Real-time Virtual Sonography Research Articles

Performance of Combined Magnetic Resonance Imaging/Ultrasound Fusion-guided and Systematic Biopsy of the Prostate in Biopsy-naïve Patients and Patients with Prior Biopsies

BackgroundAs recent prospective studies showed targeted biopsies (TBs) to be superior to systematic biopsies (SBs), magnetic resonance imaging (MRI) is gaining wider acceptance in the diagnostic setup of prostate cancer (PCa). ObjectiveTo examine the performance of MRI/ultrasound fusion-guided TB in combination with SB in the detection of PCa in patients with and without prior biopsy. Design, setting, and participantsA total of 219 men undergoing combined transrectal TB and 12-core SB from February 2014 to November 2018 were analysed. For all patients showing a suspicion of PCa in multiparametric MRI, TB was performed using fusion imaging with real-time virtual sonography. Outcome measurements and statistical analysisCancer detection rates (CDRs) and significant CDRs for TB, SB, and TB+SB were analysed. Further stratification was performed for a number of previous biopsy sessions and Prostate Imaging Reporting and Data System (PI-RADS) score. Significant PCa was defined as any PCa with Gleason score ≥3+4. Results and limitationsOf all, 141 patients were biopsy naïve, while 78 patients had at least one prior biopsy. Median prostate-specific antigen (PSA) level prior to biopsy was 8.4ng/ml (interquartile range 5.5–11.8ng/ml). The overall CDR was 63.5% (139/219), while the PI-RADS–dependent CDRs for the combination of TB+SB were 29.1%, 67.7%, and 86.2% for patients with PI-RADS 3, 4, and 5, respectively. Looking at TB or SB alone, CDRs were 55.7% and 57.5%. The overall CDR for significant PCa was 51.6%. (18.2%, 50.5%, and 81.5% for PI-RADS 3, 4, and 5, respectively). CDRs were significantly higher for biopsy-naïve patients (65.2% vs 67.4% vs 71.6% for TB vs SB vs TB+SB) than for patients with one previous negative biopsy (38.2% vs 43.6% vs 50.9% for TB vs SB vs TB+SB; all p<0.01). ConclusionsMultiparametric MRI can raise the CDR in patients with and without biopsies performed earlier. With higher PI-RADS lesions, the risk of harbouring PCa increases. Combining TB with SB further improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy. Patient summaryMultiparametric magnetic resonance imaging before prostate biopsy increases cancer detection rates in biopsy-naïve patients and patients with a previous negative biopsy. The combination of targeted biopsy with systematic biopsy improved the diagnostic accuracy in biopsy-naïve patients and after one previous negative biopsy.

Usefulness of intestinal real-time virtual sonography in patients with inflammatory bowel disease.

Transabdominal ultrasonography (US) examination for the intestine is often difficult, and its precedence for intestinal examination depends on accessibility to experienced ultrasonographers. Real-time virtual sonography (RVS) assists examination of US as a fusion method by synchronizing US images with pre-captured computed tomography or magnetic resonance images. We aimed to evaluate the feasibility to use RVS for the examination of the intestine. The time to scan three parts of the intestine was compared between conventional US and RVS in seven participants without intestinal diseases. Whether RVS accurately synchronized US images with reference images of intestinal target lesions was judged in 20 patients with inflammatory bowel disease. Examination time to scan the ascending colon and the ileocecum using intestinal RVS was significantly shorter than that using conventional US alone (36.7 vs 50.0s [P=0.0313] and 35.4 vs 66.4s [P=0.0156], respectively) in participants without intestinal diseases. Well-synchronized US images of the intestinal lesions, such as stenosis, with reference computed tomography/magnetic resonance images were obtained by RVS in all the lesions in the fixed parts of the colon (ascending and descending colon), and images of nine lesions in 12 lesions (75%) were well synchronized in the unfixed part of the intestine in Crohn's disease patients. Real-time virtual sonography significantly reduced the examination time of intestinal US. Intestinal RVS can help the ultrasonographer to guide the US probe to detect and monitor intestinal lesions by synchronizing reference images, especially in inflammatory bowel disease patients (UMIN Clinical Trials Registry number: UMIN000011571).

Precise Navigation of the Surgical Plane with Intraoperative Real-time Virtual Sonography and 3D Simulation in Liver Resection

The precise intraoperative navigation of the surgical plane remains challenging in liver surgery; however, an innovative imaging technique—real-time virtual sonography (RVS)—may provide a solution. In this modality, preoperative three-dimensional (3D) resection simulation data are transmitted to an RVS workstation and can be used in combination with intraoperative ultrasound to navigate the surgical plane in real time. This paper describes this technique and our experiences in detail. From November 2015 to March 2017, 26 patients with primary liver cancer underwent liver resection under RVS navigation. The operative procedures employed included hemihepatectomy, bisegmentectomy, segmentectomy, and limited resection. RVS was utilized uneventfully and successfully in each operation. The median time required for spatial position registration was 3 (1–12) min, and as the case volume increased, the time required for registration markedly decreased. The surgical plane under RVS navigation was consistent with that of the preoperative plan, and the resection margin was confirmed negative in each case. In conclusion, RVS in combination with 3D simulation is a feasible, safe, and promising technique for the precise intraoperative navigation of liver resection for primary liver cancer. It could be applied to other resectable liver diseases and may be utilized in other centers.

Pre-Operative Planning Using Real-Time Virtual Sonography, an MRI/Ultrasound Image Fusion Technique, for Breast-Conserving Surgery in Patients with Non-Mass Enhancement on Breast MRI: A Preliminary Study

The purpose of this retrospective study was to evaluate the effect of pre-operative planning using real-time virtual sonography (RVS), a magnetic resonance imaging (MRI)/ultrasound (US) image fusion technique on breast-conserving surgery (BCS) in patients with non-mass enhancement (NME) on breast MRI. Between 2011 and 2015, we enrolled 12 consecutive patients who had lesions with NME that exceeded the US hypo-echoic area, in which it was particularly difficult to evaluate the tumor margin. During pre-operative planning before breast-conserving surgery, RVS was used to delineate the enhancing area on the breast surface after additional supine breast MRI was performed. We analyzed both the surgical margin positivity rate and the re-operation rate. All NME lesions corresponded to the index cancer. In all patients, the diameter of the NME lesion was greater than that of the hypo-echoic lesion. The median diameters of the NME and hypo-echoic lesions were 24 mm (range: 12–39 mm) and 8.0 mm (range: 4.9–18 mm), respectively (p = 0.0002). After RVS-derived skin marking was performed on the surface of the affected breast, lumpectomy and quadrantectomy were conducted in 7 and 5 patients, respectively. The surgical margins were negative in 10 (83%) patients. Two patients with positive margins were found to have ductal carcinoma in situ in 1 duct each, 2.4 and 3.2 mm from the resection margin, respectively. None of the patients required additional resection. Although further prospective studies are required, the findings of our preliminary study suggest that it is very well possible that the use of RVS-derived skin marking during pre-operative planning for BCS in patients with NME would have resulted in surgical outcomes similar to or better than those obtained without the use of such marking.

A prospective study of magnetic resonance imaging and ultrasonography (MRI/US)-fusion targeted biopsy and concurrent systematic transperineal biopsy with the average of 18-cores to detect clinically significant prostate cancer

BackgroundThis study compared the detection rates for clinically significant prostate cancer (CSPC) between magnetic resonance imaging and ultrasonography (MRI/US)-fusion-targeted biopsy (TB), systematic biopsy (SB) and combination of TB and SB.MethodsThis prospective study evaluated simultaneous TB and SB for consecutive patients with suspicious lesions that were detected using pre-biopsy multiparametric MRI. A commercially available real-time virtual sonography system was used to perform the MRI/US-fusion TB with the transperineal technique. The prostate imaging reporting and data system version 2 (PI-RADS v2) was assigned to categorize the suspicious lesions.ResultsA total of 177 patients were included in this study. The detection rate for CSPC was higher using SB, compared to TB (57.1% vs 48.0%, p = 0.0886). The detection rate for CSPC was higher using the combination of TB and SB, compared to only SB (63.3% vs 57.1%, p = 0.2324). Multivariate analysis revealed that PIRADS v2 category 4 and an age of <65 years were independent predictors for TB upgrading (vs. the SB result).ConclusionsPI-RADS v2 category 4 and an age of <65 years were predictive factors of upgrading the Gleason score by MRI/US-fusion TB. Thus, MRI/US-fusion TB may be appropriate for patients with those characteristics.Trial registrationThis study was retrospectively registered at the University Hospital Medical Information Network (UMINID000025911) in Jan 30, 2017.

A New Navigation System of Renal Puncture for Endoscopic Combined Intrarenal Surgery: Real-time Virtual Sonography-guided Renal Access

To evaluate the clinical utility of a new navigation technique for percutaneous renal puncture using real-time virtual sonography (RVS) during endoscopic combined intrarenal surgery. Thirty consecutive patients who underwent endoscopic combined intrarenal surgery for renal calculi, between April 2014 and July 2015, were divided into the RVS-guided puncture (RVS; n = 15) group and the ultrasonography-guided puncture (US; n = 15) group. In the RVS group, renal puncture was repeated until precise piercing of a papilla was achieved under direct endoscopic vision, using the RVS system to synchronize the real-time US image with the preoperative computed tomography image. In the US group, renal puncture was performed under US guidance only. In both groups, 2 urologists worked simultaneously to fragment the renal calculi after inserting the miniature percutaneous tract. The mean sizes of the renal calculi in the RVS and the US group were 33.5 and 30.5 mm, respectively. A lower mean number of puncture attempts until renal access through the calyx was needed for the RVS compared with the US group (1.6 vs 3.4 times, respectively; P = .001). The RVS group had a lower mean postoperative hemoglobin decrease (0.93 vs 1.39 g/dL, respectively; P = .04), but with no between-group differences with regard to operative time, tubeless rate, and stone-free rate. None of the patients in the RVS group experienced postoperative complications of a Clavien score ≥2, with 3 patients experiencing such complications in the US group. RVS-guided renal puncture was effective, with a lower incidence of bleeding-related complications compared with US-guided puncture.

Second-look US Using Real-time Virtual Sonography, a Coordinated Breast US and MRI System with Electromagnetic Tracking Technology: A Pilot Study

Our aim was to retrospectively evaluate the utility of second-look ultrasound (US) using real-time virtual sonography (RVS) for detection of conventional B-mode (cB-mode) occult magnetic resonance imaging (MRI)-detected breast lesions. Between July 2011 and May 2015, 53 consecutive patients who underwent second-look US to identify lesions detected by prone MRI were enrolled in this study. Second-look US using RVS was performed for cB-mode occult MRI-detected breast lesions after an additional supine MRI. In the 53 patients, 59 lesions were initially detected by prone MRI, followed by second-look US. Of the 59 lesions, 20 (34%) were identified by second-look US using cB-mode. Of the 39 (66%) cB-mode occult lesions, 38 (97%) were detected in supine MRI and 33 (85%) were detected by second-look US using RVS. MRI morphology types of the 33 lesions were as follows: mass, 16; non-mass enhancement, 5; and focus, 12. US-guided biopsy under RVS or excisional biopsy demonstrated that of the 33 lesions, 8 (24%) were malignant and the remaining 25 (76%) were benign. A total of 53 (90%) MRI-detected lesions were sonographically identified using both cB-mode and RVS (p < 0.001). All five remaining US-occult lesions could be followed up under RVS after the enhancing area was marked on the breast surface using RVS. Although further prospective studies are required, the findings of our pilot study suggest that second-look US using RVS with additional supine MRI may improve the sonographic and histopathologic detection rate of cB-mode occult MRI-detected breast lesions.

The value of transrectal ultrasound and magnetic resonance imaging fusion targeted prostate biopsy in biopsy-naive men

Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging(TRUS/MR) fusion targeted prostate biopsy(targeted biopsy, TB) in the biopsy naive patients. Methods Between September 2015 and September 2016, 91 patients with PI-RADS ≥3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated. The age of patients was 46-83 years (median 68). Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ml), in which 36 cases with PSA 20 ng/ml. Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB). The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB. Results The total detection rate for PCa was 57.1%, with a comparable positive rate between TB (44.0%) and SB (51.7%) groups which did not significantly differ (P=0.14). The proportion of CsPCa in TB group was higher than that in SB group (80.0% vs. 68.1%, P=0.21). In TB group, detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1% vs. 10.3%, P 20ng/ml (27.8% vs. 36.1%, 50% vs. 56.7%, 60% vs. 68%, respectively). Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men. TB maybe tend to detect high proportion of CsPCa. PI-RADS is instructive to select appropriate patients for TB. Key words: Prostate biopsy; Prostatic neoplasms; Transrectal ultrasound and magnetic resonance imaging fusion(TRUS/MR)

V4-03 CT/MRI-US FUSION GUIDED RENAL MASS BIOPSY: INITIAL EXPERIENCE

You have accessJournal of UrologyImaging/Uroradiology1 Apr 2017V4-03 CT/MRI-US FUSION GUIDED RENAL MASS BIOPSY: INITIAL EXPERIENCE Andre Abreu, Sameer Chopra, Carlee Beckler, Masakatsu Oishi, Nariman Ahmadi, Toshitaka Shin, Andre Berger, Mihir Desai, Monish Aron, Inderbir Gill, and Osamu Ukimura Andre AbreuAndre Abreu More articles by this author , Sameer ChopraSameer Chopra More articles by this author , Carlee BecklerCarlee Beckler More articles by this author , Masakatsu OishiMasakatsu Oishi More articles by this author , Nariman AhmadiNariman Ahmadi More articles by this author , Toshitaka ShinToshitaka Shin More articles by this author , Andre BergerAndre Berger More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Osamu UkimuraOsamu Ukimura More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.902AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Real-time Virtual Sonography (RVS) system allows image-fusion of real-time live US with pre-operative contrast-enhanced CT/MRI. Both real-time US and fused-image of CT are real-timely displayed in parallel in US-machine. The objectives are to assess the feasibility and safety of a pilot study for offie RVS-guided renal mass biopsy (RMB). METHODS Pre-operative: After 8 hours of fasting, the patient is placed in prone position in outpatient facility and monitored. US/CT registration: The DICOM data of a previous CT scan or MRI is loaded into the RVC system. The image is rotate to be at the same orientation of the patient. The kidney of interest and the plane with a reference point that a shows a good window to puncture the renal mass is selected.The kidney of interest is then US-scanned and the images are compared with the CT scan. When the images match to each other the plane with the reference point is fused with pre-operative contrast CT scan using the RVS system. The kidney is scanned and the best location to target the renal mass is selected. Co-axial needle technique: A 17G hollow needle is connected to a needle-guide under 21-degree inclination and attached to the US probe. Under local anesthesia, a 17G hollow-needle, is first placed along the planned puncturing dotted-line toward the renal mass up to the Gerota′s fascia. Biopsy: A 18G biopsy-gun is inserted through the co-axial-outersheath, advanced along the planned puncturing dotted-line upto the tumor and is fired to obtain the biopsy-tissue from the tumor. Usually two to three cores are taken, all through the hollow needle. RESULTS From April to June of 2014, 13 patients underwent RMB. Only single-use of local anesthesia was required in all cases. Co-axial needle technique facilitated (i) visualization of the biopsy-needle in live US, (ii) multiple-sampling through it, and (iii) decreasing the seeding risk of malignant cells. RVS system facilitated targeting the contrast-enhanced lesion, as it improved visualization of important anatomical landmarks. Intra-operatively accompanied pathology-team was important to determine the adequacy of tissue-sampling. Biopsy histology was concordant with surgical specimen in 7 of 10 patients undergoing surgery. Additionally, 2 patients with histology of oncocytoma chose active surveillance. There were no complications. CONCLUSIONS Outpatient RMB performed by urologist is safe and promising. This was achieved using local anesthesia, co-axial needle technique, and intra-operative co-operation with pathology-team, and introduction of real-time image-fusion technology of live US with contrast CT/MRI. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e376 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Andre Abreu More articles by this author Sameer Chopra More articles by this author Carlee Beckler More articles by this author Masakatsu Oishi More articles by this author Nariman Ahmadi More articles by this author Toshitaka Shin More articles by this author Andre Berger More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Osamu Ukimura More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Abstract P4-02-13: Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions

Abstract PURPOSE: Breast ultrasound (US) is a diagnostic imaging modality that is now widely used as an adjunct to mammography for evaluation of breast abnormalities. In the Breast Imaging-Reporting and Data System (BI-RADS) lexicon, a solid mass with an oval shape, well-circumscribed margins and parallel orientation is classified as category 3 (BI-RADS category 3 mass lesions) . This mass should have a risk of malignancy of &amp;lt; 2%. Surveillance breast US in short-interval follow-up for BI-RADS category 3 mass lesions is an acceptable alternative to biopsy. The surveillance US is recommended 6 month after initial lesion identification and then every year for at least 2 y. However, inconsistent reproducibility for US due to operator dependence is still a clinical issue. The aim of our study was to verify the utility of US using real-time virtual sonography (RVS) - to coordinate present US images with past US images reconstructed from previously acquired US volume data using magnetic tracking system – in a short-interval follow--up for BI-RADS category 3 mass lesions. METHOD AND MATERIALS: We enrolled 20 women (23 lesions) with more than 24 months of follow-up after classification as BI-RADS category 3 during initial US. US surveillance was scheduled at 6, 12 and 24 months. Three-dimensional assessment of morphologic features was performed while serially checking past US volume data corresponding to the present US probe position. Measurement of the target lesion diameter was performed after the probe was adjusted to include the maximum diameter of a past US image at each visit. RESULTS: RVS was technically successful in 100% of patients. All target lesions were detected, including two iso-echoic lesions. The mean target lesion diameters at baseline and at 6, 12 and 24 months were 8.2+4.2, 8.4+4.5, 8.1+4.5 and 8.3+5.0 mm, respectively . Statistical analysis using a Friedman test with multiple comparisons revealed no significant difference between the diameters at each time point (p = 0.785). RVS was used to directly compare the US morphologic characteristics and sized of lesions. Furthermore, the RVS data can be reproduced in their entirety for independent review at a later date by using stored US volume data. CONCLUSION:Our results suggest that RVS is reproducible, operator-independent technique for comparison of US images of BI-RADS category 3 mass lesions obtained at different time points. Citation Format: Nakano S, Fujii K, Kousaka J, Mouri Y, Ando T. Breast ultrasound surveillance with image fusion technique in a short-interval follow-up for BI-RADS category 3 mass lesions [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-02-13.

Precision of MRI/ultrasound-fusion biopsy in prostate cancer diagnosis: an ex vivo comparison of alternative biopsy techniques on prostate phantoms.

Comparing the accuracy of MRI/ultrasound-guided target-biopsy by transrectal biopsy (TRB) with elastic versus rigid image fusion versus transperineal biopsy (TPB) with rigid image fusion in a standardized setting. Target-biopsy of six differently sized and located lesions was performed on customized CIRS 070L prostate phantoms. Lesions were only MRI-visible. After prior MRI for lesion location, one targeted biopsy per lesion was obtained by TRB with elastic image fusion with Artemis™ (Eigen, USA), TRB with rigid image fusion with real-time virtual sonography (Hitachi, Japan) and TPB with rigid image fusion with a brachytherapy approach (Elekta, Sweden), each on a phantom of 50, 100 and 150ml prostate volume. The needle trajectories were marked by contrast agent and detected in a postinterventional MRI. Overall target detection rate was 79.6% with a slight superiority for the TPB (83.3 vs. 77.8 vs. 77.8%). TRB with elastic image fusion showed the highest overall precision [median distance to lesion center 2.37mm (0.14-4.18mm)], independent of prostate volume. Anterior lesions were significantly more precisely hit than transitional and basal lesions (p=0.034; p=0.015) with comparable accuracy for TRB with elastic image fusion and TPB. In general, TRB with rigid image fusion was inferior [median 3.15mm (0.37-10.62mm)], particularly in small lesions. All biopsy techniques allow detection of clinically significant tumors with a median error of 2-3mm. Elastic image fusion appears to be the most precise technique, independent of prostate volume, target size or location.

PD23-04 EFFICACY OF REAL-TIME VIRTUAL SONOGRAPHY-GUIDED RENAL ACCESS FOR ENDOSCOPIC COMBINED INTRARENAL SURGERY

You have accessJournal of UrologyStone Disease: Surgical Therapy IV1 Apr 2016PD23-04 EFFICACY OF REAL-TIME VIRTUAL SONOGRAPHY-GUIDED RENAL ACCESS FOR ENDOSCOPIC COMBINED INTRARENAL SURGERY Shuzo Hamamoto, Rei Unno, Kazumi Taguchi, Ryosuke Ando, Atsushi Okada, Keiichi Tozawa, Kenjiro Kohri, and Takahiro Yasui Shuzo HamamotoShuzo Hamamoto More articles by this author , Rei UnnoRei Unno More articles by this author , Kazumi TaguchiKazumi Taguchi More articles by this author , Ryosuke AndoRyosuke Ando More articles by this author , Atsushi OkadaAtsushi Okada More articles by this author , Keiichi TozawaKeiichi Tozawa More articles by this author , Kenjiro KohriKenjiro Kohri More articles by this author , and Takahiro YasuiTakahiro Yasui More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1743AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Real-time virtual sonography (RVS) is a diagnostic imaging support system that can be synchronized with real-time ultrasonography in conjunction with computed tomography (CT) using a magnetic navigation system. The application of RVS for percutaneous nephrolithotomy has not yet been reported. This study aimed to examine the effect of RVS-guided renal access during endoscopic combined intrarenal surgery (ECIRS) for large renal calculi. METHODS We retrospectively evaluated 12 patients with large renal calculi (35.1 ± 3.3 mm) who underwent ECIRS in our center between April 2014 and January 2015. The Digital Imaging and Communication in Medicine volume data from preoperative CT performed in the prone position were loaded in the RVS unit. The operation was performed as follows: 1) All of the patients were oriented in the prone split-leg position to allow for retrograde and antegrade access; 2) One urologist performed retrograde intrarenal surgery by using a Holmium-YAG laser with a ureteroscope through a ureteral access sheath, while the other performed renal puncture using the RVS system (Figure); and 3) After inserting the percutaneous tract, each urologist worked simultaneously to fragment the renal calculi. RESULTS All of the procedures were successfully performed using a single tract. The mean number of renal punctures until gaining renal access through the calyx, which provides the best access to the calculus, was 1.6. The mean surgical duration was 107.0 ± 10.5 minutes, and the mean length of hospital stay was 5.3 ±0.5 days. The mean decrease in hemoglobin level was 0.76 ± 0.15 g/dL. Complete stone clearance after a single ECIRS treatment session was achieved in 7 patients (87.5%). None of the patients required a blood transfusion and had a Clavien grade ≥ 2. CONCLUSIONS RVS-guided renal access improved the precision of the calyceal puncture, which decreased the incidence of bleeding complications and improved the stone clearance rates during ECIRS. This is the first report to evaluate the efficacy of the RVS system for renal access. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e507 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Shuzo Hamamoto More articles by this author Rei Unno More articles by this author Kazumi Taguchi More articles by this author Ryosuke Ando More articles by this author Atsushi Okada More articles by this author Keiichi Tozawa More articles by this author Kenjiro Kohri More articles by this author Takahiro Yasui More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP16-17 CAN SYSTEMATIC BIOPSY BE SAFELY OMITTED IN THE ERA OF MRI/TRUS-FUSION TARGETED PROSTATE BIOPSY?

You have accessJournal of UrologyProstate Cancer: Detection & Screening I1 Apr 2016MP16-17 CAN SYSTEMATIC BIOPSY BE SAFELY OMITTED IN THE ERA OF MRI/TRUS-FUSION TARGETED PROSTATE BIOPSY? Yasukazu Nakanishi, Hiroshi Fukushima, Minato Yokoyama, Madoka Kataoka, Ken-ichi Tobisu, and Fumitaka Koga Yasukazu NakanishiYasukazu Nakanishi More articles by this author , Hiroshi FukushimaHiroshi Fukushima More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Madoka KataokaMadoka Kataoka More articles by this author , Ken-ichi TobisuKen-ichi Tobisu More articles by this author , and Fumitaka KogaFumitaka Koga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2582AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Multi-parametric MRI (mpMRI) prior to prostate biopsy has been increasingly utilized for accurate diagnosis of significant cancer (SC) and avoidance of overdiagnosis of insignificant cancer (IC). Here, we assessed diagnostic performance of mpMRI/TRUS-fusion targeted biopsy (TgB) in comparison with that of systematic multisite biopsy (SyB) and asked if SyB can be safely omitted in diagnosing SC. METHODS From April 2013 to August 2015, 202 men with elevated PSA (<20 ng/ml) or abnormal DRE finding were enrolled in this study. All pts underwent mpMRI prior to biopsy. mpMRI findings were evaluated according to Prostate Imaging-Reporting and Data System (PI-RADS) and scores ≥3 were considered positive. All patients underwent transperineal 14-core SyB and those with mpMRI-positive lesions further underwent 4-core TgB per lesion using real-time virtual sonography (Arietta70, Hitachi-Aloka Medical). SC was defined as Gleason score ≥4+3 or maximum cancer length ≥5 mm. We evaluated the diagnostic performance of SyB ± TgB in detecting all cancer and SC. RESULTS The median (range) age and PSA levels were 69 years (45-82) and 7.8 ng/ml (1.6-19.6). Of the 202 men, 166 (82%) were positive for MRI. Detection rates of all cancer, SC and IC were 58% (117/202), 44% (89/202) and 14% (28/202), respectively, and 16% (32/202) were categorized to NCCN high-risk disease. TgB showed significantly higher SC detection rate and lower IC detection rate than SyB (47% vs 36%, p = 0.03; and 7% vs 35%, p = 0.004; respectively). TgB alone detected 88% of SC (78/89) and more importantly 97% of high-risk disease (31/32). CONCLUSIONS Most of clinically significant diseases were diagnosed by MRI/TRUS-fusion targeted biopsy alone. Our data suggest that multisite systematic biopsy can be safely omitted in the era of MRI/TRUS-fusion targeted biopsy depending on the patient's general condition. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e167 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yasukazu Nakanishi More articles by this author Hiroshi Fukushima More articles by this author Minato Yokoyama More articles by this author Madoka Kataoka More articles by this author Ken-ichi Tobisu More articles by this author Fumitaka Koga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD18-02 SYNCHRONOUS REAL-TIME VIRTUAL SONOGRAPHY WITH THREE-DIMENSIONAL COMPUTED TOMOGRAPHY SCAN NAVIGATION TO CREATE PERCUTANEOUS RENAL ACCESS TO THE TARGET CALIX DURING PERCUTANEOUS NEPHROLITHOTOMY

You have accessJournal of UrologyStone Disease: Surgical Therapy II1 Apr 2016PD18-02 SYNCHRONOUS REAL-TIME VIRTUAL SONOGRAPHY WITH THREE-DIMENSIONAL COMPUTED TOMOGRAPHY SCAN NAVIGATION TO CREATE PERCUTANEOUS RENAL ACCESS TO THE TARGET CALIX DURING PERCUTANEOUS NEPHROLITHOTOMY Tatsuhiko Hoshii and Tsutomu Nishiyama Tatsuhiko HoshiiTatsuhiko Hoshii More articles by this author and Tsutomu NishiyamaTsutomu Nishiyama More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1181AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Percutaneous renal access in the context of percutaneous nephrolithotomy (PNL) for kidney stones is a difficult technique, requiring rapid and precise access to a particular calix. We present the usefulness of synchronous real-time virtual ultrasonography (US) (RVS) with three-dimensional (3D) computed tomography (CT) scan navigation to create percutaneous renal access to the target calix during PNL. METHODS We performed thin-slice contrast-enhanced CT examinations in a prone position before PNL. RVS system consists of an ultrasound scanner, a position sensor unit, and a computer with RVS software (HI VISION Preirus; Hitachi Aloka Medical, Tokyo, Japan). (Figure) Multiplanar reconstruction images were reconstructed using CT. The previously acquired CT data were loaded onto RVS system. The patients were placed in a prone position. While the operator handled RVS system, the ultrasound machine generated multiplanar reconstruction images from the CT volume data, corresponding to the US images of the same or very similar cross section. The magnetic sensor on the sonography probe precisely captured the magnetic field alternation of the position, direction, or rotation via the transmitter placed at the patient’s counter side of the lesion. We could mark the target calix detected on CT. Virtual images with marks were revisualized while using conventional US that helped the operator perform percutaneous renal access to the target calix. RESULTS We performed percutaneous renal access to the target calix during percutaneous nephrostomy in the context of PNL successfully using synchronous RVS with 3D CT scan navigation for a 26-year-old man with right kidney stones. CONCLUSIONS We will be able to create efficiently minimally invasive percutaneous renal access to the target calix using RVS system. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e404 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tatsuhiko Hoshii More articles by this author Tsutomu Nishiyama More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Ultrasonography imaging of the anterolateral ligament using real-time virtual sonography

BackgroundThe anterolateral ligament (ALL) functions as a stabilizer in the internal rotation of the knee. Previous studies have reported the ALL can be identified using magnetic resonance imaging (MRI); however, there are no reports on using ultrasonography (US) for this purpose. Real-time virtual sonography (RVS) uses magnetic navigation and computer software for the synchronized display of real-time US and multiplanar reconstruction MRI images. This study investigated the ability of using US with RVS to evaluate the ALL. MethodsNine healthy subjects were enrolled. The Digital Imaging Communications in Medicine MRI dataset was loaded into the Hitachi Aloka Preirus, and US images were displayed on the same monitor. When the ALL was identified using MRI, the monitor was frozen to evaluate the ALL. The ALL was divided into the femoral, meniscal, and tibial portions. The portions and thickness of the ALLs and the lateral inferior genicular artery (LIGA), a landmark for the ALL, were evaluated. ResultsAll portions of the ALL could be identified using MRI. Using US, the tibial portion of the ALL was detected in all subjects and the femoral portion was detected in seven subjects; however, the meniscal portions could not be identified. The average ALL thickness as measured by US was 1.3±0.1mm and the LIGA was identified in all cases. ConclusionsMost portions of the ALL can be identified using US. As most ALL injuries occur at the femoral or tibial portion, US may be useful as a diagnostic tool for ALL injury.Level of Evidence: 4

Initial Experience Performing Percutaneous Ultrasound Examination with Real-Time Virtual Sonography with Color Display

Purpose: We report the efficacy of percutaneous ultrasound (US) examination using a novel real-time virtual sonography (RVS) method that collates multiple Digital Imaging and Communications in Medicine (DICOM) data sources and displays reference images in color. Materials and Methods: A total of 7 patients with 9 hepatocellular carcinomas were evaluated. Using the SYNAPSE VINCENT volume analyzer, DICOM data of the portal vein, hepatic vein, tumor, and hepatic segment were isolated from contrast-enhanced computed tomography DICOM data. Each portion of DICOM data was uploaded into an US scanner (HI VISION Ascendus, Hitachi Aloka Medical Ltd., Tokyo, Japan) and unified on a US platform to create a single reference image. Each uploaded portion of DICOM data was assigned a different color. Further, conventional RVS was performed using this information. Results: The maximal tumoral diameter ranged from 6.4 to 15 mm (mean ± SD, 11.0 ± 2.8). DICOM data could be isolated, enabling the display of color RVS in all patients. Color RVS facilitated superior visibility compared with conventional grayscale RVS and facilitated the comprehension of spatial positioning. Conclusion: RVS with color display demonstrates utility in increasing operator comprehension of spatial and positional relationships during percutaneous US examination.

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Radiofrequency ablation assisted by real-time virtual sonography for hepatocellular carcinoma inconspicuous under sonography and high-risk locations

Radiofrequency ablation (RFA) is an effective and real-time targeting modality for small hepatocellular carcinomas (HCCs). However, mistargeting may occur when the target tumor is confused with cirrhotic nodules or because of the poor conspicuity of the index tumor under ultrasonography (US). Real-time virtual sonography (RVS) can provide the same reconstruction computed tomography images as US images. The aim of this study is to investigate the usefulness of RVS-assisted RFA for HCCs that are inconspicuous or conspicuous under US. A total of 21 patients with 28 HCC tumors—divided into US inconspicuous and high-risk subgroup (3 tumors in 3 patients), US inconspicuous and nonhigh-risk subgroup (5 tumors in 4 patients), US conspicuous and high-risk subgroup (16 tumors in 14 patients), and US conspicuous and nonhigh-risk subgroup (4 tumors in 3 patients)—underwent RVS-assisted RFA between May 2012 and June 2014 in our institution. The mean diameter of the nodules was 2.0 ± 1.1 cm. The results showed that the complete ablation rate is 87.5% (7/8) in the US undetectable group and 75% (15/20) in the US detectable group. A comparison between six tumors with incomplete ablation and 22 tumors with complete ablation showed higher alpha-fetoprotein level (mean, 1912 ng/mL vs. 112 ng/mL) and larger tumor size (mean diameter, 26 mm vs. 16 mm) in the incomplete ablation nodules (both p < 0.05). In conclusion, RVS-assisted RFA is useful for tumors that are difficult to detect under conventional US and may also be useful for tumors in high-risk locations because it may prevent complication induced by mistargeting.

Real-time virtual sonography examination and biopsy for suspicious breast lesions identified on MRI alone.

The purpose of our study was to assess whether there is a potential additional value of real-time virtual sonography (RVS) to second-look ultrasound (US) examination and biopsy for breast lesions identified on MRI alone. A retrospective review of the records of 70 consecutive patients (78 lesions) with breast abnormalities identified on MRI alone was performed. All suspicious enhancing lesions were subsequently evaluated with second-look US. Lesions not observed on second-look US underwent RVS. Pathological findings were confirmed by subsequent percutaneous biopsy or excision. Of the 78 MRI-detected lesions, second-look US correlation was made in 50 (64 %), including 22 malignant and 28 benign lesions. The remaining 28 lesions (36 %) were scheduled to undergo RVS. Four lesions were not visible on the second breast MRI. The remaining 24 lesions were RVS correlated and underwent RVS-guided biopsy; these included seven malignant and 17 benign lesions. Overall, 74 of 74 (100 %) true MRI-detected lesions were confirmed by histological results without using MRI-guided breast biopsy. The cancer rate was 29 %. RVS can increase the sonographic detection and biopsy rate of lesions identified on breast MRI alone. • All 74 MRI-detected lesions were confirmed without using MRI-guided biopsy. • Four lesions were not visible on second breast MRI. • RVS can increase sonographic detection of lesions identified on breast MRI alone. • RVS-guided breast biopsy can be an alternative to MRI-guided biopsy.

Fusion imaging for evaluation of deep infiltrating endometriosis: feasibility and preliminary results.

Magnetic resonance imaging (MRI) and ultrasound scanning complement each other in screening for and diagnosis of endometriosis. Fusion imaging, also known as real-time virtual sonography, is a new technique that uses magnetic navigation and computer software for the synchronized display of real-time ultrasound and multiplanar reconstructed MR images. Our aim was to evaluate the feasibility and ability of fusion imaging to assess the main anatomical sites of deep infiltrating endometriosis (DIE) in patients with suspected active endometriosis. This prospective study was conducted over a 1-month period in patients referred to a trained radiologist for an ultrasound-based evaluation for endometriosis. Patients with a prior pelvic MRI examination within the past year were offered fusion imaging, in addition to the standard evaluation. All MRI examinations were performed on a 1.5-T MRI machine equipped with a body phased-array coil. The MRI protocol included acquisition of at least two fast spin-echo T2-weighted orthogonal planes. The Digital Imaging Communications in Medicine dataset acquired at the time of the MRI examination was loaded into the fusion system and displayed together with the ultrasound image on the same monitor. The sets of images were then synchronized manually using one plane and one anatomical reference point. The ability of this combined image to identify and assess the main anatomical sites of pelvic endometriosis (uterosacral ligaments, posterior vaginal fornix, rectum, ureters and bladder) was evaluated and compared with that of standard B-mode ultrasound and MRI. Over the study period, 100 patients were referred for ultrasound examination because of endometriosis. Among them were 20 patients (median age, 35 (range, 27-49) years) who had undergone MRI examination within the past year, with a median (range) time interval between MRI and ultrasound examination of 171 (1-350) days. All 20 patients consented to undergo additional evaluation by fusion imaging. However, in three (15%) cases, fusion imaging was not technically possible because of changes since the initial MRI examination resulting from either interval surgery (n = 2; 10%) or pregnancy (n = 1; 5%). Data acquisition, matching and fusion imaging were performed in under 10 min in each of the other 17 cases. The overall ability of each technique to identify and assess the main anatomical landmarks of endometriosis was as follows: uterosacral ligaments: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); posterior vaginal fornix: ultrasound, 88% (30/34); MRI, 100% (34/34); fusion imaging, 100% (34/34); rectum: ultrasound, 100% (17/17); MRI, 82.3% (14/17); fusion imaging, 100% (17/17); ureters: ultrasound, 0%; MRI, 100% (34/34); fusion imaging, 100% (34/34); and bladder: ultrasound, 100%; MRI, 100%; fusion imaging, 100%. Fusion imaging is feasible for the assessment of endometriotic lesions. Because it combines information from both ultrasound and MRI techniques, fusion imaging allows better identification of the main anatomical sites of DIE and has the potential to improve the performance of ultrasound and MRI examination.