Korean J Radiol.  2015 Feb;16(1):90-98. 10.3348/kjr.2015.16.1.90.

Magnetic Resonance Imaging-Guided Prostate Biopsy: Present and Future

• Kim CK

• KMID: 2069987
• DOI: http://doi.org/10.3348/kjr.2015.16.1.90

Abstract

Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores.

Keyword

Prostate cancer; MRI; MRI-guided biopsy; Targeted biopsy

MeSH Terms

Humans
Image-Guided Biopsy
Magnetic Resonance Imaging
Male
Neoplasm Staging
Prostate/*pathology/radiography
Prostatic Neoplasms/pathology/radiography

Figure

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  Fig. 1 56-year-old man with stage T3a Gleason 4 + 3 prostate cancer (prostate specific antigen = 28.5 ng/mL) in left peripheral zone (PZ). A. On axial T2-weighted image, focal mass of low signal intensity (arrow) is seen in left PZ on mid-gland level with indistinct and irregular capsular margin suggesting extracapsular extension. B, C. Mass (arrow) in left PZ shows focally high signal intensity on axial diffusion-weighted (B) and reduced apparent diffusion coefficient (ADC) value on ADC map (C) images. D. On axial color-coded ktrans map of dynamic contrast-enhanced image, mass (arrow) reveals focal, asymmetric enhancement in corresponding site of Figure 1A.

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  Fig. 2 In-bore targeting devices. A. 150/175 mm 18-gauge automatic biopsy gun, prostate needle guide, bottles for sampled cores and lidocaine jelly are shown. B. Biopsy device with base plate for patient positioning (Invivo, Schwerin, Germany).

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  Fig. 3 74-year-old man with stage T2a Gleason score 3 + 4 prostate cancer (prostate specific antigen = 14.56 ng/mL) in right transition zone (TZ) with history of one previous negative transrectal ultrasound-guided biopsy underwent subsequent multiparametric MRI for clinical suspicion of prostate cancer. A-D. Axial color-coded wash-in/wash-out image (A) and dynamic contrast-enhanced (D) images show asymmetric increased enhancement (cross) in right TZ. This mass demonstrates focal low signal intensity (cross) on axial apparent diffusion coefficient map (B) and T2-weighted (C) images. E. Oblique axial T2-weighted image confirms needle position (arrow) in right TZ. In this MRI-guided biopsy specimen, Gleason score 3 + 4 prostate cancer was found.

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