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

描述（由申请人提供）：前列腺癌（CaP）是美国男性中最常见的内部恶性肿瘤，每年有192，000例新发病例和27，300例死亡。然而，CaP也以一种常见的、非致命的、不重要的形式存在，不会引起疾病。多达一半的新诊断的CaP病例在组织学上是无意义的，但90%的CaP患者，无论严重与否，都选择立即治疗。对前列腺内的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。我们建议评估先进的成像系统，Artemis设备，在男性接受前列腺活检，以排除恶性肿瘤。该设备采用常规超声图像的数字视频处理来（1）创建前列腺的同时3D重建，（2）系统地规划活检部位，（3）数字地记录活检部位以供将来再次调用，以及（4）以实时方式将前列腺的先前获得的磁共振成像（MRI）与同时超声图像融合。这项新技术的潜在优势包括提高了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再次活检，以及直接使用MRI图像和超声进行活检靶向。前列腺的MRI，当以多模式方式进行时-3特斯拉线圈结合动态对比增强和弥散加权成像-似乎接近临床实用性，在前列腺内可视化癌症。在本研究中，将使用新成像系统获得的结果与（1）接受前列腺切除术的男性（在UCLA，N=350/年）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（南加州大量未满足的需求）的活检结果进行比较。将通过比较两种模式中每种模式上看到的前列腺中基准标记的位置来测试超声/MRI融合的准确性。MRI作为活检指导的价值将通过比较针对MRI上看到的可疑病变的活检结果与12芯系统活检来进行测试。该监测臂将在一个结构化的前瞻性项目中为低风险CaP男性患者提供成像设备纵向测试的机会。多模态MRI和Artemis设备提供的前列腺成像和精确活检的改进可能有助于重新定义显著和不显著的癌症。 公共卫生相关性：该项目旨在通过开发Artemis设备重新定义前列腺癌的意义，Artemis设备是一种帮助可视化和跟踪器官内疾病的工具。通过将多模态MRI引入超声套件，允许对可疑病变进行精确成像、跟踪和定位，该设备有可能改善目前可用的癌症诊断方法。最终目标是更早地诊断出严重的癌症，并比现在更准确地跟踪低风险癌症。

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. PUBLIC HEALTH RELEVANCE: This project aims to re-define prostate cancer significance through development of the Artemis device, a tool to help visualize and track disease within the organ. By bringing multi-modal MRI to the ultrasound suite, allowing precise imaging, tracking, and targeting of suspicious lesions, the device offers the potential to improve currently available methods of cancer diagnosis. The ultimate goals are to diagnose serious cancers earlier and follow low-risk cancers more accurately than now possible.