2316 ARTEMIS: AN OFFICE-BASED DEVICE FOR MRI FUSION AND TARGETED PROSTATE BIOPSY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology1 Apr 20112316 ARTEMIS: AN OFFICE-BASED DEVICE FOR MRI FUSION AND TARGETED PROSTATE BIOPSY Leonard Marks, Shyam Natarajan, Daniel Margolis, Jiaoti Huang, Dinesh Kumar, Ramkrishnan Narayanan, Rob Bentley, Maria Luz Macairan, and Patricia Lieu Leonard MarksLeonard Marks Los Angeles, CA More articles by this author , Shyam NatarajanShyam Natarajan Los Angeles, CA More articles by this author , Daniel MargolisDaniel Margolis Los Angeles, CA More articles by this author , Jiaoti HuangJiaoti Huang Los Angeles, CA More articles by this author , Dinesh KumarDinesh Kumar Grass Valley, CA More articles by this author , Ramkrishnan NarayananRamkrishnan Narayanan Grass Valley, CA More articles by this author , Rob BentleyRob Bentley Grass Valley, CA More articles by this author , Maria Luz MacairanMaria Luz Macairan Los Angeles, CA More articles by this author , and Patricia LieuPatricia Lieu Los Angeles, CA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2562AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate biopsy (Bx) has for 3 decades been systematic, guided by transrectal ultrasound (TRUS), but without lesion-targeting or Bx-tracking. We developed a workflow for use of an electro-mechanical device (Artemis, Eigen; FDA approval May08), capable of fusing prior MRI with real-time TRUS images in a urological office suite, allowing Bx of lesions (targets) revealed by MRI and recording of Bx sites. METHODS 195 men, ages 35-84 y.o., underwent 208 Artemis-guided biopsy sessions to rule out prostate cancer (CaP) in our initial use of the device. In the Artemis device, a 3D reconstruction of the prostate was created from TRUS planimetric scans, obtained with a Hitachi 5500. In 54 men, MRI at 3T had lesions measured on T2 images (DM), with suspicion for CaP graded by diffusion-weighted and dynamic contrast imaging. MRimages were entered into an Artemis portal via CD and digitally fused with TRUS (Figure). Using the fused images for guidance, 3 Bx were first taken from any targets, then systematic biopsies were obtained. Bx sites were graphically recorded within the surrogate in all cases. RESULTS Artemis-guided Bx was completed successfully in 164 of the first 208 sessions. Reasons for manual completion were patient motion, positioning difficulties, poor tolerance, or scanning error in prostates >100 gm. After initial experience, MRI fusion Bx was added and entire procedure was completed successfully in 49 of 54 men, requiring additional 5 min./case (total ∼20 min). In determining degree of CaP suspicion (Grade 1–5), DWI was most useful, less diffusion = greater suspicion (Table). Among the most recent 15 cases with MRI fusion, all were completed successfully; Bx showed CaP in 36.5% of targeted cores (19 of 52) vs 8% of systematic Bx cores (9 of 104) in same men, p<0.03; post-Bx tracking showed targeted Bx to be accurate in all cases. In 2 men, CaP was diagnosed only with targeted Bx. Lesion Grade ADC (Sq u/sec) # Targeted Biopsies # Showing CaP 1 >1200 1 0 2 1000-1200 15 0 3 800-1000 32 7 4 600-800 11 6 5 <600 2 1 ADC = apparent diffusion coefficient. CONCLUSIONS The Artemis device may be useful to fuse prostate MRI with real-time TRUS, allowing targeted sampling of suspicious lesions, enhancing the accuracy of Bx. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e928-e929 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leonard Marks Los Angeles, CA More articles by this author Shyam Natarajan Los Angeles, CA More articles by this author Daniel Margolis Los Angeles, CA More articles by this author Jiaoti Huang Los Angeles, CA More articles by this author Dinesh Kumar Grass Valley, CA More articles by this author Ramkrishnan Narayanan Grass Valley, CA More articles by this author Rob Bentley Grass Valley, CA More articles by this author Maria Luz Macairan Los Angeles, CA More articles by this author Patricia Lieu Los Angeles, CA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...