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MAGMA. 2019 May 9. doi: 10.1007/s10334-019-00751-5. [Epub ahead of print]

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

Author information

1
Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, Haus 4, 04103, Leipzig, Germany. Nicolas.Linder@medizin.uni-leipzig.de.
2
Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstrasse 20, Haus 4, 04103, Leipzig, Germany.
3
Institute of Pathology, University of Leipzig, Leipzig, Germany.
4
Department of Urology, Leipzig University Hospital, Leipzig, Germany.

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.

KEYWORDS:

Biopsy; Magnetic resonance imaging; Needle; Prostatic neoplasms; Robotics

PMID:
31073867
DOI:
10.1007/s10334-019-00751-5

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