Hayet Amalou MD, Presenter: Nothing to Disclose

Sheng Xu PhD, Abstract Co-Author: Nothing to Disclose

Baris Turkbey MD, Abstract Co-Author: Nothing to Disclose

Peter L. Choyke MD, Abstract Co-Author: Researcher, Koninklijke Philips Electronics NV Researcher, General Electric Company Researcher, Siemens AG Researcher, F. Hoffmann-La Roche Ltd Researcher, iCAD, Inc

Peter Pinto, Abstract Co-Author: Nothing to Disclose

Bradford J. Wood MD, Abstract Co-Author: Grant, Koninklijke Philips Electronics NV Grant, Celsion Corporation Grant, Biocompatibles International plc Grant, W. L. Gore & Associates, Inc

To describe different methods enabling fusion biopsy for prostate cancer (PCa) as a rapidly emerging technique in GU imaging.

A variety of tools have been developed for fusing MR & TRUS for prostate biopsy. The technologies are described with applications, workflows, strengths & weaknesses. An early phase clinical trial based upon electromagnetic (EM) tracking enrolled > 850 patients who underwent fusion guided prostate biopsy with EM tracking. MR localized suspicious targets for cancer based upon multi-parametric 3T MR (T2, ADC, DCE, Spectroscopy) with an endorectal coil. The prostate capsule was segmented on T2. Targets were defined by GU radiologists & sent to a workstation with segmentations and T2 volumes. Automated rigid registration with optional manual refinement & motion compensation were performed with 2 EM coils attached to the TRUS transducer.

Fusion guided prostate biopsy can be used for at least two very different purposes: 1.) Prospective guidance of biopsy needle towards targets pre-defined on MR. 2.) Mapping & archiving the location of standard blind sextant random conventional biopsies for potential later retrospective referencing (such as for annual relook biopsies in patients with low Gleason scores or undergoing active surveillance or watchful waiting). The UroNav system (In Vivo, Philips Healthcare, Gainsville, FL) is based upon an EM platform. The Artemis system (Eigen, Grass Valley, CA) is based upon mechanical (or “passive robotic”) registration. The Urostation system (Koelis, La Tronche, France) is based upon image fusion and image processing. Whether originally designed for function #1 or #2, most systems can perform both. This tool may have added value for patients with Gleason 6 or 7 (3+4), when it can be helpful to watch with MR and sample with fusion biopsy at some interval. > 12,000 biopsies were performed with simultaneous EM tracking and fusion in an office-like outpatient setting, with patients receiving both standard and fusion biopsies. MR-defined targets were biopsied without the requirement for the physical proximity of the MR gantry.  

Fusion prostate biopsy is a novel tool for referencing TRUS biopsy to prior MR, which may be useful for both prospective targeting or retrospective mapping.

Fusion biopsy improves cancer detection rates, & the radiologist should be aware of at least 3 technologies for this tool.

Amalou, H, Xu, S, Turkbey, B, Choyke, P, Pinto, P, Wood, B, 3 Different Tools to Fuse MR to Ultrasound for Prostate Biopsy.  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13025709.html