Karl Engelhard MD, Presenter: Nothing to Disclose

Hans-Peter Hollenbach MS, Abstract Co-Author: Nothing to Disclose

Berthold Kiefer PhD, Abstract Co-Author: Employee, Siemens AG

Dirk G. Engehausen MD, Abstract Co-Author: Nothing to Disclose

To investigate the diagnostic valency of MRI-guided biopsy in detecting and localizing prostate cancer

65 patients with elevated PSA levels (PSA>4ng/ml, mean 10.6mg/ml) and episodes of prior tumor negative TRUS-guided biopsies (1-5, mean1.6) underwent MRI-guided prostate biopsy in a 1.5T scanner (Magnetom Espree, Siemens Healthcare, Erlangen). Localization of tumor suspected areas was done with an endorectal and two body-phased array coils using a T2-weighted TSE sequence, a diffusion weighted (DWI) protocol inclusive an ADC-map and a gadolinium contrast enhanced 3D-gradient echo sequence. After removing the endorectal coil the biopsy device was inserted into the rectum and 2 to 6 (mean 4.5) core biopsies were taken manually in a supine position of the patient. A patho-histological correlation was done between tumor suspected MRI areas and biopsy results of these regions. In 23 men with radical prostatectomy following cancer diagnosis each of 104 tumor containing biopsy cores of the suspected regions was correlated with the sites of tumor location in the pathological specimens.

All tumor suspected areas could be sucessfully punctured. Prostate cancer was found in 43%, benign prostate hyperplasia (BPH) in 66%, prostatitis in 38% and normal prostate tissue in 5%. With respect to cancer depiction MRI-guided biopsy showed a sensitivity, specificity, accuracy, negative and positive predictive value of 75%, 100%, 86%, 100% and 75% respectively. With reference to the correlation of tumor localization in the pathological specimens and biopsy sides in MRI of tumor containing biopsy cores a sensitivity of 96%, a specificity of 98%, an accuracy of 97% could be demonstrated. The neagative predictive value was 96%, by a positive predicitive value of 98%. In 9 patients with at first tumor negative MRI-guided biopsy results cancer was found in follow up over 26 months by TRUS-guided biopsy or transurethral resection (TUR).

MRI-guided prostate biopsy is suitable and accurate in detecting and localizing prostate cancer, missing a rest of tumors which can only be diagnosed in clinical follow up.

In diagnostic management of patients with elevatd or raising PSA levels the described method offers a reasonable alternative to a repeated systematic multi-site TRUS guided prostate biopsy

Engelhard, K, Hollenbach, H, Kiefer, B, Engehausen, D, MRI-guided Prostate Biopsy at 1.5T. Patho-Histological Correlation of MRI Findings with the Results of Biopsy and Radical Prostatectomy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8005066.html