MR-compatible Assistance System for Biopsy in a High-Field-Strength System: Initial Results in Patients with Suspicious Prostate Lesions

Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Radiology (Impact Factor: 6.87). 03/2011; 259(3):903-10. DOI: 10.1148/radiol.11101559
Source: PubMed


To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system.
The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented.
The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed.
Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.

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    • "Recent advances in robotically guided interventions have been successful in assisting placement of needles or related instruments for surgery or interventional procedures [4–9]. Magnetic resonance imaging (MRI)-compatible robots have also been developed despite their significant engineering challenges and are continuing to be investigated for prostate biopsy utilising the potential advantages of multiparametric MRI. "
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    • "Chinese scientists are also producing sealed multi-element transducers that can be coupled to the patient with a water-filled bladder [22]. In the last years, MR-compatible robots have been developed for MR-guided surgery [28] and have been modified to move an HIFU transducer within the MR bore [29,30]. Following this line of thought, we could have not just better clinical HIFU systems, but also systems whose integration in an EBRT environment would be less problematic. "
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    • "Compared to US, MRI provides excellent visualization of the prostate gland with its substructures, focal lesions within the gland and surrounding periprostatic tissues and is widely believed to be the ideal modality for imaging prostate cancer (Beyersdorff et al 2002). In the recent years, researchers have been investigating the clinical utility of MRI for targeted biopsy by fusing the preprocedurally acquired MRI with the intraprocedural US (Ukimura et al 2010, Natarajan et al 2011) or by means of intraoperative MRI for needle and anatomy visualization (Cormack et al 2000, D'Amico et al 2000, Hata et al 2001, Beyersdorff et al 2002, Susil et al 2003, 2004, Menard et al 2004, Krieger et al 2005, Zangos et al 2005, Susil et al 2006, Engelhard et al 2006, Blumenfeld et al 2007, de Oliveira et al 2008, Hambrock et al 2008, Rea et al 2008, Lakosi et al 2009, Oguro et al 2009, Menard et al 2010, 2011, Yakar et al 2011, Zangos et al 2011, Schouten et al 2012). While US-guided biopsy has been emerging because of its availability, portability, and the recent progress in imaging quality of US, MRI-guided biopsy has the advantages of better soft tissue contrast and applicability to patients who cannot undergo TRUS-guided biopsy due to previous total colectomy. "
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