Investig Clin Urol.  2019 Jan;60(1):4-13. 10.4111/icu.2019.60.1.4.

Magnetic resonance imaging-transrectal ultrasound fusion image-guided prostate biopsy: Current status of the cancer detection and the prospects of tailor-made medicine of the prostate cancer

• Shoji S

• KMID: 2434619
• DOI: http://doi.org/10.4111/icu.2019.60.1.4

Abstract

Multi-parametric magnetic resonance imaging (mpMRI) has been increasingly used to diagnose clinically significant prostate cancer (csPCa) because of its growing availability and its ability to combine anatomical and functional data. Magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion imaging provides MRI information with TRUS images for prostate biopsies. This technique combines the superior sensitivity of MRI for targeting suspicious lesions with the practicality and familiarity of TRUS. MRI-TRUS fusion image-guided prostate biopsy is performed with different types of image registration (rigid vs. elastic) and needle tracking methods (electromagnetic tracking vs. mechanical position encoders vs. image-based software tracking). A systematic review and meta-analysis showed that MRI-targeted biopsy detected csPCa at a significantly higher rate than did TRUS-guided biopsy, while it detected significantly fewer cases of insignificant PCas. In addition to the high accuracy of MRI-targeted biopsy for csPCa, localization of csPCa is accurate. The ability to choose the route of biopsy (transperineal vs. transrectal) is required, depending on the patients' risk and the location and size of suspicious lesions on mpMRI. Fusion image-guided prostate biopsy has the potential to allow precise management of prostate cancer, including active surveillance, radical treatment, and focal therapy.

Keyword

Biopsy; Magnetic resonance imaging; Prostatic neoplasms; Ultrasonography

MeSH Terms

Biopsy*
Magnetic Resonance Imaging
Needles
Passive Cutaneous Anaphylaxis
Prostate*
Prostatic Neoplasms*
Recognition (Psychology)
Ultrasonography*

Figure

• 

  Fig. 1 mpMRI of a representative case suspected with prostate cancer. mpMRI includes a combination of high-resolution T2WIs, DCE images, DWIs, and ADC. The lesion suspected as cancer was diagnosed in the anterior in transition zone (in the white arrows) on mpMRI, which was diagnosed as Prostate Imaging and Reporting and Data System category 5. mpMRI, multi-parametric magnetic resonance imaging; T2WI, T2-weighted image; DCE, dynamic contrast-enhanced; DWI, diffusion-weighted image; ADC, apparent diffusion coefficient. A 1.5Tesla magnet (Signa HDx) with an 8-channel cardiac coil.

• 

  Fig. 2 Composition of MRI-TRUS fusion image-guided prostate biopsy. MRI-TRUS fusion image-guided prostate biopsy comprises image registration (rigid or elastic), the needle tracking method (electromagnetic tracking, mechanical position encoders, or image-based software tracking), and the route of biopsy (transperineal or transrectal). MRI-TRUS, magnetic resonance imaging-transrectal ultrasound.

• 

  Fig. 3 Elastic fusion of MRI and TRUS. Three-dimensional information is transferred from mpMRI to TRUS of the prostate with elastic image fusion software. MRI, magnetic resonance imaging; TRUS, transrectal ultrasound; mpMRI, multi-parametric MRI.

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  Fig. 4 Process of MRI-TRUS fusion image-guided prostate biopsy with BioJet version 2.0. (A) First, the operator marks the target point on the work station. Transperineal template coordinates are shown on the monitor. Biopsy simulation is performed in a 3D model of the prostate. (B) Transperineal template-assisted biopsy is then performed by viewing axial and sagittal real-time fusion 2D images of the prostate. For a difficult case of the template-assisted transperineal approach due to the pelvis, transperineal free-hand biopsy is performed by viewing axial and sagittal real-time fusion 2D images of the prostate. (C) After each biopsy, biopsy needle tracking is recorded in 2D and 3D fusion images of the prostate. 3D, three-dimensional; 2D, two-dimensional; TZ, transition zone; PZ, peripheral zone.

• 

  Fig. 5 Process of focal therapy for localized prostate cancer with high-intensity focused ultrasound. MRI-TRUS elastic fusion image-guided transperineal biopsy is performed with the BioJet system. The recorded localization of mpMRI-visible csPCa is converted to the treatment planning screen of TRUS images on a workstation of the HIFU device (Sonablate 500). The treatment range is determined and csPCa is treated. Contrast-enhanced MRI is performed at 2 weeks after treatment for evaluation of the treatment effect. MRI-TRUS, magnetic resonance imaging-transrectal ultrasound; mpMRI, multi-parametric magnetic resonance imaging; 3D, three-dimensional.

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