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In-bore biopsies of the prostate assisted by a remote-controlled manipulator at 1.5 T

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Abstract

Purpose

To evaluate the technical and clinical utility of a fully MRI-compatible, pneumatically driven remote-controlled manipulator (RCM) for targeted biopsies of the prostate at 1.5 T.

Materials and methods

The data of the first 22 patients that were biopsied under robotic assistance were analyzed. Interventional planning relied on T2-weighted (T2w) turbo spin-echo (TSE) images (axial and sagittal) with a high-b-value diffusion-weighted acquisition added in selected cases. Alignment of the needle guide was controlled with a short balanced SSFP sequence in two oblique planes along the MR-visible sheath. Signals were acquired with a combination of elements from a 30-channel body and a 32-channel spine coil. Biopsy samples were taken with a fully automatic 18-G biopsy gun with a length of 150 or 175 mm.

Results

Mean age was 66.6 years and average PSA level was 11.5 ng/ml. Fourteen out of 22 patients (63%) had received prior biopsies under transrectal ultrasound guidance. Diagnostic MRI reports (before biopsy) involved 17 cases with a single suspicious finding (four PI-RADS 3, one PI-RADS 3–4, eight PI-RADS 4 and nine PI-RADS 5 cases). The median effective procedure time was 33.9 (range 25.0–55.9) min for 16 cases with one CSR and 63.4 (52.7–81.8) min for 5 cases with two CSRs. The biopsy with three CSRs took 74.0 min. Histopathologic examination revealed prostate cancer in 14 of 22 cases.

Conclusion

MR-targeted, transrectal biopsy of the prostate could be reliably performed with a robotic manipulator at a field strength of 1.5 T. Balanced SSFP imaging is considered a viable option for fast procedural control. Follow-up work needs to evaluate to what extent in-bore adjustments and workflow enhancements will contribute to shorter procedure times or higher patient comfort.

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Abbreviations

bSSFP:

Balanced steady-state free precession

BPH:

Benign prostate hyperplasia

CSR:

Cancer-suspicious region

DCE:

Dynamic contrast-enhanced

FOV:

Field-of-view

MR-TRUS-TB:

MR-TRUS fusion biopsy

MR-TB:

MR-targeted biopsy

PZ:

Peripheral zone

PCa:

Prostate cancer

PI-RADS:

Prostate imaging reporting and data system

PSA:

Prostate-specific antigen

RCM:

Remote-controlled manipulator

T2w:

T2-weighted

TSE:

Turbo spin-echo

TZ:

Transitional zone

TRUS:

Transrectal ultrasound

TRUS-B:

TRUS-guided biopsy

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, Haus 4, 04103, Leipzig, Germany

    Nicolas Linder, Alexander Schaudinn, Tim-Ole Petersen, Nikolaos Bailis, Patrick Stumpp, Thomas Kahn, Michael Moche & Harald Busse

  2. Institute of Pathology, University of Leipzig, Leipzig, Germany

    Lars-Christian Horn

  3. Department of Urology, Leipzig University Hospital, Leipzig, Germany

    Jens-Uwe Stolzenburg

Authors
  1. Nicolas Linder
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  2. Alexander Schaudinn
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  3. Tim-Ole Petersen
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  4. Nikolaos Bailis
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  7. Jens-Uwe Stolzenburg
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  10. Harald Busse
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Contributions

NL, AS, MM and HB designed the study. NL, AS, TP, NB, PS, LH, JS and HB performed the acquisition of data. NL and HB analyzed and interpreted the data. NL and HB drafted the manuscript. Critical revision was provided by LH, JS, TK and MM

Corresponding author

Correspondence to Nicolas Linder.

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Conflict of interest

HB has received a speaker honorarium from Siemens Healthcare, Germany. All other authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Ethical approval

Retrospective analysis was approved by the Institutional Review Board at the Medical Faculty of the University of Leipzig.

Informed consent

All patients provided (written) informed consent for the procedure.

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Linder, N., Schaudinn, A., Petersen, TO. et al. In-bore biopsies of the prostate assisted by a remote-controlled manipulator at 1.5 T. Magn Reson Mater Phy 32, 599–605 (2019). https://doi.org/10.1007/s10334-019-00751-5

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  • DOI: https://doi.org/10.1007/s10334-019-00751-5

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