European Radiology

, Volume 28, Issue 6, pp 2690–2699 | Cite as

Feasibility study of MR-guided transgluteal targeted in-bore biopsy for suspicious lesions of the prostate at 3 Tesla using a freehand approach

  • Frank FischbachEmail author
  • Lukas Wien
  • Sascha Krueger
  • Bernhard Schnackenburg
  • Daniel Baumunk
  • Björn Friebe
  • Martin Schostak
  • Jens Ricke
  • Katharina Fischbach



The aim of our study was (1) to establish an in-bore targeted biopsy of suspicious prostate lesions, avoiding bowel penetration using a transgluteal approach and (2) to assess operator setup, patient comfort and safety aspects in the clinical setting for freehand real-time MR-guidance established for percutaneous procedures in an open MR-scanner.

Material and methods

30 patients with suspect prostate lesions were biopsied in a cylindrical 3T-MRI system using a transgluteal approach in freehand technique. One to three biopsies were sampled using continuous dynamic imaging. Size, location and visibility of the lesion, intervention time, needle artefact size, interventional complications and histopathological diagnosis were recorded.


All biopsies were technically successful. Nineteen patients showed evidence of prostate carcinoma. Cancer detection rate was 50 % in patients with previously negative TRUS-biopsy. The average intervention time was 26 min including a learning curve as the time was 13 min by the end of the study. No antibiotic prophylaxis was performed as none of the patients showed signs of infection.


MR-guided targeted freehand biopsies of prostate lesions using a transgluteal approach are both technically feasible and time efficient in a standard closed-bore 3T-MR scanner as well as safe for the individual patient.

Key Points

Open-bore freehand interventional principles were adapted to closed-bore systems.

Prostate MR-guided freehand biopsies were feasible in a clinical setting.

A transgluteal approach provides a short and simplified work flow.

An inoculation of the prostate with bowel flora is avoided.

The intervention time is comparable to the stereotactic approach.


Prostate cancer Prostate biopsy Targeted biopsy Interventional MR Fluoroscopic guidance 



This manuscript is dedicated to our friend and co-author Lukas Wien, who suddenly passed away. Lukas was an extraordinary and kind person and is missed sadly by all of us.


This study received funding by Philips Medical Healthcare.

Compliance with ethical standards


The scientific guarantor of this publication is Frank Fischbach, MD.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Sascha Kruger and Bernhard Schnackenburg are employees of Philips Medical Healthcare.

Frank Fischbach, Katharina Fischbach and Jens Ricke received research grants from Philips Medical Healthcare.

The other authors declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Frank Fischbach
    • 1
    Email author
  • Lukas Wien
    • 1
  • Sascha Krueger
    • 2
  • Bernhard Schnackenburg
    • 2
  • Daniel Baumunk
    • 3
  • Björn Friebe
    • 1
  • Martin Schostak
    • 3
  • Jens Ricke
    • 1
  • Katharina Fischbach
    • 1
  1. 1.Department of RadiologyOtto von Guericke University, Medical SchoolMagdeburgGermany
  2. 2.Philips HealthcarePhilips GmbH Innovative TechnologiesHamburgGermany
  3. 3.Department of UrologyOtto von Guericke University, Medical SchoolMagdeburgGermany

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