Trans-rectal interventional MRI: initial prostate biopsy experience
2010
Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate gland when evaluated along with
T2-weighted images, diffusion-weighted images (DWI) and their corresponding apparent diffusion coefficient (ADC)
maps can yield valuable information in patients with rising or elevated serum prostate-specific antigen (PSA) levels 1 . In
some cases, patients present with multiple negative trans-rectal ultrasound (TRUS) biopsies, often placing the patient
into a cycle of active surveillance. Recently, more patients are undergoing TRIM for targeted biopsy of suspicious
findings with a cancer yield of ~59% compared to 15% for second TRUS biopsy 2 to solve this diagnostic dilemma and
plan treatment. Patients were imaged in two separate sessions on a 1.5T magnet using a cardiac phased array parallel
imaging coil. Automated CAD software was used to identify areas of wash-out. If a suspicious finding was identified on
all sequences it was followed by a second imaging session. Under MRI-guidance, cores were acquired from each target
region 3 . In one case the microscopic diagnosis was prostatic intraepithelial neoplasia (PIN), in the other it was invasive
adenocarcinoma. Patient 1 had two negative TRUS biopsies and a PSA level of 9ng/mL. Patient 2 had a PSA of
7.2ng/mL. He underwent TRUS biopsy which was negative for malignancy. He was able to go on to treatment for his
prostate carcinoma (PCa) 4 . MRI may have an important role in a subset of patients with multiple negative TRUS
biopsies and elevated or rising PSA.
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