Lars Schimmoeller MD, Presenter: Nothing to Disclose

Michael Quentin MD, Abstract Co-Author: Nothing to Disclose

Christian Arsov MD, Abstract Co-Author: Nothing to Disclose

Frederic Dietzel, Abstract Co-Author: Nothing to Disclose

Gerald Antoch MD, Abstract Co-Author: Speaker, Siemens Medical AG Speaker, Bayer AG Speaker, BTG International Ltd

Dirk Blondin MD, Abstract Co-Author: Nothing to Disclose

Andreas Hiester, Abstract Co-Author: Nothing to Disclose

Robert Rabenalt, Abstract Co-Author: Nothing to Disclose

Peter Albers MD, PhD, Abstract Co-Author: Nothing to Disclose

Retrospective investigation of patient comfort during MR-guided in-bore and MRI/ultrasound (MRI/US) fusion-guided prostate biopsies.

260 patients with MR-guided in-bore biopsies and prior intrarectal instillation of 2% lidocaine gel (group A, n=67) or periprostatic nerve block (PPNB) with 2% mepivacaine (group B, n=128), and patients with MRI/US fusion-guided biopsies plus additional systematic transrectal, ultrasound-guided biopsy and prior application of PPNB with 2% mepivacaine (group C, n=65) were included. The maximal procedural pain (MPP) was based on a 0-10 visual analog scale and the operating room time (ORT) was recorded for each biopsy session.

Patients in group A had significantly higher biopsy-related MPP scores (3.1±2.1) compared to subjects in group B (2.0±1.9; p<0.01) or group C (1.8±1.7; p<0.01). Pain did not significantly differ between group B and group C (p=0.84). Biopsies in group C required significantly less time (29.4±11.3 minutes) compared to biopsies in group A (41.4±10.8; p<0.01) and group B (39.3±10; p<0.01). There was a weak correlation between MPP scores and ORT (rS=0.25, rS=0.22 and rS=0.27 for groups A, B and C, respectively), but no correlation between MPP scores and number of targeted cores or prostate volume. Increased experience led to a reduction of the mean ORT in each biopsy technique.

MR-guided in-bore and MRI/US fusion-guided biopsies are equal in terms of MPP using the same analgesic technique. With PPNB during MR-guided in-bore biopsy patients report significantly less pain compared to intrarectal instillation of lidocaine gel. The MRI/US fusion-guided biopsy is superior in terms of ORT.

Pain levels are low for both targeted MR-guided biopsy techniques. Using the same analgesic technique both biopsy techniques are equal to each other. For the MR-guided biopsy patients report significantly less pain with prior PPNB compared to intrarectal instillation of a local anesthetic. The MRI/US fusion-guided biopsy can easily incorporate a targeted and systematic biopsy into one session requiring less time compared to MR-guided in-bore biopsy.

Schimmoeller, L, Quentin, M, Arsov, C, Dietzel, F, Antoch, G, Blondin, D, Hiester, A, Rabenalt, R, Albers, P, Pain during MR-guided In-bore and MRI/US-fusion Prostate Biopsy: Comparison of Different Analgesic Techniques.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14045548.html