MP19-10 CAN MAGNETIC RESONANCE/ULTRASOUND FUSION IMAGING TECHNOLOGY BE USED FOR REAL TIME IMAGE GUIDANCE DURING FOCAL SURGICAL THERAPY FOR PROSTATE CANCER? A FEASIBILITY STUDY.

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology III1 Apr 2016MP19-10 CAN MAGNETIC RESONANCE/ULTRASOUND FUSION IMAGING TECHNOLOGY BE USED FOR REAL TIME IMAGE GUIDANCE DURING FOCAL SURGICAL THERAPY FOR PROSTATE CANCER? A FEASIBILITY STUDY. Haidar Abdul-Muhsin, Akira Kawashima, Alvin Silva, Melissa Stanton, Gianni Moshero, Erik Castle, Paul Andrews, and Mitchell Humphreys Haidar Abdul-MuhsinHaidar Abdul-Muhsin More articles by this author , Akira KawashimaAkira Kawashima More articles by this author , Alvin SilvaAlvin Silva More articles by this author , Melissa StantonMelissa Stanton More articles by this author , Gianni MosheroGianni Moshero More articles by this author , Erik CastleErik Castle More articles by this author , Paul AndrewsPaul Andrews More articles by this author , and Mitchell HumphreysMitchell Humphreys More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2758AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multiparametric magnetic resonance imaging (mMRI) opened up a new frontier in the management of prostate cancer. The most common application to date is the fusion with ultrasound images to provide real time targeted guidance during prostate biopsies. However, the potential of this technology to determine the limits of surgical intervention has not been previously assessed to provide real time guidance in focal surgical therapy METHODS In a cadaveric model, multi-focal localized prostate cancer was simulated using two 3x1mm MRI-compatible fiducial markers (PolymarkTM from CIVCO medical solution, Coralville, IA, USA). These were used to generate regions of interests (ROIs) on a 1.5 T surface coil MRI. The first marker was placed in the right peripheral zone at the mid gland (ROI 1) and the second marker was placed in the left seminal vesicle (ROI 2) as a referent for subsequent MRI imaging. A limited mMRI of the specimen was done after marker placement and following focal surgical excision. The radiologist created ROIs using UroNavTM fusion biopsy system (Invivo, Gainsville, FL, USA) at each marker as well as two additional ROIs that represented intrinsic lesions seen on imaging: the left transitional zone, ROI 3 (suspicious for benign prostate hyperplasia nodule) and the right anterior peripheral zone, ROI 4 (suspicious for prostate cancer). The procedure was done in the following sequence: First, Holmium laser resection of transitional zone BPH nodule, ROI 3. Second, Holmium Laser enucleation of the prostate (HoLEP) was performed to gain access to the peripheral zone. Third, a repeat MRI/US fusion imaging was done to confirm the locations of the remaining ROIs after HoLEP followed by Laser enucleation (ROIs 1 and 4). Finally the MRI/US fusion imaging was repeated to confirm the absence of the targeted ROIs which was followed by a final confirmatory mMRI RESULTS There was some image distortion with the initial MRI/US fusion imaging that resolved on subsequent imaging attributed to dehydration of the cadaver. Real time MRI/US fusion imaging consistently identified the target lesions during the procedure at the locations designated as ROIs. Successful demonstration of image confirmation during resection of the targeted lesions during the procedure was possible and was confirmed with post procedural MRI CONCLUSIONS Real time MRI/US fusion technology can be used to guide focal surgical therapy in the prostate. Additional effort to standardize the procedure and examine the reproducibility is necessary © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e207 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Haidar Abdul-Muhsin More articles by this author Akira Kawashima More articles by this author Alvin Silva More articles by this author Melissa Stanton More articles by this author Gianni Moshero More articles by this author Erik Castle More articles by this author Paul Andrews More articles by this author Mitchell Humphreys More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...