (3) and high (4) suspicion. An EM generator was placed above the pelvis which allows for real-time tracking of a biopsy guide with an embedded EM tracking sensor (Philips Healthcare, Canada). A manual 2D prostate sweep was reconstructed in 3D, registered and fused to the prostate MR images and assigned targets for biopsy. The ‘protocol' biopsy included a standard 12 core biopsy followed by a MRI/US fusion biopsy of the suspicious MR targeted lesions. RESULTS The mean age was 61.5 + 8.1 years with a median PSA 5.8 ng/ml, and 15/193 (7.7%) patients had a positive DRE. A chi-squared analysis revealed a direct correlation with the degree of MR suspicion and incidence of CaP detected per patient and per MR target lesion (p<0.01) (Table 1). A comparison between the 22 patients only positive on the 12 core biopsy and the 20 patients only positive on the MR/US biopsy revealed that the 12 core biopsy failed to diagnose 9 patients with Gleason 6, 7 patients with Gleason 7, and 4 patients with Gleason >8. The fusion biopsy system missed no patients with Gleason > 8 (p=0.005). (Chart 1) MRI Suspicion NO CANCER DETECTED CANCER DETECTED LOW Patient 63.9% 46/72 36.1% 26/72 Lesion 85% 255/300 15.0% 45/300 MODERATE Patient 41.6% 32/77 58.4% 45/77 Lesion 65.1% 114/175 34.5% 60/174 HIGH Patient 15.9% 7/44 84.1% 37/44 Lesion 33.8% 23/68 67.6% 46/68 CONCLUSIONS The fusion platform can stratify patients in to 3 groups which have a statistically different incidence of CaP. 84.1% of patients with a high suspicion lesion(s) were found to have CaP on the ‘protocol' biopsy. Secondly, when the platform fails to detect cancer compared to the 12 core biopsy, the cancer missed was statistically lower risk. This platform will help improve the quantification of a patient's CaP and possibly improve the selection of patients for focal therapy, active surveillance and/or whole gland therapy. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e340 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ardeshir Rastinehad Bethesda, MD More articles by this author Jochen Kruecker Bethesda, MD More articles by this author Compton Benjamin Bethesda, MD More articles by this author Paul Chung Bethesda, MD More articles by this author Baris Turkbey Bethesda, MD More articles by this author Sheng Xu Bethesda, MD More articles by this author Julia Locklin Bethesda, MD More articles by this author Stacey Gates Bethesda, MD More articles by this author Carey Buckner Bethesda, MD More articles by this author Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Neil Glossop Bethesda, MD More articles by this author Peter Choyke Bethesda, MD More articles by this author Bradford Wood Bethesda, MD More articles by this author Peter Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

This case illustrates the ability of electromagnetic tracking navigation to localize difficult targets in real time during biopsy or ablation of lesions that are only transiently apparent on arterial phase computed tomography and may be unapparent on sonography. Readily available technology enabling multimodality registration to sonography allows for the use of positron emission tomographic, magnetic resonance imaging, and computed tomographic information during sonographically guided procedures and examinations.

Adrenal tumors comprise a broad spectrum of benign and malignant neoplasms and include functional adrenal adenomas, pheochromocytomas, primary adrenocortical carcinoma, and adrenal metastases. Percutaneous ablative approaches that have been described and used in the treatment of adrenal tumors include percutaneous radiofrequency ablation, cryoablation, microwave ablation, and chemical ablation. Local tumor ablation in the adrenal gland presents unique challenges, secondary to the adrenal gland's unique anatomic and physiological features. The results of clinical series employing percutaneous ablative techniques in the treatment of adrenal tumors are reviewed in this article. Clinical and technical considerations unique to ablation in the adrenal gland are presented, including approaches commonly used in our practices, and risks and potential complications are discussed.

Comparing conventional 12-core biopsy with targeted prostate biopsy enabled by realtime fusion of pre-acquired MRI with live transrectal ultrasound (TRUS) outside the MRI suite T2-weighted, dynamic contrast enhanced, diffusion weighted and spectroscopy MRI of the prostate were obtained in 101 patients. Two radiologists assigned a consensus suspicion level (low, moderate, high) to each lesion suspicious for prostate cancer (PCa). In each patient, the highest lesion suspicion level was used to define the patient suspicion level. Lesion locations were identified on T2 images and transferred to a system using electromagnetic tracking for realtime TRUS/MRI fusion guidance of biopsy outside the MRI suite. Both sextant biopsy and TRUS/MRI fusion-targeted biopsy with 2 cores per lesion were performed in all patients. The number of positive biopsies and Gleason scores were compared and correlated with MRI suspicion levels. 12.1% (151/1245) of sextant biopsy cores and 22.0% (128/583) of targeted cores were positive for PCa. In lesions labeled low, moderate, and high suspicion for PCa, the positive biopsy core rate was 8.0%, 26.4% and 55.5%, respectively. In patients labeled low, moderate, and high suspicion, positive sextant core rates were 6.4%, 10.0% and 23.7%, and positive targeted core rates were 6.6%, 20.4%, and 43.2%, respectively. Per-patient positive biopsy rates were 23.8%, 51.5% and 76.9% for sextant biopsy and 19.0%, 51.5% and 80.8% for targeted biopsy. Mean Gleason scores in targeted low, moderate and high suspicion lesions were 6.3 +- 0.7, 6.8 +- 0.6 and 7.9 +- 1.0. TRUS/MRI fusion guidance enables targeted biopsy of MRI-identified lesions outside the MRI suite. Positive targeted biopsy core rates increase with MRI suspicion level of the targeted lesion. For moderate and high suspicion patients, positive targeted core rates are significantly higher than sextant core rates. Gleason scores obtained in targeted lesions increase significantly with increasing MRI suspicion level, suggesting that TRUS/MRI fusion guidance may be particularly useful to detect aggressive cancer in patients with moderate or high suspicion MRI findings.

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 20102100 CANCER DETECTION RATES ON MR / ULTRASOUND (US) FUSED IMAGE GUIDED PROSTATE BIOPSIES DIRECTLY CORRELATES WITH MULTI-PARAMETRIC MRI Paul H. Chung, Ardeshir R. Rastinehad, Angelo A. Baccala, Jochen Kruecker, Sheng Xu, Julia K. Locklin, Baris I. Turkbey, Joanna H. Shih, Heinric Williams, Gennady Bratslavsky, Neil D. Glossop, Peter L. Choyke, Bradford J. Wood, and Peter A. Pinto Paul H. ChungPaul H. Chung Bethesda, MD More articles by this author , Ardeshir R. RastinehadArdeshir R. Rastinehad Bethesda, MD More articles by this author , Angelo A. BaccalaAngelo A. Baccala Bethesda, MD More articles by this author , Jochen KrueckerJochen Kruecker Briarcliff Manor, NY More articles by this author , Sheng XuSheng Xu Briarcliff Manor, NY More articles by this author , Julia K. LocklinJulia K. Locklin Bethesda, MD More articles by this author , Baris I. TurkbeyBaris I. Turkbey Bethesda, MD More articles by this author , Joanna H. ShihJoanna H. Shih Bethesda, MD More articles by this author , Heinric WilliamsHeinric Williams Bethesda, MD More articles by this author , Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author , Neil D. GlossopNeil D. Glossop Toronto, ON More articles by this author , Peter L. ChoykePeter L. Choyke Bethesda, MD More articles by this author , Bradford J. WoodBradford J. Wood Bethesda, MD More articles by this author , and Peter A. PintoPeter A. Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2174AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The current standard for diagnosing prostate cancer is based on random biopsies utilizing gray scale ultrasound. Our novel platform combines the benefits combining MR imaging and MR/US fusion to perform directed biopsies with image guidance. We report our first 101 patients. METHODS A single radiologist (P.C.) reviewed multi-parametric MR images from patients with suspicion or diagnosis of prostate cancer, 101 patients entered our research protocol. The ecMRI of the prostate obtained T2, dynamic contrast enhanced (DCE), diffusion weighted images (DWI), and proton spectroscopy images. All lesions were then identified and graded by number of modalities positive: low (<2), mod (3) and high (4) suspicion. An electromagnetic field (EM) generator (Northern Digital Inc., Waterloo, Canada) was placed above the pelvis which allows for real-time tracking of a custom made biopsy probe with an embedded miniature electromagnetic tracking sensor (Traxtal Inc., A Philips Healthcare Company, Toronto, Canada) incorporated into the needle guide (Civco Inc, Kalona IA, USA). A 2D prostate sweep is performed manually to render a 3D ultrasound image that is then registered and fused to the pre-operative prostate MR images and assigned targets for biopsy. The protocol included a standard 12 core biopsy combined with MRI/US fusion biopsy of the suspicious MR targeted lesions utilizing EM tracking. RESULTS The mean age was 62.7 + 8.3 years with a median PSA 5.8, and 90.1% (91/101) were cT1c. The chi-squared analysis comparing degree of MR suspicion and incidence of cancer detected per patient, and per lesion was performed (p<0.05), (Table 1). There was a direct correlation between degree of suspicion and the yield of biopsied lesions, 14.1% (22/156), 35.2% (25/71), 72.2% (26/36) for low, moderate, and high suspicion respectively (Table 1). CONCLUSIONS Utilizing our novel platform to screen and diagnose patients with prostate cancer may be crucial in the emerging field of focal therapy and active surveillance. Using multi-parametric MR images of patients, we were able to quantitatively assess risk of detecting prostate cancer using our biopsy protocol. In the high suspicion group determined by MR, 17/19 (89.5 %) patients were found to have cancer. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e816-e817 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Paul H. Chung Bethesda, MD More articles by this author Ardeshir R. Rastinehad Bethesda, MD More articles by this author Angelo A. Baccala Bethesda, MD More articles by this author Jochen Kruecker Briarcliff Manor, NY More articles by this author Sheng Xu Briarcliff Manor, NY More articles by this author Julia K. Locklin Bethesda, MD More articles by this author Baris I. Turkbey Bethesda, MD More articles by this author Joanna H. Shih Bethesda, MD More articles by this author Heinric Williams Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Neil D. Glossop Toronto, ON More articles by this author Peter L. Choyke Bethesda, MD More articles by this author Bradford J. Wood Bethesda, MD More articles by this author Peter A. Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MRI is currently the most promising imaging modality for prostate cancer diagnosis due to its high resolution and multi-parametric nature. However, currently there is no standard for integration of diagnostic information from different MRI sequences. We propose a method to increase the diagnostic accuracy of MRI by correlating biopsy specimens with four MRI sequences including T2 weighted MRI, Diffusion Weight Imaging, Dynamic Contrast Enhanced MRI and MRI spectroscopy. This method uses device tracking and image fusion to determine the specimen's position on MRI images. The proposed method is unbiased and cost effective. It does not substantially interfere with the standard biopsy workflow, allowing it to be easily accepted by physicians. A study of 41 patients was carried out to validate the approach. The performance of all four MRI sequences in various combinations is reported. Guidelines are given for multi-parametric imaging and tracked biopsy of prostate cancer.

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2010303 INCREASED YIELD OF CANCER DETECTION WITH EMRI/US GUIDED FUSED BIOPSY IN PATIENTS WITH PREVIOUS NEGATIVE BIOPSY Angelo A. Baccala, Ardeshir R. Rastinehad, Paul H. Chung, Jochen Kruecker, Sheng Xu, Julia K. Locklin, Stacey P. Gates, Joanna H. Shih, Neil D. Glossop, W. Marston Linehan, Gennady Bratslavsky, Baris I. Turkbey, Peter L. Choyke, Bradford J. Wood, and Peter A. Pinto Angelo A. BaccalaAngelo A. Baccala Bethesda, MD More articles by this author , Ardeshir R. RastinehadArdeshir R. Rastinehad Washington, DC More articles by this author , Paul H. ChungPaul H. Chung Bethesda, MD More articles by this author , Jochen KrueckerJochen Kruecker Briarcliff Manor, NY More articles by this author , Sheng XuSheng Xu Briarcliff Manor, NY More articles by this author , Julia K. LocklinJulia K. Locklin Bethesda, MD More articles by this author , Stacey P. GatesStacey P. Gates Frederick, MD More articles by this author , Joanna H. ShihJoanna H. Shih Bethesda, MD More articles by this author , Neil D. GlossopNeil D. Glossop Toronto, ON More articles by this author , W. Marston LinehanW. Marston Linehan Bethesda, MD More articles by this author , Gennady BratslavskyGennady Bratslavsky Bethesda, MD More articles by this author , Baris I. TurkbeyBaris I. Turkbey Bethesda, MD More articles by this author , Peter L. ChoykePeter L. Choyke Bethesda, MD More articles by this author , Bradford J. WoodBradford J. Wood Bethesda, MD More articles by this author , and Peter A. PintoPeter A. Pinto Bethesda, MD More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.366AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Repeat prostate biopsy in patients that had a previously negative biopsy has yielded cancer in as low as 13% of men. Saturation biopsy has increased the yield as a repeat biopsy technique to 34%. The technology associated with Endorectal Coil Multi-Parametric Magnetic Resonance Imaging (eMRI) on a 3 Tesla magnet yields a high signal to noise ratio imaging modality that may be used to localize prostate cancer and guide directed biopsies accordingly. We use a novel platform that registers and fuses real-time trans-rectal ultrasound images with previously obtained MR images. We review our database to determine the yield of our eMRI guided fused biopsy protocol to detect prostate cancer in patients that had a previous negative standard biopsy. METHODS A T3 eMRI is performed pre-operatively. T2 weighted, dynamic contrast enhanced, diffusion weighted, and spectroscopy images were obtained and interpreted. Prostate lesions suspicious for cancer were scored. A traditional 12 core TRUS prostate biopsy is then performed. Prostate US images were then fused to the eMRI images. Biopsies of eMRI targeted lesions were performed using a custom probe with spatial tracking of the biopsy needle by an electromagnetic field (Traxtal Technologies Inc,Canada and Phillips Corporation, Netherlands). We reviewed our database of 101 patients that had an eMRI biopsy and determined those that had a previous standard biopsy. 65 patients met these criteria. They were then evaluated as to outcomes on their eMRI guided fused biopsy and its correlation with previous standard biopsy results. RESULTS Of the 65 patients in our study that had a previous biopsy, 29 were negative and 36 were positive. Of those that were previously negative, 13/29 (48%) were diagnosed with prostate cancer by our methods. CONCLUSIONS eMRI guided sono fused biopsies increase the yield of prostate cancer detection in patients with a previously negative biopsy. This increased yield of 48% vs 34% in repeat saturation biopsy patients represents patients that either may not have been detected or that have had a delay in prostate cancer detection using traditional biopsy criteria and methods. Table 1. Prior Bx PATIENT WITH CANCER N0 Yes Total Negative 16 13 29 Positive 12 24 36 Total 28 37 65 © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e120-e121 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Angelo A. Baccala Bethesda, MD More articles by this author Ardeshir R. Rastinehad Washington, DC More articles by this author Paul H. Chung Bethesda, MD More articles by this author Jochen Kruecker Briarcliff Manor, NY More articles by this author Sheng Xu Briarcliff Manor, NY More articles by this author Julia K. Locklin Bethesda, MD More articles by this author Stacey P. Gates Frederick, MD More articles by this author Joanna H. Shih Bethesda, MD More articles by this author Neil D. Glossop Toronto, ON More articles by this author W. Marston Linehan Bethesda, MD More articles by this author Gennady Bratslavsky Bethesda, MD More articles by this author Baris I. Turkbey Bethesda, MD More articles by this author Peter L. Choyke Bethesda, MD More articles by this author Bradford J. Wood Bethesda, MD More articles by this author Peter A. Pinto Bethesda, MD More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Navigation systems, devices, and intraprocedural software are changing the way interventional oncology is practiced. Before the development of precision navigation tools integrated with imaging systems, thermal ablation of hard-to-image lesions was highly dependent on operator experience, spatial skills, and estimation of positron emission tomography-avid or arterial-phase targets. Numerous navigation systems for ablation bring the opportunity for standardization and accuracy that extends the operator's ability to use imaging feedback during procedures. In this report, existing systems and techniques are reviewed and specific clinical applications for ablation are discussed to better define how these novel technologies address specific clinical needs and fit into clinical practice.