Magnetic resonance-ultrasound fusion prostate biopsy in the diagnosis of prostate cancer

Abstract

The advent of multiparametric magnetic resonance imaging (mpMRI) has ushered in a new era for urologists who perform prostate needle biopsies. The fusion of MRI with transrectal ultrasound (TRUS) allows the direct targeting of suspicious lesions, which has been shown to improve the performance of conventional random biopsy techniques by increasing detection of clinically relevant disease while also decreasing detection of low-risk cancer. However, as with any new technology, many questions regarding effectiveness, reproducibility, and generalizability still remain. In this review, we 1) provide a summary of the various sequences that comprise a MRI of the prostate; 2) evaluate the three different ways of incorporating MRI into targeted biopsies of the prostate including in-bore MRI-guided biopsy, cognitive fusion, and device-mediated fusion; 3) review the sensitivity of MR-US fusion in the detection of clinically significant and clinically insignificant disease; and 4) review the barriers to the widespread implementation of MR-US fusion into everyday practice. While other articles in this issue of Urologic Oncology Seminars will discuss other aspects of MRI in the management of prostate cancer, the purpose of this article is to provide an overview of MR-US fusion biopsies in the diagnosis of prostate cancer.

Performance Characteristics of Transrectal Shear Wave Elastography Imaging in the Evaluation of Clinically Localized Prostate Cancer: A Prospective Study

“…However, TRUS guided biopsy is an invasive procedure with known risks including acute bleeding, sepsis, urinary retention and even death [21][22][23]. Therefore, image fusion techniques, Doppler and contrast enhanced ultrasound methods have been used to improve detection of PCa while also aiming to reduce the number of biopsies performed and minimising the occurrence of adverse events [24][25][26][27].…”

Diagnosis of prostate cancer

“…Compared to random systematic sampling alone, both cognitive and device-mediated fusion appear to improve diagnosis of significant cancer with a sensitivity of MR-US fusion ranging between 80% and 95% [35] . Three platforms using different modes of image fusions are available for transrectal biopsy: Uronav-( http://www.invivocorp.com ), Koelis ( http://www.koelis.com ), and Artemis ( http://www.eigen.com ).…”

Magnetic Resonance–Guided Prostate Ablation

“…There are three key tracking methods: (1) image organ-based tracking, (2) electromagnetic sensor-based tracking, and (3) mechanical arm, sensorbased tracking. 24 Image organ (prostate)-based tracking method fuses prior MRI with real-time three-dimensional US using a surface-based registration and elastic organ-based deformation algorithm (Trinity, Koelis, Meylan, France). MRI-identified suspicious lesions are loaded into the system which then projects the target into the biopsy aiming mechanism on the US probe.…”