OBJECTIVE: To evaluate the feasibility and utility of registration and fusion of real-time transrectal ultrasonography (TRUS) and previously acquired magnetic resonance imaging (MRI) to guide prostate biopsies. PATIENTS AND METHODS: Two National Cancer Institute trials allowed MRI-guided (with or with no US fusion) prostate biopsies during placement of fiducial markers. Fiducial markers were used to guide patient set-up for daily external beam radiation therapy. The eligible patients had biopsy-confirmed prostate cancer that was visible on MRI. A high-field (3T) MRI was performed with an endorectal coil in place. After moving to an US suite, the patient then underwent TRUS to visualize the prostate. The US transducer was equipped with a commercial needle guide and custom modified with two embedded miniature orthogonal five-degrees of freedom sensors to enable spatial tracking and registration with MR images in six degrees of freedom. The MRI sequence of choice was registered manually to the US using custom software for real-time navigation and feedback. The interface displayed the actual and projected needle pathways superimposed upon the real-time US blended with the prior MR images, with position data updating in real time at 10 frames per second. The registered MRI information blended to the real-time US was available to the physician who performed targeted biopsies of highly suspicious areas. RESULTS: Five patients underwent limited focal biopsy and fiducial marker placement with real-time TRUS-MRI fusion. The Gleason scores at the time of enrollment on study were 8, 7, 9, 9, and 6. Of the 11 targeted biopsies, eight showed prostate cancer. Positive biopsies were found in all patients. The entire TRUS procedure, with fusion, took approximately 10 min. CONCLUSION: The fusion of real-time TRUS and prior MR images of the prostate is feasible and enables MRI-guided interventions (like prostate biopsy) outside of the MRI suite. The technique allows for navigation within dynamic contrast-enhanced maps, or T2-weighted or MR spectroscopy images. This technique is a rapid way to facilitate MRI-guided prostate therapies such as external beam radiation therapy, brachytherapy, cryoablation, high-intensity focused ultrasound ablation, or direct injection of agents, without the cost, throughput, or equipment compatibility issues that might arise with MRI-guided interventions inside the MRI suite.
OBJECTIVE: To evaluate the feasibility and utility of registration and fusion of real-time transrectal ultrasonography (TRUS) and previously acquired magnetic resonance imaging (MRI) to guide prostate biopsies. PATIENTS AND METHODS: Two National Cancer Institute trials allowed MRI-guided (with or with no US fusion) prostate biopsies during placement of fiducial markers. Fiducial markers were used to guide patient set-up for daily external beam radiation therapy. The eligible patients had biopsy-confirmed prostate cancer that was visible on MRI. A high-field (3T) MRI was performed with an endorectal coil in place. After moving to an US suite, the patient then underwent TRUS to visualize the prostate. The US transducer was equipped with a commercial needle guide and custom modified with two embedded miniature orthogonal five-degrees of freedom sensors to enable spatial tracking and registration with MR images in six degrees of freedom. The MRI sequence of choice was registered manually to the US using custom software for real-time navigation and feedback. The interface displayed the actual and projected needle pathways superimposed upon the real-time US blended with the prior MR images, with position data updating in real time at 10 frames per second. The registered MRI information blended to the real-time US was available to the physician who performed targeted biopsies of highly suspicious areas. RESULTS: Five patients underwent limited focal biopsy and fiducial marker placement with real-time TRUS-MRI fusion. The Gleason scores at the time of enrollment on study were 8, 7, 9, 9, and 6. Of the 11 targeted biopsies, eight showed prostate cancer. Positive biopsies were found in all patients. The entire TRUS procedure, with fusion, took approximately 10 min. CONCLUSION: The fusion of real-time TRUS and prior MR images of the prostate is feasible and enables MRI-guided interventions (like prostate biopsy) outside of the MRI suite. The technique allows for navigation within dynamic contrast-enhanced maps, or T2-weighted or MR spectroscopy images. This technique is a rapid way to facilitate MRI-guided prostate therapies such as external beam radiation therapy, brachytherapy, cryoablation, high-intensity focused ultrasound ablation, or direct injection of agents, without the cost, throughput, or equipment compatibility issues that might arise with MRI-guided interventions inside the MRI suite.
Authors: Aristotelis G Anastasiadis; Matthias P Lichy; Udo Nagele; Markus A Kuczyk; Axel S Merseburger; Joerg Hennenlotter; Stefan Corvin; Karl-Dietrich Sievert; Claus D Claussen; Arnulf Stenzl; Heinz-Peter Schlemmer Journal: Eur Urol Date: 2006-03-24 Impact factor: 20.096
Authors: Jurgen J Fütterer; Stijn W T P J Heijmink; Tom W J Scheenen; Gerrit J Jager; Christina A Hulsbergen-Van de Kaa; J Alfred Witjes; Jelle O Barentsz Journal: Radiology Date: 2005-11-22 Impact factor: 11.105
Authors: Patrick Kupelian; Howard Thames; Larry Levy; Eric Horwitz; Alvaro Martinez; Jeff Michalski; Thomas Pisansky; Howard Sandler; William Shipley; Michael Zelefsky; Anthony Zietman; Deborah Kuban Journal: Int J Radiat Oncol Biol Phys Date: 2005-05-31 Impact factor: 7.038
Authors: M Perrotti; K R Han; R E Epstein; E C Kennedy; F Rabbani; K Badani; A J Pantuck; R E Weiss; K B Cummings Journal: J Urol Date: 1999-10 Impact factor: 7.450
Authors: Jurgen J Fütterer; Marc R Engelbrecht; Henkjan J Huisman; Gerrit J Jager; Christina A Hulsbergen-van De Kaa; J Alfred Witjes; Jelle O Barentsz Journal: Radiology Date: 2005-11 Impact factor: 11.105
Authors: T H Kuru; C Tulea; T Simpfendörfer; V Popeneciu; M Roethke; B A Hadaschik; M Hohenfellner Journal: Urologe A Date: 2012-01 Impact factor: 0.639
Authors: Jonathan Chappelow; B Nicolas Bloch; Neil Rofsky; Elizabeth Genega; Robert Lenkinski; William DeWolf; Anant Madabhushi Journal: Med Phys Date: 2011-04 Impact factor: 4.071