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Bera K, Ramaiya N, Paspulati RM, Nakamoto D, Tirumani SH. 3.0-T MR-guided transgluteal in-bore-targeted prostate biopsy under local anesthesia in patients without rectal access: a single-institute experience and review of literature. Abdom Radiol (NY) 2024; 49:1223-1230. [PMID: 38383816 PMCID: PMC10954944 DOI: 10.1007/s00261-024-04183-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 02/23/2024]
Abstract
PURPOSE To describe the technique and evaluate the performance of MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia in patients without rectal access. METHODS Ten men (mean age, 69 (range 57-86) years) without rectal access underwent 13 MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia. All patients underwent mp-MRI at our institute prior to biopsy. Three patients had prior US-guided transperineal biopsy which was unsuccessful in one, negative in one, and yielded GG1 (GS6) PCa in one. Procedure time, complications, histopathology result, and subsequent management were recorded. RESULTS Median interval between rectal surgery and presentation with elevated PSA was 12.5 years (interquartile range (IQR) 25-75, 8-36.5 years). Mean PSA was 11.9 (range, 4.8 -59.0) ng/ml and PSA density was 0.49 (0.05 -3.2) ng/ml/ml. Distribution of PI-RADS v2.0/2.1 scores of the targeted lesions were PI-RADS 5-3; PI-RADS 4-6; and PI-RADS 3-1. Mean lesion size was 1.5 cm (range, 1.0-3.6 cm). Median interval between MRI and biopsy was 5.5 months (IQR 25-75, 1.5-9 months). Mean procedure time was 47.4 min (range, 29-80 min) and the number of cores varied between 3 and 5. Of the 13 biopsies, 4 yielded clinically significant prostate cancer (csPca), with a Gleason score ≥ 7, 1 yielded insignificant prostate cancer (Gleason score = 6), 7 yielded benign prostatic tissue, and one was technically unsuccessful. 3/13 biopsies were repeat biopsies which detected csPCa in 2 out of the 3 patients. None of the patients had biopsy-related complication. Biopsy result changed management to radiation therapy with ADT in 2 patients with the rest on active surveillance. CONCLUSION MRI-guided transgluteal in-bore-targeted biopsy of the prostate gland under local anesthesia is feasible in patients without rectal access.
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Affiliation(s)
- Kaustav Bera
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.
| | - Nikhil Ramaiya
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
| | - Raj Mohan Paspulati
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Dean Nakamoto
- Department of Radiology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, 44106, USA
| | - Sree Harsha Tirumani
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA
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Harth C, De Vulder N, Hermie L, Vanlangenhove P. Stereotactic transgluteal prostatic biopsy using Cone-Beam CT navigation and prebiopsy MRI image fusion in a patient without rectal access. Eur J Radiol 2024; 170:111265. [PMID: 38118391 DOI: 10.1016/j.ejrad.2023.111265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/22/2023]
Affiliation(s)
- C Harth
- Department of Vascular and Interventional Radiology, Ghent University Hospital, Belgium.
| | - N De Vulder
- Department of Radiology, Ghent University Hospital, Belgium
| | - L Hermie
- Department of Vascular and Interventional Radiology, Ghent University Hospital
| | - P Vanlangenhove
- Department of Vascular and Interventional Radiology, Ghent University Hospital
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Miyajima K, Urabe F, Nakano J, Iwatani K, Tashiro K, Tsuzuki S, Sato S, Takahashi H, Kimura T, Miki K. Novel technique for cognitive magnetic resonance imaging-transperineal ultrasound fusion transperineal prostate biopsy with injection of bubbled jelly into urethra after abdominoperineal excision. IJU Case Rep 2023; 6:365-369. [PMID: 37928278 PMCID: PMC10622202 DOI: 10.1002/iju5.12624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/02/2023] [Indexed: 11/07/2023] Open
Abstract
Introduction Prostate biopsy is commonly performed using a transrectal ultrasound probe through a transrectal or transperineal approach. However, this is not possible for patients without a rectum. Case presentation A 75-year-old male was referred to our hospital because of an elevated prostate-specific antigen and a suspicious prostate lesion (PIRADS 5) in the left peripheral zone. The patient had previously undergone abdominoperineal resection for rectal cancer, which excluded the use of transrectal ultrasound. We describe the use of the transperineal ultrasound-guided biopsy with cognitive magnetic resonance imaging-transperineal ultrasound fusion and the utility of the injection of bubbled lidocaine jelly into urethra to improve its visualization. The pathological findings revealed clinically significant cancer with a Gleason score of 5 + 4. Conclusion Cognitive magnetic resonance imaging-transperineal ultrasound fusion transperineal prostate biopsy with injection of bubbled jelly into urethra is a feasible and practical technique that does not require any specialized equipment.
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Affiliation(s)
- Keiichiro Miyajima
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Fumihiko Urabe
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Juria Nakano
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Kosuke Iwatani
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Kojiro Tashiro
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Shunsuke Tsuzuki
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Shun Sato
- Department of PathologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Hiroyuki Takahashi
- Department of PathologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Takahiro Kimura
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
| | - Kenta Miki
- Department of UrologyThe Jikei University School of MedicineMinato‐kuTokyoJapan
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Khanmohammadi S, Golzarian J, Akhlaghpoor S. CT-guided Transgluteal Prostate Fiducial Marker Insertion for Localized Radiation Therapy. Cardiovasc Intervent Radiol 2023; 46:1409-1413. [PMID: 37640950 DOI: 10.1007/s00270-023-03539-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE To Evaluate the safety and technical success of transgluteal CT-guided fiducial marker implantation into the prostate as an alternative method to transperineal and transrectal approaches. MATERIAL AND METHODS We retrospectively identified all patients who had undergone CT-guided transgluteal fiducial marker insertion between 2020 and 2022. Four patients with confirmed prostate cancer were identified. One radiologist performed all procedures via a bilateral transgluteal approach under the guidance of real-time CT-fluoroscopy. Twenty cm long pre-waxed 18G guiding needles, preloaded with smooth gold fiducial markers, were used to implant markers. Technical success was defined as the successful placement of the fiducial markers into the planned positions. RESULTS The mean age of patients was 70 years. The mean procedure time was 19.25 (SD: 6.75) min, and the mean total dose length product (DLP) was 801.75 (SD: 291.17) mGycm, which is compatible with the 12 mSv estimated effective dose. All procedures were technically successful (100%). All patients tolerated the procedure and did not require any analgesia for pain, and there were no requests to stop or pause the procedure. Only one patient reported hematuria one day after the procedure, which required no treatment. CONCLUSION Transgluteal CT-guided fiducial marker implantation into the prostate is an alternative method to transperineal and transrectal approaches. In this technique, the risk of septic complications is minor, and general anesthesia is not required. Thus, transgluteal CT-guided marker insertion is a feasible and well-tolerated method for image-guided radiation therapy (IGRT) in patients with prostate cancer.
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Affiliation(s)
- Shaghayegh Khanmohammadi
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Jafar Golzarian
- Vascular and Interventional Radiology, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Shahram Akhlaghpoor
- Department of Radiology, Pardis Noor Medical Imaging Center, No 5, 25th Street, Sa'adat abad street, Tehran, Iran.
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Liang H, Tse ZTH. MR conditional prostate intervention systems and actuations review. Proc Inst Mech Eng H 2023; 237:18-34. [PMID: 36458323 PMCID: PMC9841823 DOI: 10.1177/09544119221136169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Magnetic resonance imaging (MRI) has the ability to provide high-resolution images of soft tissues without the use of radiation. So much research has been focused on the development of actuators and robotic devices that can be used in the MRI environment so "real-time" images can be obtained during surgeries. With real-time guidance from MRI, robots can perform surgical procedures with high accuracy and through less invasive routes. This technique can also significantly reduce the operation time and simplify pre-surgical procedures. Therefore, research on robot-assisted MRI-guided prostate intervention has attracted a great deal of interest, and several successful clinical trials have been published in recent years, pointing to the great potential of this technology. However, the development of MRI-guided robots is still in the primary stage, and collaboration between researchers and commercial suppliers is still needed to improve such robot systems. This review presents an overview of MRI-guided prostate intervention devices and actuators. Additionally, the expected technical challenges and future advances in this field are discussed.
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Affiliation(s)
| | - Zion Tsz Ho Tse
- Zion Tsz Ho Tse, School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK.
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CT-PLANNED transperineal prostate BIOPSY IN patients without a rectum. Urol Case Rep 2020; 33:101409. [PMID: 33102106 PMCID: PMC7574335 DOI: 10.1016/j.eucr.2020.101409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022] Open
Abstract
A patient at risk of harboring prostate cancer with a history of ulcerative colitis surgically managed with total colectomy (including the distal rectum and anal canal) underwent CT-planned transperineal prostate biopsy with fluoroscopic guidance. We describe the planning and intraoperative technique to obtain prostate biopsy cores.
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High concordance of findings obtained from transgluteal magnetic resonance imaging - and transrectal ultrasonography-guided biopsy as compared with prostatectomy specimens. BJU Int 2017; 120:365-376. [DOI: 10.1111/bju.13840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hansen NL, Caglic I, Berman LH, Kastner C, Doble A, Barrett T. Multiparametric Prostate Magnetic Resonance Imaging and Cognitively Targeted Transperineal Biopsy in Patients With Previous Abdominoperineal Resection and Suspicion of Prostate Cancer. Urology 2016; 96:8-14. [PMID: 27155312 DOI: 10.1016/j.urology.2016.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/19/2016] [Accepted: 04/28/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To report our experience with a combination of prostate magnetic resonance imaging (MRI) and transperineal ultrasound biopsy for evaluating the prostate in patients with elevated prostate-specific antigen (PSA) who have previously undergone abdominoperineal resection (APR). PATIENTS AND METHODS We reviewed the records of 11 patients with a history of APR and clinical suspicion of prostate cancer due to elevated PSA levels over a 5-year period. All patients underwent multiparametric MRI at our institution prior to biopsy. MR diagnoses were validated either by transperineal ultrasound biopsy (Likert 3-5) guided by visual registration or clinical follow-up >6 months (Likert 1-2). RESULTS All 7 cases with highly suspicious lesions (Likert 4-5) on MRI demonstrated cancer-1 case of Gleason 3 + 3 and 6 cases of Gleason ≥3 + 4 disease. Two cases with Likert 3 MR lesions revealed benign tissue upon biopsy. Two patients with no suspicious lesions on MRI were followed-up clinically, with PSA levels remaining stable over a mean period of 17.5 months (range 7-28 months). CONCLUSION The use of prebiopsy multiparametric prostate MRI and subsequent cognitively targeted transperineal biopsy guided by visual registration can aid in the diagnostic pathway of patients with APR and a suspicion of prostate cancer.
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Affiliation(s)
- Nienke L Hansen
- Department of Diagnostic and Interventional Radiology, University Hospital RWTH Aachen, Aachen, Germany; CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Iztok Caglic
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, University Medical Centre Maribor, Maribor, Slovenia
| | - Laurence H Berman
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
| | - Christof Kastner
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Andrew Doble
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Tristan Barrett
- CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.
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Hoffner MKM, Huebner F, Scholtz JE, Zangos S, Schulz B, Luboldt W, Vogl TJ, Bodelle B. Impact of an endorectal coil for 1H-magnetic resonance spectroscopy of the prostate at 3.0T in comparison to 1.5T: Do we need an endorectal coil? Eur J Radiol 2016; 85:1432-8. [PMID: 27423684 DOI: 10.1016/j.ejrad.2016.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 05/25/2016] [Accepted: 05/31/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To evaluate the influence of endorectal coil (ERC) regarding spectral quality and diagnostic suitability and diagnostic performance in 3.0T 1H-magnetic resonance spectroscopy imaging (MRSI) compared to 1.5T MRSI. MATERIALS AND METHODS The study was approved by the Institutional Review Board. MRSI of the prostate was performed on 19 patients at 1.5T with ERC (protocol 1), at 3.0T with a disabled ERC (protocol 2) and at 3.0T with ERC (protocol 3). Age, weight, body size, body-mass-index, prostate volume, time between measurements, diagnostic suitability of spectra, histopathological results after biopsy of cancer suspect lesions (CSL), sensitivity and specificity were evaluated. Signal-to-noise ratio (SNR) was calculated and compared using semiparametrical multiple Conover-comparisons. Correlations between SNR and prostate volume and BMI were indicated using Pearson correlation coefficient. Distribution of SNR was evaluated for prostate quadrants. RESULTS Diagnostic suitable spectra were achieved in 76 % (protocol 1, 100% in CSL), 32 % (protocol 2, 59% in CSL) and 50 % (protocol 3, 80% in CSL) of the voxels. SNR was significantly higher in protocol 3 compared to protocol 2 and 1 (93,729 vs. 27,836 vs. 32,897, p<0.0001) with significant difference between protocol 2 and 1 (p<0.023). Highest SNR was achieved in the dorsal prostate (protocols 1 and 3; p<0.0001). Sensitivity at 3.0T was higher with use of ERC. Specificity was highest at 1.5T with ERC. CONCLUSION The ERC improves the diagnostic suitability and the SNR in MRSI at 3.0T. Less voxels at 3.0T with disabled ERC are suitable for diagnosis compared to 1.5T with ERC. MRSI at 3.0T with ERC shows the highest SNR. SNR in dorsal quadrants of the prostate was higher using ERC.
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Affiliation(s)
- Maximilian K M Hoffner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Frank Huebner
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Jan Erik Scholtz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Stephan Zangos
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Schulz
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Wolfgang Luboldt
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
| | - Boris Bodelle
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, Haus 23c, 60590 Frankfurt am Main, Hesse, Germany.
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Abstract
The diagnosis and treatment of prostate cancer continue to evolve with advances in science and technology. The utilization of multiparametric MRI (mp-MRI) to identify lesions in the prostate has given clinicians the ability to visualize malignancy in the prostate with greater confidence. With this new ability came the advancement of fusion biopsy platforms, which allow for direct targeting of these lesions. As with any new technology in medicine, the proper use of these modalities and how they fit into current clinical practice need to be addressed. This review summarizes the current knowledge on how to best optimize which men undergo mp-MRI and fusion biopsies both in the screening and treatment settings.
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Closed-Bore Interventional MRI: Percutaneous Biopsies and Ablations. AJR Am J Roentgenol 2015; 205:W400-10. [DOI: 10.2214/ajr.15.14732] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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CT-Guided Transgluteal Biopsy for Systematic Random Sampling of the Prostate in Patients Without Rectal Access. AJR Am J Roentgenol 2015; 205:578-83. [DOI: 10.2214/ajr.14.14129] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Evaluation of Diffusion Kurtosis Imaging Versus Standard Diffusion Imaging for Detection and Grading of Peripheral Zone Prostate Cancer. Invest Radiol 2015; 50:483-9. [DOI: 10.1097/rli.0000000000000155] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Feasibility Study of 3-T DWI of the Prostate: Readout-Segmented Versus Single-Shot Echo-Planar Imaging. AJR Am J Roentgenol 2015; 205:70-6. [PMID: 26102382 DOI: 10.2214/ajr.14.13489] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Multiparametric MRI in biopsy guidance for prostate cancer: fusion-guided. BIOMED RESEARCH INTERNATIONAL 2014; 2014:439171. [PMID: 25126559 PMCID: PMC4122009 DOI: 10.1155/2014/439171] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/09/2014] [Accepted: 06/11/2014] [Indexed: 12/21/2022]
Abstract
Prostate cancer (PCa) is the most common solid-organ malignancy among American men and the second most deadly. Current guidelines recommend a 12-core systematic biopsy following the finding of an elevated serum prostate-specific antigen (PSA). However, this strategy fails to detect an unacceptably high percentage of clinically significant cancers, leading researchers to develop new, innovative methods to improve the effectiveness of prostate biopsies. Multiparametric-MRI (MP-MRI) has emerged as a promising instrument in identifying suspicious regions within the prostate that require special attention on subsequent biopsy. Fusion platforms, which incorporate the MP-MRI into the biopsy itself and provide active targets within real-time imaging, have shown encouraging results in improving the detection rate of significant cancer. Broader applications of this technology, including MRI-guided focal therapy for prostate cancer, are in early phase trials.
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