Skip to main content
Log in

MR/US Fusion Technology: What Makes It Tick?

  • New Imaging Techniques (S Rais-Bahrami and A George, Section Editors)
  • Published:
Current Urology Reports Aims and scope Submit manuscript

Abstract

MR/US fusion biopsy has emerged as a significant refinement of traditional prostate cancer diagnostic techniques. Utilizing not only quantitative imaging suspicion information from mpMRI but also the spatial accuracy and three-dimensional localization allows such strategies to specifically sample areas of concern with the gland. As such, diagnostic certainty is markedly improved. In this manuscript, we aim to highlight the multidisciplinary approach (amongst urologists, radiologists, pathologists, imaging technologists, nursing staff, and patients) which is required to launch and maintain a successful prostate imaging program.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Moyer VA. Force USPST. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(2):120–34.

    Article  PubMed  Google Scholar 

  2. • Turkbey B, Mani H, Shah V, et al. Multiparametric 3T prostate magnetic resonance imaging to detect cancer: histopathological correlation using prostatectomy specimens processed in customized magnetic resonance imaging based molds. J Urol. 2011;186(5):1818–24. This work represents the initial true “gold standard” comparator of mpMRI vs surgical histopathology due to novel 3-d printed whole mount molds which allow the prostate speciment to be incised directly along the cooresponding imaging plane.

  3. Haas GP, Delongchamps NB, Jones RF, et al. Needle biopsies on autopsy prostates: sensitivity of cancer detection based on true prevalence. J Natl Cancer Inst. 2007;99(19):1484–9.

    Article  PubMed  Google Scholar 

  4. Pinto PA, Chung PH, Rastinehad AR, et al. Magnetic resonance imaging/ultrasound fusion guided prostate biopsy improves cancer detection following transrectal ultrasound biopsy and correlates with multiparametric magnetic resonance imaging. J Urol. 2011;186(4):1281–5.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Vourganti S, Rastinehad A, Yerram NK, et al. Multiparametric magnetic resonance imaging and ultrasound fusion biopsy detect prostate cancer in patients with prior negative transrectal ultrasound biopsies. J Urol. 2012;188(6):2152–7.

    Article  PubMed  PubMed Central  Google Scholar 

  6. •• Siddiqui MM, Rais-Bahrami S, Turkbey B, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA. 2015;313(4):390–7. An important work highlighting the first thousand men enrolled in the NCI series of MR/US fusion biopsy. A comparison is made between diagnostic performance of targeted biopsy and systematic screening. The merits of target only biopsy are explored.

  7. Walton Diaz A, Hoang AN, Turkbey B, et al. Can magnetic resonance-ultrasound fusion biopsy improve cancer detection in enlarged prostates? J Urol. 2013;190(6):2020–5.

    Article  PubMed  Google Scholar 

  8. de Gorski A, Roupret M, Peyronnet B, et al. Accuracy of magnetic resonance imaging/ultrasound fusion targeted biopsies to diagnose clinically significant prostate cancer in enlarged compared to smaller prostates. J Urol. 2015;194(3):669–73.

    Article  PubMed  Google Scholar 

  9. Nix JW, Turkbey B, Hoang A, et al. Very distal apical prostate tumours: identification on multiparametric MRI at 3 Tesla. BJU Int. 2012;110(11 Pt B):E694–700.

    Article  PubMed  Google Scholar 

  10. Volkin D, Turkbey B, Hoang AN, et al. Multiparametric magnetic resonance imaging (MRI) and subsequent MRI/ultrasonography fusion-guided biopsy increase the detection of anteriorly located prostate cancers. BJU Int. 2014;114(6b):E43–49.

    Article  CAS  PubMed  Google Scholar 

  11. Radtke JP, Boxler S, Kuru TH, et al. Improved detection of anterior fibromuscular stroma and transition zone prostate cancer using biparametric and multiparametric MRI with MRI-targeted biopsy and MRI-US fusion guidance. Prostate Cancer Prostatic Dis. 2015;18(3):288–96.

    Article  CAS  PubMed  Google Scholar 

  12. Gordetsky JB, Nix JW, Rais-Bahrami S. Perineural invasion in prostate cancer is more frequently detected by multiparametric MRI targeted biopsy compared with standard biopsy. Am J Surg Pathol. 2016;40(4):490–4.

    Article  PubMed  Google Scholar 

  13. Raskolnikov D, George AK, Rais-Bahrami S, et al. Multiparametric magnetic resonance imaging and image-guided biopsy to detect seminal vesicle invasion by prostate cancer. J Endourol. 2014;28(11):1283–9.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Raskolnikov D, George AK, Rais-Bahrami S, et al. The role of magnetic resonance image guided prostate biopsy in stratifying men for risk of extracapsular extension at radical prostatectomy. J Urol. 2015;194(1):105–11.

    Article  PubMed  Google Scholar 

  15. NCCN Guidelines Version 2.2016 Prostate Cancer Early Detection. https://www.nccn.org/professionals/physician_gls/pdf/prostate_detection.pdf. Accessed 6/25/2016.

  16. American Urological Association (AUA) and Society of Abdominal Radiology (SAR) Joint Consensus Statement. Prostate MRI and MRI-Targeted Biopsy in Patients With Prior Negative Biopsy. Collaborative Initiative of the American Urological Association and the Society of Abdominal Radiology’s Prostate Cancer Disease-Focused Panel. https://c.ymcdn.com/sites/abdominalradiology.site-ym.com/resource/resmgr/Edu_DFPprostate/AUA-SAR.pdf. Accessed 6/25/2016.

  17. Vargas HA, Akin O, Afaq A, et al. Magnetic resonance imaging for predicting prostate biopsy findings in patients considered for active surveillance of clinically low risk prostate cancer. J Urol. 2012;188(5):1732–8.

    Article  PubMed  Google Scholar 

  18. Park BH, Jeon HG, Choo SH, et al. Role of multiparametric 3.0-Tesla magnetic resonance imaging in patients with prostate cancer eligible for active surveillance. BJU Int. 2014;113(6):864–70.

    Article  PubMed  Google Scholar 

  19. Stamatakis L, Siddiqui MM, Nix JW, et al. Accuracy of multiparametric magnetic resonance imaging in confirming eligibility for active surveillance for men with prostate cancer. Cancer. 2013;119(18):3359–66.

    Article  PubMed  Google Scholar 

  20. Hu JC, Chang E, Natarajan S, et al. Targeted prostate biopsy in select men for active surveillance: do the Epstein criteria still apply? J Urol. 2014;192(2):385–90.

    Article  PubMed  PubMed Central  Google Scholar 

  21. • Walton Diaz A, Shakir NA, George AK, et al. Use of serial multiparametric magnetic resonance imaging in the management of patients with prostate cancer on active surveillance. Urol Oncol. 2015;33(5):202 e201–207. This report (along with Felker et al below) represents the first longitudinal follow-up of men with MR/US FB on Active Surveillance for low risk prostate cancer.

  22. Felker ER, Wu J, Natarajan S, et al. Serial magnetic resonance imaging in active surveillance of prostate cancer: incremental value. J Urol. 2016;195(5):1421–7.

    Article  PubMed  Google Scholar 

  23. Muller BG, Kaushal A, Sankineni S, et al. Multiparametric magnetic resonance imaging-transrectal ultrasound fusion-assisted biopsy for the diagnosis of local recurrence after radical prostatectomy. Urol Oncol. 2015;33(10):425 e421–426.

    Article  Google Scholar 

  24. Dedini RD, Karacozoff AM, Shellock FG, Xu D, McClellan RT, Pekmezci M. MRI issues for ballistic objects: information obtained at 1.5-, 3- and 7-Tesla. Spine J. 2013;13(7):815–22.

    Article  PubMed  Google Scholar 

  25. Pinkstaff DM, Igel TC, Petrou SP, Broderick GA, Wehle MJ, Young PR. Systematic transperineal ultrasound-guided template biopsy of the prostate: three-year experience. Urology. 2005;65(4):735–9.

    Article  PubMed  Google Scholar 

  26. Bott SR, Henderson A, Halls JE, Montgomery BS, Laing R, Langley SE. Extensive transperineal template biopsies of prostate: modified technique and results. Urology. 2006;68(5):1037–41.

    Article  PubMed  Google Scholar 

  27. Medved M, Sammet S, Yousuf A, Oto A. MR imaging of the prostate and adjacent anatomic structures before, during, and after ejaculation: qualitative and quantitative evaluation. Radiology. 2014;271(2):452–60.

    Article  PubMed  PubMed Central  Google Scholar 

  28. • Turkbey B, Merino MJ, Gallardo EC, et al. Comparison of endorectal coil and nonendorectal coil T2W and diffusion-weighted MRI at 3 Tesla for localizing prostate cancer: correlation with whole-mount histopathology. J Magn Reson Imaging. 2014;39(6):1443–8. This meticulous study highlights the merits of endorectal coil even in the era of 3 Tesla field strength magnets.

  29. • Logan JK, Rais-Bahrami S, Turkbey B, et al. Current status of magnetic resonance imaging (MRI) and ultrasonography fusion software platforms for guidance of prostate biopsies. BJU Int. 2014;114(5):641–52. A comprehensive overview of various MR/US fusion plaforms, with detailed comparisons highlighted.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Puech P, Ouzzane A, Gaillard V, et al. Multiparametric MRI-targeted TRUS prostate biopsies using visual registration. Biomed Res Int. 2014;2014:819360.

    Article  PubMed  PubMed Central  Google Scholar 

  31. • Wysock JS, Rosenkrantz AB, Huang WC, et al. A prospective, blinded comparison of magnetic resonance (MR) imaging-ultrasound fusion and visual estimation in the performance of MR-targeted prostate biopsy: the PROFUS trial. Eur Urol. 2014;66(2):343–51. A novel trial demonstrating the merits of targeted biopsy in absence of fusion biopsy platforms.

    Article  PubMed  Google Scholar 

  32. Chiu LP, Tung HH, Lin KC, et al. Effectiveness of stress management in patients undergoing transrectal ultrasound-guided biopsy of the prostate. Patient Prefer Adherence. 2016;10:147–52.

    PubMed  PubMed Central  Google Scholar 

  33. Hong CW, Rais-Bahrami S, Walton-Diaz A, et al. Comparison of magnetic resonance imaging and ultrasound (MRI-US) fusion-guided prostate biopsies obtained from axial and sagittal approaches. BJU Int. 2015;115(5):772–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Current Urology Reports would like to thank Dr. Art Rastinehad for his assistance with the topic and review.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Srinivas Vourganti.

Ethics declarations

Conflict of Interest

Srinivas Vourganti, Norman Starkweather, and Andrij Wojtowycz each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on New Imaging Techniques

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vourganti, S., Starkweather, N. & Wojtowycz, A. MR/US Fusion Technology: What Makes It Tick?. Curr Urol Rep 18, 20 (2017). https://doi.org/10.1007/s11934-017-0671-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11934-017-0671-1

Keywords

Navigation