Biopsy Tracking and MRI Fusion to Enhance Imaging of Cancer Within the Prostate

活检追踪和 MRI 融合可增强前列腺内癌症的成像

• 批准号: 8296566
• 负责人: Leonard Stephen Marks
• 金额: $ 45.62万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-07-05 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8296566
• 关键词: Accounting; Autopsy; Biopsy; California; Cessation of life; Clinical; Development; Devices; Diagnosis; Diffusion; Diffusion weighted imaging; Disease; Early Diagnosis; FDA approved; Feasibility Studies; Future; Gleason Grade for Prostate Cancer; Goals; Growth; Guidelines; Histologic; Human; Image; Imaging Device; Indolent; Institutes; Lesion; Life; Location; Longevity; Magnetic Resonance; Magnetic Resonance Imaging; Malignant Neoplasms; Malignant neoplasm of prostate; Measures; Methods; Modality; Newly Diagnosed; Organ; Outcome; Pathology; Patients; Pilot Projects; Process; Prostate; Prostatectomy; Prostatic; Publishing; Qualifying; Quality of life; Radiation; Radical Prostatectomy; Research; Risk; Sampling; Sampling Studies; Savings; Site; Staging; Structure; Surveillance Program; System; Testing; Time; Translations; Transrectal Ultrasound; Tumor Volume; Ultrasonography; United States National Institutes of Health; Urology; Visual; Weight; active method; arm; artemis; base; blind; cancer diagnosis; cancer imaging; cancer risk; digital; follow-up; imaging modality; improved; in vivo; male; men; new technology; novel; operation; programs; prospective; reconstruction; rectal; research clinical testing; success; tool; tumor; tumor progression

DESCRIPTION (provided by applicant): Prostate cancer (CaP) is the commonest internal malignancy in U.S. males, accounting for 192,000 new cases and 27,300 deaths annually. However, CaP also exists in a common, non-fatal, insignificant form which does not cause disease. Up to half of newly diagnosed CaP cases qualify histologically as insignificant, but 90% of men with CaP, serious and not, choose immediate curative therapy. Ability to image cancer within the prostate would help define the important cancers, but presently that ability is lacking. We propose to evaluate an advanced imaging system, the Artemis device, in men undergoing prostate biopsy to exclude malignancy. The device employs digital video processing of conventional ultrasound images to (1) create a contemporaneous 3D reconstruction of the prostate, (2) plan biopsy sites systematically, (3) digitally record the biopsy sites for future re-call, and (4) fuse or superimpose previously-obtained magnetic-resonance imaging (MRI) of the prostate with concurrent ultrasound images in a real-time manner. Potential advantages of this new technology include improved ability to sample the entire prostate thoroughly, to precisely record sampling sites for future re-biopsy, and to directly use images from MRI as well as ultrasound for biopsy targeting. MRI of the prostate, when performed in a multi-modal fashion---3Tesla coil combined with dynamic contrast enhancement and diffusion-weighted imaging---appears to be approaching clinical utility in visualizing cancer within the prostate. In the present study, results obtained with the new imaging system would be compared with (1) findings on whole-mount prostate pathology, for men undergoing prostatectomy (N=350/yr at UCLA), and (2) biopsy findings at diagnosis and subsequently, for men undergoing active surveillance (vast unmet need in Southern California). Accuracy of ultrasound/MRI fusion would be tested by comparing location of fiducial markers in the prostate seen on each of the two modalities. Value of MRI as a biopsy guide would be tested by comparing results of biopsies targeted at suspicious lesions seen on MRI vs 12-core systematic biopsies. The surveillance arm will provide opportunity for longitudinal testing of the imaging device in men with low- risk CaP in a structured, prospective program. Improved imaging and precise biopsy of the prostate, as provided by multi-modal MRI and the Artemis device, may help re-define significant and insignificant cancer.

描述（由申请人提供）：前列腺癌 (CaP) 是美国男性最常见的内部恶性肿瘤，每年新增病例 192,000 例，死亡人数 27,300 例。然而，CaP 也以一种常见、非致命、微不足道的形式存在，不会引起疾病。多达一半的新诊断 CaP 病例在组织学上被认为是不严重的，但 90% 的 CaP 男性，无论严重与否，都会选择立即治疗。对前列腺内癌症进行成像的能力将有助于确定重要的癌症，但目前缺乏这种能力。我们建议在接受前列腺活检以排除恶性肿瘤的男性中评估先进的成像系统 Artemis 装置。该设备采用传统超声图像的数字视频处理来 (1) 创建前列腺的同步 3D 重建，(2) 系统地规划活检部位，(3) 以数字方式记录活检部位以供将来调用，以及 (4) 将先前获得的前列腺磁共振成像 (MRI) 与实时超声图像融合或叠加。这项新技术的潜在优势包括提高对整个前列腺进行彻底采样的能力，精确记录采样部位以供将来重新活检，以及直接使用 MRI 和超声图像进行活检定位。当以多模态方式进行前列腺 MRI 时（3 特斯拉线圈与动态对比增强和扩散加权成像相结合），在可视化前列腺内癌症方面似乎正在接近临床实用性。在本研究中，新成像系统获得的结果将与（1）接受前列腺切除术的男性（加州大学洛杉矶分校每年 350 例）的整体前列腺病理学结果进行比较，以及（2）诊断时和随后接受主动监测的男性的活检结果（南加州存在巨大的未满足的需求）。通过比较两种方式中看到的前列腺中基准标记的位置，可以测试超声/MRI 融合的准确性。通过比较 MRI 上发现的可疑病变的活检结果与 12 核系统活检的结果，可以测试 MRI 作为活检指南的价值。监测臂将提供在结构化、前瞻性计划中对患有低风险 CaP 的男性进行成像设备纵向测试的机会。多模式 MRI 和 Artemis 设备提供的改进的前列腺成像和精确活检可能有助于重新定义重要和不重要的癌症。