Fast 3-T MR-guided transrectal prostate biopsy using an in-room tablet device for needle guide alignment: a feasibility study

Abstract

ObjectivesTo assess the feasibility of adding a tablet device inside the scanner room to assist needle-guide alignment during magnetic resonance (MR)-guided transrectal prostate biopsy.MethodsTwenty patients with one cancer-suspicious region (CSR) with PI-RADS score ≥ 4 on diagnostic multiparametric MRI were prospectively enrolled. Two orthogonal scan planes of an MR fluoroscopy sequence (~3 images/s) were aligned to the CSR and needle-guide pivoting point. Targeting was achieved by manipulating the needle-guide under MR fluoroscopy feedback on the in-room tablet device. Technical feasibility and targeting success were assessed. Complications and biopsy procedure times were also recorded.ResultsNeedle-guide alignment with the in-room tablet device was technically successful in all patients and allowed sampling after a single alignment step in 19/20 (95%) CSRs (median size 14 mm, range: 4-45). Biopsy cores contained cancer in 18/20 patients. There were no per-procedural or post-biopsy complications. Using the tablet device, the mean time to first biopsy was 5.8 ± 1.0 min and the mean total procedure time was 23.7 ± 4.1 min.ConclusionsUse of an in-room tablet device to assist needle-guide alignment was feasible and safe during MR-guided transrectal prostate biopsy. Initial experience indicates potential for procedure time reduction.Key Points• Performing MR-guided prostate biopsy using an in-room tablet device is feasible.• CSRs could be sampled after a single alignment step in 19/20 patients.• The mean procedure time for biopsy with the tablet device was 23.7 min.Electronic supplementary materialThe online version of this article (10.1007/s00330-018-5497-9) contains supplementary material, which is available to authorized users.

Real‐Time Magnetic Resonance Imaging

“…Most in-bore biopsy procedures of prostate, liver, breast, and brain lesions use standard T2-weighted, T1-weighted, diffusion-weighted, or dynamic contrast-enhanced imaging for iterative confirmation of needle placement (113,114,128), with a few studies employing high frame-rate dynamic needle guidance (129,130). MRI-guided cardiovascular procedures are the most technically demanding, requiring rapid multi-planar imaging for device navigation.…”

“…129 Most in-bore biopsy procedures of prostate, liver, breast, and brain lesions use standard T 2 -weighted, T 1 -weighted, diffusion-weighted, or dynamic contrast-enhanced imaging for iterative confirmation of needle placement, 117,118,130 with a few studies employing high frame-rate dynamic needle guidance. 131,132 MRI-guided cardiovascular procedures are the most technically demanding, requiring rapid multiplanar imaging for device navigation. Most commonly, a 2D Cartesian bSSFP acquisition is used, in combination with parallel imaging, to achieve 5-10 frames/sec, with magnetization preparation pulses for contrast variation (Fig.…”