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Magnetic resonance imaging-guided prostate biopsy: present and future.

Kim CK - Korean J Radiol (2015)

Bottom Line: Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value.The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions.A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores.

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74-year-old man with stage T2a Gleason score 3 + 4 prostate cancer (prostate specific antigen = 14.56 ng/mL) in right transition zone (TZ) with history of one previous negative transrectal ultrasound-guided biopsy underwent subsequent multiparametric MRI for clinical suspicion of prostate cancer.A-D. Axial color-coded wash-in/wash-out image (A) and dynamic contrast-enhanced (D) images show asymmetric increased enhancement (cross) in right TZ. This mass demonstrates focal low signal intensity (cross) on axial apparent diffusion coefficient map (B) and T2-weighted (C) images. E. Oblique axial T2-weighted image confirms needle position (arrow) in right TZ. In this MRI-guided biopsy specimen, Gleason score 3 + 4 prostate cancer was found.
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Figure 3: 74-year-old man with stage T2a Gleason score 3 + 4 prostate cancer (prostate specific antigen = 14.56 ng/mL) in right transition zone (TZ) with history of one previous negative transrectal ultrasound-guided biopsy underwent subsequent multiparametric MRI for clinical suspicion of prostate cancer.A-D. Axial color-coded wash-in/wash-out image (A) and dynamic contrast-enhanced (D) images show asymmetric increased enhancement (cross) in right TZ. This mass demonstrates focal low signal intensity (cross) on axial apparent diffusion coefficient map (B) and T2-weighted (C) images. E. Oblique axial T2-weighted image confirms needle position (arrow) in right TZ. In this MRI-guided biopsy specimen, Gleason score 3 + 4 prostate cancer was found.

Mentions: Currently, clinical indications of MRGB for detecting PCa are as following: 1) high suspicion of PCa based on an elevated PSA level and previously negative TRUSBx results (Fig. 3); 2) a rising PSA level and abnormal mp-MRI findings in biopsy-naive men; 3) active surveillance; and 4) biochemical failure after radiation therapy. In a number of studies, MRGB has been mainly performed in patients with elevating or persistently elevated PSA levels and previously negative TRUSBx results (7, 10, 24, 30). Only a few studies have reported the results of MRGB in biopsy-naive men with rising PSA level and abnormal mp-MRI finding (6, 21).


Magnetic resonance imaging-guided prostate biopsy: present and future.

Kim CK - Korean J Radiol (2015)

74-year-old man with stage T2a Gleason score 3 + 4 prostate cancer (prostate specific antigen = 14.56 ng/mL) in right transition zone (TZ) with history of one previous negative transrectal ultrasound-guided biopsy underwent subsequent multiparametric MRI for clinical suspicion of prostate cancer.A-D. Axial color-coded wash-in/wash-out image (A) and dynamic contrast-enhanced (D) images show asymmetric increased enhancement (cross) in right TZ. This mass demonstrates focal low signal intensity (cross) on axial apparent diffusion coefficient map (B) and T2-weighted (C) images. E. Oblique axial T2-weighted image confirms needle position (arrow) in right TZ. In this MRI-guided biopsy specimen, Gleason score 3 + 4 prostate cancer was found.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4296281&req=5

Figure 3: 74-year-old man with stage T2a Gleason score 3 + 4 prostate cancer (prostate specific antigen = 14.56 ng/mL) in right transition zone (TZ) with history of one previous negative transrectal ultrasound-guided biopsy underwent subsequent multiparametric MRI for clinical suspicion of prostate cancer.A-D. Axial color-coded wash-in/wash-out image (A) and dynamic contrast-enhanced (D) images show asymmetric increased enhancement (cross) in right TZ. This mass demonstrates focal low signal intensity (cross) on axial apparent diffusion coefficient map (B) and T2-weighted (C) images. E. Oblique axial T2-weighted image confirms needle position (arrow) in right TZ. In this MRI-guided biopsy specimen, Gleason score 3 + 4 prostate cancer was found.
Mentions: Currently, clinical indications of MRGB for detecting PCa are as following: 1) high suspicion of PCa based on an elevated PSA level and previously negative TRUSBx results (Fig. 3); 2) a rising PSA level and abnormal mp-MRI findings in biopsy-naive men; 3) active surveillance; and 4) biochemical failure after radiation therapy. In a number of studies, MRGB has been mainly performed in patients with elevating or persistently elevated PSA levels and previously negative TRUSBx results (7, 10, 24, 30). Only a few studies have reported the results of MRGB in biopsy-naive men with rising PSA level and abnormal mp-MRI finding (6, 21).

Bottom Line: Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value.The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions.A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

ABSTRACT
Systemic transrectal ultrasound-guided biopsy (TRUSBx) is the standard procedure for diagnosing prostate cancer (PCa), but reveals a limited accuracy for the detection of cancer. Currently, multiparametric MR imaging (mp-MRI) is increasingly regarded as a promising method to detect PCa with an excellent positive predictive value. The use of mp-MRI during a MRI-guided biopsy (MRGB) procedure improves the quality of a targeted biopsy. The aim of this article is to provide an overview about the MRGB technique for PCa detection, to review the accuracy and clinical indications of MRGB and discuss its current issues and further directions. A MRGB seems accurate and efficient for the detection of clinically significant PCa in men with previous negative TRUSBx. Moreover, it may decrease the detection of clinically insignificant cancers with fewer biopsy cores.

Show MeSH
Related in: MedlinePlus