Clinical application of a 3D ultrasound-guided prostate biopsy system.
Clinical application of a 3D ultrasound-guided prostate biopsy system.
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DOI：
10.1016/j.urolonc.2011.02.014
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发表时间：
2011-05
期刊：
影响因子：
--
通讯作者：
Fenster A
中科院分区：
文献类型：
--
作者：
Natarajan S;Marks LS;Margolis DJ;Huang J;Macairan ML;Lieu P;Fenster A
三十年来，前列腺活检（Bx）一直使用2D超声（US）以系统但盲目的方式进行。本文描述了3D Bx跟踪和瞄准设备（Artemis，Eigen，Grass Valley，CA）的初步临床评价。我们的主要目的是测试新的3D方法在接受首次和随访Bx的男性中的准确性，以排除前列腺癌（CaP）。研究中的患者为年龄35-87岁（66.1 ± 9.9岁）的男性，计划接受Bx以排除CaP，并进入IRB批准的方案。218名受试者接受了常规经直肠超声（TRUS）;然后将跟踪系统连接到超声探头上;扫描前列腺并创建3D重建。所有Bx部位均在3D中可视化并进行电子跟踪。在11名男性中进行了一项初步研究，以测试器械将Bx返回到原始部位的能力。在47名男性中，在TRUS之前进行了多参数3 T MRI（包括T2加权图像、动态对比增强和弥散加权成像），允许在活检期间将存储的MRI图像与实时US融合。MRI上的病变由放射科医生勾画，指定CaP可疑级别，并融合到TRUS中进行活检靶向。在180/218例患者中成功完成了3D Bx跟踪，在最后50例男性中成功率接近95%。使用Artemis器械进行Bx的平均时间为15分钟，MRI融合和Bx靶向需要额外5分钟。在跟踪研究中，能够在1.2 +/- 1.1 mm S.D.内返回到之前的Bx部位（n=32）。的Bx位点，并独立于前列腺体积或位置。在MRI融合研究中，当针对可疑病变时，发现Bx阳性率为33%，而系统性、非靶向Bx的阳性率为7%（19/57个核心与9/124个核心，p=0.03）。使用3D跟踪和图像融合有可能将MRI转变为临床工具，以帮助活检并改善目前用于诊断和随访CaP的方法。
Prostate biopsy (Bx) has for three decades been performed in a systematic, but blind fashion using 2D ultrasound (US). Herein is described the initial clinical evaluation of a 3D Bx tracking and targeting device (Artemis, Eigen, Grass Valley, CA). Our main objective was to test accuracy of the new 3D method in men undergoing first and follow-up Bx to rule out prostate cancer (CaP). Patients in the study were men ages 35-87 (66.1 +/- 9.9 yrs), scheduled for Bx to rule out CaP, who entered into an IRB-approved protocol. 218 subjects underwent conventional trans-rectal US (TRUS); the tracking system was then attached to the US probe; the prostate was scanned and a 3D reconstruction was created. All Bx sites were visualized in 3D and tracked electronically. In 11 men, a pilot study was conducted to test ability of the device to return a Bx to an original site. In 47 men, multi-parametric 3 Tesla MRI – incorporating T2-weighted images, dynamic contrast enhancement, and diffusion-weighted imaging – was performed in advance of the TRUS, allowing the stored MRI images to be fused with real-time US during biopsy. Lesions on MRI were delineated by a radiologist, assigned a grade of CaP suspicion, and fused into TRUS for biopsy targeting. 3D Bx tracking was completed successfully in 180/218 patients, with a success rate approaching 95% among the last 50 men. Average time for Bx with the Artemis device was 15 minutes with an additional 5 minutes for MRI fusion and Bx targeting. In the tracking study, an ability to return to prior Bx sites (n=32) within 1.2 +/- 1.1 mm S.D. was demonstrated and was independent of prostate volume or location of Bx site. In the MRI fusion study, when suspicious lesions were targeted, a 33% Bx-positivity rate was found compared to a 7% positivity rate for systematic, non-targeted Bx (19/57 cores vs. 9/124 cores, p=0.03). Use of 3D tracking and image fusion has the potential to transform MRI into a clinical tool to aid biopsy and improve current methods for diagnosis and follow-up of CaP.
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