Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging.
Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging.
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DOI：
10.1016/j.juro.2011.05.078
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Wood BJ
中科院分区：
文献类型：
--
作者：
Pinto PA;Chung PH;Rastinehad AR;Baccala AA Jr;Kruecker J;Benjamin CJ;Xu S;Yan P;Kadoury S;Chua C;Locklin JK;Turkbey B;Shih JH;Gates SP;Buckner C;Bratslavsky G;Linehan WM;Glossop ND;Choyke PL;Wood BJ
开发了一种新的平台，融合活检前磁共振成像和实时经直肠超声成像，以识别和活检可疑的前列腺癌病变。报告了前101例患者的癌症检出率。这项前瞻性的单机构研究得到了机构审查委员会的批准。患者行3.0 T直肠内线圈多参数磁共振成像，包括t2加权、波谱、动态增强和扩散加权磁共振成像序列。根据可疑癌变的序列数，将可疑癌变病变分为低（2个或以下）、中（3个）和高（4个）三个级别。患者行标准12芯经直肠超声活检和磁共振成像/超声融合引导活检，磁共振成像病变进行电磁跟踪。卡方和聚类内重新抽样分析用于将磁共振成像的怀疑与活检检测到的癌症发病率联系起来。患者平均年龄63岁。活检时前列腺特异性抗原中位数为5.8 ng/ml， 90.1%的患者直肠指检呈阴性。磁共振低怀疑、中怀疑、高怀疑的患者诊断为癌症的比例分别为27.9%、66.7%、89.5% （p <0.0001）。磁共振成像/超声融合引导活检每核比标准的12核经直肠超声活检在磁共振成像上的所有怀疑程度检测到更多的癌症。这种新型的磁共振成像/超声融合引导活检平台可以定位于磁共振成像上的前列腺癌。需要进一步的研究来确定该平台在癌症检测、主动监测和局部治疗中的作用，并确定哪些患者可能受益。
A novel platform was developed that fuses pre-biopsy magnetic resonance imaging with real-time transrectal ultrasound imaging to identify and biopsy lesions suspicious for prostate cancer. The cancer detection rates for the first 101 patients are reported. This prospective, single institution study was approved by the institutional review board. Patients underwent 3.0 T multiparametric magnetic resonance imaging with endorectal coil, which included T2-weighted, spectroscopic, dynamic contrast enhanced and diffusion weighted magnetic resonance imaging sequences. Lesions suspicious for cancer were graded according to the number of sequences suspicious for cancer as low (2 or less), moderate (3) and high (4) suspicion. Patients underwent standard 12-core transrectal ultrasound biopsy and magnetic resonance imaging/ultrasound fusion guided biopsy with electromagnetic tracking of magnetic resonance imaging lesions. Chi-square and within cluster resampling analyses were used to correlate suspicion on magnetic resonance imaging and the incidence of cancer detected on biopsy. Mean patient age was 63 years old. Median prostate specific antigen at biopsy was 5.8 ng/ml and 90.1% of patients had a negative digital rectal examination. Of patients with low, moderate and high suspicion on magnetic resonance imaging 27.9%, 66.7% and 89.5% were diagnosed with cancer, respectively (p <0.0001). Magnetic resonance imaging/ultrasound fusion guided biopsy detected more cancer per core than standard 12-core transrectal ultrasound biopsy for all levels of suspicion on magnetic resonance imaging. Prostate cancer localized on magnetic resonance imaging may be targeted using this novel magnetic resonance imaging/ultrasound fusion guided biopsy platform. Further research is needed to determine the role of this platform in cancer detection, active surveillance and focal therapy, and to determine which patients may benefit.
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