MR-Guided Interventions for Prostate Cancer

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MR imaging for prostate cancer

It is unfortunate that there is no single imaging method that embodies all of the optimal characteristics for the integration of diagnostic and interventional procedures for prostate cancer. CT permits accurate spatial visualization of interventional devices (Fig. 1A) but does not provide real-time feedback or adequate soft tissue delineation. Transrectal ultrasound (TRUS) is the current “gold standard” for guiding prostate interventions due to its ease of use and real-time image feedback. Soft

Needle core biopsy

Currently, prostate biopsy is conducted under TRUS guidance. Although a positive biopsy result is a clear indication of cancer, a negative biopsy result is often indefinite and problematic because it is known that the sextant biopsy procedure has a relatively low sensitivity and high sampling error [25]. To address this problem, an 8- to 10-biopsy regimen, depending on prostate size, has been proposed [26], with sensitivity increasing up to 80%. Repeat sextant biopsy is another approach, which

Permanent implant

For patients with localized prostate cancer at low risk for extraprostatic extension, permanent-seed brachytherapy is an accepted and effective minimally invasive treatment strategy. Radioactive seeds are conventionally placed and left throughout the prostate gland under ultrasound guidance using a transperineal template. One important performance measure of the procedure is the proportion of the prostate gland receiving the minimum desired dose. Treatment-related toxicity is associated with

Thermal therapy

The role of thermal therapies for patients with prostate cancer remains investigational at this time. Beyond anatomic guidance, there is a strong rationale for integrating thermal treatment, specifically heat therapy, in the MR imaging environment where temperature can be monitored noninvasively during the procedure [59]. This treatment has been demonstrated by Chen and colleagues [60], whereby patients who had locally recurrent prostate carcinoma received percutaneous interstitial microwave

Summary

MR imaging is currently the most effective diagnostic imaging tool for visualizing the anatomy and pathology of the prostate gland. Currently, the practicality and cost effectiveness of transrectal ultrasound dominates image guidance for needle-based prostate interventions. Challenges to the integration of diagnostic and interventional MR imaging have included the lack of real-time feedback, the complexity of the imaging technique, and limited access to the perineum within the geometric

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    This work was supported in part by the National Science Foundation grant NSF ERC9731478, the US Army grant PC10029, and the National Institutes of Health grants R01 HL 57483 and R01 HL 61672.

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