Real-time Transrectal Ultrasonography Research Articles

PO0211: Real Time Transrectal Ultrasound (TRUS) Guided Needle Insertion and Tracking in Hybrid Image Guided Adaptive Brachytherapy (IGABT) for Cervical Cancer Patients

PO0211: Real Time Transrectal Ultrasound (TRUS) Guided Needle Insertion and Tracking in Hybrid Image Guided Adaptive Brachytherapy (IGABT) for Cervical Cancer Patients

Superior detection of significant prostate cancer by transperineal prostate biopsy using MRI-transrectal ultrasound fusion image guidance over cognitive registration.

The BioJet system allows the fusion of magnetic resonance imaging (MRI) images with real-time transrectal ultrasonography to accurately direct biopsy needles to the target lesions. To date, the superiority of targeted biopsy using the BioJet system over cognitive registration remains unknown. This retrospective study included 171 biopsy-naïve men with elevated prostate-specific antigen (2.5-20ng/mL) and MRI-positive lesions; 74 and 97 men underwent a four-core targeted biopsy per MRI-positive target lesion and a 14-core systematic biopsy transperineally using the BioJet system and cognitive registration, respectively. Detection rates of significant cancer, defined as grade group ≥ 2 or maximum cancer length ≥ 5mm, were compared between the BioJet system and cognitive registration using propensity score matching and a multivariate logistic regression model. After propensity score matching (67 men for each group), the detection rates of significant cancer were significantly higher in the BioJet group than in the cognitive group for both targeted (76% vs. 46%, P = 0.002) and systematic (70% vs. 46%, P = 0.018) biopsy. Multivariate analysis of the entire cohort also showed that the BioJet system was independently associated with significant cancer detection by targeted and systematic biopsy (P < 0.01), along with a higher prostate-specific antigen density and a higher prostate imaging reporting and data system score. Transperineal prostate biopsy using the BioJet system is superior to cognitive registration in detecting significant cancer for targeted and systematic biopsies.

High-Dose-Rate Interstitial Brachytherapy for Deeply Situated Gynecologic Tumors Guided by Combination of Transrectal and Transabdominal Ultrasonography: A Technical Note.

Background and PurposeHigh-dose-rate interstitial brachytherapy (HDR-ISBT) is recommended to obtain a better local tumor control for uterine cancer patients in specific situations such as bulky lesions, an extension to the lateral parametrium, or tumors with irregular shapes. Our group uses real-time transrectal ultrasonography (TRUS) to guide freehand interstitial needle insertion. Occasionally, target tumors locate deeper beyond the rectum and cannot be visualized by TRUS. CT can guide needles to deeply located tumors, but in such cases, repeated image obtainment is required to achieve ideal needle localization. In this report, we present nine cases of patients who underwent HDR-ISBT for deeply situated tumors guided by a combination of transrectal and transabdominal ultrasonography (TR/TA-US).Material and MethodsNine uterine cancer patients whose tumors were located deeper than the reach of TRUS and underwent HDR-ISBT guided by TR/TA-US were presented. All nine cases had no distal organ metastasis and underwent external beam radiation therapy (EBRT) to the pelvic region for 45–50.4 Gy in 25–28 fractions followed by boost HDR-ISBT for deeply situated tumors guided by TR/TA-US.ResultsThere were seven cervical cancer and two endometrial cancer patients: six with extensive uterine corpus invasion, one cervical cancer with massive pelvic lymph node metastasis, one cervical cancer with postoperative pelvic recurrence, and one with left ovarian direct tumor invasion. The median follow-up period was 15 months (range 3–28 months). The average clinical target volume at the time of first HDR-ISBT was 131 ml (range 44–335 ml). The linear distance from the vaginal entrance to the deepest part of the tumor at first time brachytherapy of nine cases was 14.0 (9.0–17.0) cm. HDR-ISBT dose fractionation was 24–30 Gy in four or five fractions. Seven out of nine cases had no local recurrence in the follow-up period. One had local in-field recurrence 25 months after HDR-ISBT. Another case with carcinosarcoma could not obtain local control and underwent salvage hysterectomy for a residual uterine tumor 11 months after HDR-ISBT. Four cases had extra-field recurrence in lymph nodes or distant organs.ConclusionsIn brachytherapy for gynecologic malignancies, deeply situated tumors located out of reach of TRUS may obtain favorable local control by HDR-ISBT guided with TR/TA-US.

Design, Development, and Multi-Characterization of an Integrated Clinical Transrectal Ultrasound and Photoacoustic Device for Human Prostate Imaging.

The standard diagnostic procedure for prostate cancer (PCa) is transrectal ultrasound (TRUS)-guided needle biopsy. However, due to the low sensitivity of TRUS to cancerous tissue in the prostate, small yet clinically significant tumors can be missed. Magnetic resonance imaging (MRI) with TRUS fusion biopsy has recently been introduced as a way to improve the identification of clinically significant PCa in men. However, the spatial errors in coregistering the preprocedural MRI with the real-time TRUS causes false negatives. A real-time and intraprocedural imaging modality that can sensitively detect PCa tumors and, more importantly, differentiate aggressive from nonaggressive tumors could largely improve the guidance of biopsy sampling to improve diagnostic accuracy and patient risk stratification. In this work, we seek to fill this long-standing gap in clinical diagnosis of PCa via the development of a dual-modality imaging device that integrates the emerging photoacoustic imaging (PAI) technique with the established TRUS for improved guidance of PCa needle biopsy. Unlike previously published studies on the integration of TRUS with PAI capabilities, this work introduces a novel approach for integrating a focused light delivery mechanism with a clinical-grade commercial TRUS probe, while assuring much-needed ease of operation in the transrectal space. We further present the clinical potential of our device by (i) performing rigorous characterization studies, (ii) examining the acoustic and optical safety parameters for human prostate imaging, and (iii) demonstrating the structural and functional imaging capabilities using deep-tissue-mimicking phantoms. Our TRUSPA experimental studies demonstrated a field-of-view in the range of 130 to 150 degrees and spatial resolutions in the range of 300 μm to 400 μm at a soft tissue imaging depth of 5 cm.

Single-Center Experience in Targeted Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging‑Transrectal Ultrasound Elastic Fusion Technique

Introduction: Transrectal ultrasound (TRUS)-guided random biopsies are used to be the gold standard when diagnosing prostate cancer. A relatively new system with organ tracking that fuses real-time TRUS images with previously acquired multiparametric magnetic resonance imaging (mpMRI) images for prostate biopsy guidance is presented here. The primary goal of the study is to correlate (1) the mpMRI findings with the Gleason score grading of the prostate biopsies performed under mpMRI-TRUS elastic fusion and (2) the prostate-specific antigen (PSA) levels with the Gleason grading. Materials and Methods: Between January 2017 and August 2018, 58 patients had targeted prostate biopsy using mpMRI-TRUS elastic fusion technique (Urostation). These patients had previously the mpMRI of the prostate at our center using three-dimensional T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast enhanced imaging. Of all 58 patients, 32 patients were classified as having Prostate Imaging-Reporting And Data System (PI-RADS) 4/5, 21 patients as PI-RADS 3, and five as PI-RADS 2. Results: Twenty-seven patients had positive biopsies for prostate cancer. Positive results were found in 25 patients having PI-RADS 4/5 (25 out of 32). Of these patients, 20 had positive specimens from the dominant lesion, four from both the targeted lesion and nontargeted areas, and one from a nontargeted area. Positive results were found in two patients classified as PI-RADS 3 from targeted and nontargeted areas. These results show that 78% of the patients classified by mpMRI as PI-RADS 4/5 and 10% of the patients classified as PI-RADS 3 had positive biopsies for prostate cancer. The results also showed a correlation between the PI-RADS score on mpMRI, the Gleason score, and the PSA levels. Conclusion: mpMRI-TRUS fusion biopsy is a safe and accurate method for targeted prostate biopsies. Our preliminary results are comparable to the published international numbers and show a good correlation between the PI-RADS classification and histopathology, as well as correlation between PI-RADS, Gleason scores, and PSA levels of positive biopsies.

Acetato de deslorelina y gonadotropina coriónica humana y su respuesta ovulatoria en yeguas postparto

In order to evaluate the rate of follicular growth, the response time to ovulation and the percentage of ovulation in Quarter Mile postpartum mares, two treatments (T) were applied, the first with deslorelin acetate (DA) and the second with gonadotropin human chorionic (hCG). The study was conducted during January to June 2018, with sixteen 7-year-old mares, 450 kg of weight and 4.5 deliveries on average. Ovarian follicular diameter was evaluated by real-time transrectal ultrasonography in response to experimental treatments, in mares with ovarian follicles  35 mm in diameter: T1 (n= 8): Application of 1 mg of DA intramuscularly (IM), and T2 (n= 8): Application of 2500 IU of hCG via IM. There were no differences (P> 0.05) in the rate of follicular growth (AD: 0.48 ± 0.006 mm and hCG: 0.45 ± 0.035 mm), the time of response to ovulation (AD: 46.75 ± 0.48 h and hCG: 56.00 ± 8.00 h) and the percentage of ovulation (AD: 8/8, 100% and hCG: 7/8, 87.5%) in the postpartum mares evaluated. It is concluded that deslorelin acetate and human chorionic gonadotropin respond to ovarian activity in Quarter Mile postpartum mares with ovarian follicles  35 mm in diameter.

Real-time transrectal ultrasound-guided seminal vesiculoscopy for the treatment of patients with persistent hematospermia: A single-center, prospective, observational study.

This study aimed to describe endoscopic anatomy of the seminal tract and summarize our experience of transutricular seminal vesiculoscopy (TSV) guided by real-time transrectal ultrasonography (TRUS) in managing persistent hematospermia. A total of 281 consecutive patients with persistent hematospermia who underwent TSV with or without real-time TRUS were enrolled in this single-center, prospective, observational study. The median follow-up period was 36.5 (range: 8.0–97.5) months. TSV was successfully performed in 272 (96.8%) patients. The approach of a 4.5/6 F rigid vesiculoscope entering the seminal tract was categorized into four types on the basis of endoscopic presentation of the ejaculatory duct orifice and verumontanum. Seven (2.6%), 74 (27.2%), 64 (23.5%), and 127 (46.7%) patients had Types I (through the ejaculatory duct in the urethra), II (through the ejaculatory duct in the prostatic utricle), III (transutricular fenestration through a thin membrane), and IV (real-time transrectal ultrasound-guided transutricular fenestration) approach, respectively. In patients who successfully underwent surgery, bleeding occurred in the seminal vesicle in 249 (91.5%) patients. Seminal vesiculitis, calculus in the prostatic utricle, calculus in the ejaculatory duct, calculus in the seminal vesicle, prostatic utricle cysts, and seminal vesicle cysts were observed in 213 (78.3%), 96 (35.3%), 22 (8.1%), 81 (29.8%), 25 (9.2%), and 11 (4.0%) patients, respectively. Hematospermia was alleviated or disappeared in 244 (89.7%) patients 12 months after surgery. Fifteen patients had recurrent hematospermia, and the median time to recurrence was 7.5 (range: 2.0–18.5) months. TSV guided by TRUS may contribute to successful postoperative outcomes in managing persistent hematospermia.

A partial augmented reality system with live ultrasound and registered preoperative MRI for guiding robot-assisted radical prostatectomy.

We propose an image guidance system for robot assisted laparoscopic radical prostatectomy (RALRP). A virtual 3D reconstruction of the surgery scene is displayed underneath the endoscope's feed on the surgeon's console. This scene consists of an annotated preoperative Magnetic Resonance Image (MRI) registered to intraoperative 3D Trans-rectal Ultrasound (TRUS) as well as real-time sagittal 2D TRUS images of the prostate, 3D models of the prostate, the surgical instrument and the TRUS transducer. We display these components with accurate real-time coordinates with respect to the robot system. Since the scene is rendered from the viewpoint of the endoscope, given correct parameters of the camera, an augmented scene can be overlaid on the video output. The surgeon can rotate the ultrasound transducer and determine the position of the projected axial plane in the MRI using one of the registered da Vinci instruments. This system was tested in the laboratory on custom-made agar prostate phantoms. We achieved an average total registration accuracy of 3.2 ± 1.3mm. We also report on the successful application of this system in the operating room in 12 patients. The average registration error between the TRUS and the da Vinci system for the last 8 patients was 1.4 ± 0.3mm and average target registration error of 2.1 ± 0.8mm, resulting in an in vivo overall robot system to MRI mean registration error of 3.5mm or less, which is consistent with our laboratory studies.

A Monte Carlo study on the feasibility of real-time in vivo source tracking during ultrasound based HDR prostate brachytherapy treatments

PurposeThis study aims to assess the accuracy of in-vivo source tracking during real-time trans-rectal ultrasound (TRUS) based high dose rate (HDR) prostate brachytherapy (pBT) through Monte Carlo simulations of multiple HDR pBT treatments with a two-dimensional (2D) diode array, the Magic Plate 900 (MP900), embedded below the patient in a carbon-fibre couch. MethodMonte Carlo simulations of source positions representing three separate real-time TRUS based HDR pBT treatments were performed using the Geant4 toolkit. For each source position, an Ir-192 source was simulated inside a voxelized patient geometry. Dose deposited from each source position to the MP900 diodes was used to perform source tracking, and the MP900 calculated position compared to known source positions from the treatment plan. Thresholding techniques were implemented to improve source tracking accuracy with the TRUS probe present. ResultsThe average three-dimensional source position reconstruction discrepancy was 11.9 ± 2.4 mm and 1.5 ± 0.3 mm with and without the TRUS probe, respectively. Thresholding techniques improved the source position reconstruction discrepancy in the presence of the TRUS probe to 1.8 ± 0.4 mm. ConclusionInclusion of the TRUS probe inside the patient negatively affects source tracking accuracy when using the MP900 diode array for HDR pBT verification. Modification of the source tracking algorithm using thresholding techniques improves source tracking in the presence of the TRUS probe, achieving similar accuracy as when the TRUS probe is not present. This study demonstrates that accurate in-vivo source tracking during real-time TRUS based HDR pBT is feasible using the Magic Plate system.

A Prospective Comparison of Computed Tomography with Transrectal Ultrasonography Assistance and Magnetic Resonance Imaging–Based Target-Volume Definition During Image Guided Adaptive Brachytherapy for Cervical Cancers

Although magnetic resonance imaging (MRI) represents the gold standard for image guided adaptive brachytherapy (IGABT) for cervical cancer, the majority of brachytherapy (BT) continues to be guided by computed tomography (CT). However, CT seems to overestimate the target-volume definition, and the potential of transrectal ultrasonography (TRUS) needs further evaluation. This prospective, comparative study aimed to evaluate CT-based target contouring with the incorporation of TRUS during BT. Patients with locally advanced cervical cancer undergoing magnetic resonance IGABT between January 2013 and March 2014 were included. During the BT procedure, TRUS imaging with central tandem in situ was acquired at 3 representative levels. Reference points/dimensions (D1-D4) of the hypoechoic region on TRUS images with respect to the central tandem were recorded. CT and magnetic resonance BT planning imaging was performed after BT application. The high-risk clinical target volume (HR-CTV) was contoured on CT scans with incorporation of clinical and TRUS imaging findings and was compared with the gold standard MRI-based target approach. The image sets of 25 patients (International Federation of Gynecology and Obstetrics clinical stage IIB [11; 44%] and IIIB [14; 56%]) were evaluable. The mean (±standard deviation) volumes of HR-CTV on CT and MRI imaging were 39.1 (±20) cm³ and 39 (±19) cm³, respectively (r = 0.92; P < .001). A significant correlation was found between the HR-CTV dimensions (width and thickness) of CT and MRI scans at various levels (r = 0.70-0.80; P < .001). In addition, the absolute differences in target dimensions between CT and MRI were <0.5 cm. A strong correlation was seen between CT and MRI for patients with medial and lateral parametrial invasion (P < .05) compared with no parametrial disease at BT. Furthermore, the mean differences in HR-CTV width between CT and MRI contours at various levels, irrespective of parametrial involvement, was only 0.1 to 0.4 cm. This study suggests that a CT-based target and organ-at-risk delineation using MRI at diagnosis and real-time TRUS information during BT seems comparable with the gold standard MRI-based approach in IGABT for cervical cancer.

Role of MRI-US Fusion Biopsy in Diagnosing Prostatic Cancer.

Reaching a histologic diagnosis of prostatic cancer (CaP) is central to its treatment and outcome. Preoperative transrectal ultrasound (TRUS) guided biopsies miss 25-40% of higher grade CaP found in post prostatectomy specimen. MRI-US fusion biopsy technique is a technological advance with software based integration of prior MRI images and real time TRUS to improvise the prostatic biopsy yield. On combining systematic biopsies with targeted ones, along with MRI detected high risk CaP areas, 22% more low risk CaP were found. Hence, fusion biopsy leads to better detection of "clinically relevant" CaP. In certain groups of patients like elevated PSA with negative biopsies and those on active surveillance (AS), this fusion technique would make a difference in management.

Detection of prostate cancer using magnetic resonance imaging/ultrasonography image-fusion targeted biopsy in African-American men.

To assess the diagnostic yield of targeted prostate biopsy in African-American (A-A) men using image fusion of multi-parametric magnetic resonance imaging (mpMRI) with real-time transrectal ultrasonography (US). We retrospectively analysed 661 patients (117 A-A and 544 Caucasian) who had mpMRI before biopsy and then underwent MRI/US image-fusion targeted biopsy (FTB) between October 2012 and August 2015. The mpMRIs were reported on a 5-point Likert scale of suspicion. Clinically significant prostate cancer (CSPC) was defined as biopsy Gleason score ≥7. After controlling for age, prostate-specific antigen level and prostate volume, there were no significant differences between A-A and Caucasian men in the detection rate of overall cancer (35.0% vs 34.2%, P = 0.9) and CSPC (18.8% vs 21.7%, P = 0.3) with MRI/US FTB. There were no significant differences between the races in the location of dominant lesions on mpMRI, and in the proportion of 5-point Likert scoring. In A-A men, MRI/US FTB from the grade 4-5 lesions outperformed random biopsy in the detection rate of overall cancer (70.6% vs 37.2%, P = 0.003) and CSPC (52.9% vs 12.4%, P < 0.001). MRI/US FTB outperformed random biopsy in cancer core length (5.0 vs 2.4mm, P = 0.001), in cancer rate per core (24.9% vs 6.8%, P < 0.001), and in efficiency for detecting one patient with CSPC (mean number of cores needed 13.3 vs 81.9, P < 0.001), respectively. Our key finding confirms a lack of racial difference in the detection rate of overall prostate cancers and CSPC with MRI/US FTB between A-A and Caucasian men. MRI/US FTB detected more CSPC using fewer cores compared with random biopsy.

Single-Fraction High-Dose-Rate Brachytherapy Using Real-Time Transrectal Ultrasound–Based Planning in Combination With External Beam Radiation Therapy for Prostate Cancer: Dosimetrics and Early Clinical Results

To validate the feasibility of a single-fraction High Dose Rate Brachytherapy (HDRBT) Boost for prostate cancer using real-time Transrectal Ultrasound (TRUS) based planning From August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15f or 44Gy/22f or 45Gy/25f) was performed before (31%) or after (69%) HDRBT boost. Genito-Urinary (GU) and Gastro-Intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the International Prostate Symptom Score Scale (IPSS) and the Common Terminology Criteria for Adverse Events (CTCAE) v3.0. All dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 < 11% in 96%, urethra D10 <120% for 99%, urethra V125 = 0% in 100% and rectal V75<1cc in 93% of patients. Median IPSS score was 4 at baseline and did not change at 4 and 12 months after combined treatment. No patients developed ≥ grade 2 GI toxicity. With a median follow-up of 10 months, only two patients experienced biochemical failure. Among patients who didn’t receive ADT, cumulative percentage of patients with PSA ≤ 1 ng/mL at 4 and 18 months was respectively 23% and 66%. Single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality. In combination with EBRT, toxicity outcomes appear promising. A longer follow-up is needed to assess long-term outcome and toxicities.

Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: Dosimetrics and early clinical results

Purpose To validate the feasibility of a single-fraction high-dose-rate brachytherapy (HDRBT) boost for prostate cancer using real-time transrectal ultrasound (TRUS) based planning. Material and methods From August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15 fractions, 44 Gy/22 fractions, or 45 Gy/25 fractions) was performed before (31%) or after (69%) HDRBT boost. Genito-urinary (GU) and gastro-intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the international prostate symptom score scale (IPSS) and the common terminology criteria for adverse events (CTCAE) v3.0. Results All dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥ 105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 Conclusion Single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality.

Magnetic Resonance Imaging-Ultrasound Fusion-Guided Prostate Biopsy: Review of Technology, Techniques, and Outcomes.

Transrectal ultrasound (TRUS)-guided (12-14 core) systematic biopsy of the prostate is the recommended standard for patients with suspicion of prostate cancer (PCa). Advances in imaging have led to the application of magnetic resonance imaging (MRI) for the detection of PCa with subsequent development of software-based co-registration allowing for the integration of MRI with real-time TRUS during prostate biopsy. A number of fusion-guided methods and platforms are now commercially available with common elements in image and analysis and planning. Implementation of fusion-guided prostate biopsy has now been proven to improve the detection of clinically significant PCa in appropriately selected patients.

Single-fraction high-dose-rate brachytherapy using real-time transrectal ultrasound based planning in combination with external beam radiotherapy for prostate cancer: dosimetrics and early clinical results.

PurposeTo validate the feasibility of a single-fraction high-dose-rate brachytherapy (HDRBT) boost for prostate cancer using real-time transrectal ultrasound (TRUS) based planning.Material and methodsFrom August 2012 to September 2015, 126 patients underwent a single-fraction HDRBT boost of 15 Gy using real-time TRUS based planning. External beam radiation therapy (EBRT) (37.5 Gy/15 fractions, 44 Gy/22 fractions, or 45 Gy/25 fractions) was performed before (31%) or after (69%) HDRBT boost. Genito-urinary (GU) and gastro-intestinal (GI) toxicity were assessed 4 and 12 months after the end of combined treatment using the international prostate symptom score scale (IPSS) and the common terminology criteria for adverse events (CTCAE) v3.0.ResultsAll dose-planning objectives were achieved in 90% of patients. Prostate D90 ≥ 105% and ≤ 115% was achieved in 99% of patients, prostate V150 ≤ 40% in 99%, prostate V200 < 11% in 96%, urethra D10 < 120% for 99%, urethra V125 = 0% in 100%, and rectal V75 < 1 cc in 93% of patients. Median IPSS score was 4 at baseline and did not change at 4 and 12 months after combined treatment. No patients developed ≥ grade 2 GI toxicity. With a median follow-up of 10 months, only two patients experienced biochemical failure. Among patients who didn't receive ADT, cumulative percentage of patients with PSA ≤ 1 ng/ml at 4 and 18 months was respectively 23% and 66%.ConclusionsSingle-fraction HDRBT boost of 15 Gy using real-time TRUS based planning achieves consistently high dosimetry quality. In combination with EBRT, toxicity outcomes appear promising. A longer follow-up is needed to assess long-term outcome and toxicities.

Field Use of Ultrasonography to Characterize the Reproductive Tract and Early Pregnancy in a Phocid, the Weddell Seal (Leptonychotes weddellii)

The utility of transrectal ultrasonography was tested in a field setting to characterize the reproductive tract and detect early pregnancy (embryonic vesicles < 3 mm in diameter) in 17 multiparous female Weddell seals (Leptonychotes weddellii). Female Weddell seals give birth in October/November each year, followed by the breeding season (December) and embryonic diapause. Transrectal ultrasonography was attempted in January/February 2014 to examine the entire reproductive tract (uterine horns and body, ovaries with follicles and corpora lutea) using a 5-10 MHz linear-array probe with a 70 cm-long extension. A single pregnancy was detected in 14 of 17 seals (82.4%) as a circular or guitar-pick shaped nonechogenic (black) vesicle with a clearly visible echogenic border within the lumen of the uterus. The stage of embryonic development (ostensibly the gestational age) varied markedly among individuals, ranging from a vesicle with no embryo proper to a large fetus with an ocular orbit, nose/mouth, limb buds, spinal column, umbilical cord, and prominent vasculature. Two of the pregnant seals were re-examined 3-6 days after the initial examination to obtain longitudinal growth rates. Images of one or both ovaries were obtained in nine and seven of the 19 examinations, respectively. Numerous ovarian follicles (3 to 12 mm diameter) were detected and animals typically had a single well-perfused corpus luteum (determined by Doppler color-flow) ipsilateral to the uterine horn containing the pregnancy. We conclude that real-time transrectal ultrasonography is an effective tool for characterizing reproductive events in phocids including ovarian dynamics, and for elucidating the nature of embryonic diapause.

Transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound

Objective To evaluate the value of transperineal targeted biopsy with real-time fusion images of transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI) for the diagnosis of prostate cancer (PCa). Methods Clinical and imaging data of 62 consecutive patients suspected of PCa at the mpMRI scan and PSA>4.0 μg/L were retrospectively analyzed. Targeted biopsies (TB) were carried out for each cancer-suspicious lesion, and followed a systematic 12-core biopsy (SB) protocol. Pathological findings of TB and SB were analyzed. Results The age of the patients was (68.38±6.57)years (range 51-79 years). The preoperative PSA value was (10.21±5.57)μg/L (range 4.5-30.1 μg/L). Preoperative prostate volume was (34.05±9.86)ml (range 19-64 ml). The PCa patients detected by SB and/or TB were 34 (54.8%). Cancer-detected rates of SB and TB cores were 7.53% and 26.2%, respectively (P<0.001). The positive core length of SB and TB cores were (3.71±2.77)mm (range 1-14 mm) and (5.00±3.04)mm (range 2-17 mm), respectively (P=0.016). The positive core percent of SB and TB cores were (28.77±20.13)% (range 7-100%) and (35.76±18.73)% (range 11%-100%), respectively (P=0.048). Moreover, clinically cores detected by the SB and TB for final diagnosis of PCa were 19 cores (2.6%) and 48 cores (18.5%), respectively (P<0.001). Conclusions Transperineal TB using real-time TRUS and mpMRI fusion imaging can improve sampling quality and elevate clinically detection rate of PCa when application combined with SB. Key words: Endosonography; Magnetic resonance imaging; Fusion image; Prostatic neoplasms; Biopsy, needle

PD44-12 FEASIBILITY AND INITIAL RESULTS OF 18 FLUOROCHOLINE PET/MRI/TRUS FUSION PROSTATE BIOPSY

You have accessJournal of UrologyProstate Cancer: Detection and Screening IV1 Apr 2015PD44-12 FEASIBILITY AND INITIAL RESULTS OF 18FLUOROCHOLINE PET/MRI/TRUS FUSION PROSTATE BIOPSY Jeffrey Montgomery, Matthew Davenport, Lakshmi Kunju, Charles Meyer, Ganesh Palapattu, Todd Morgan, Alon Weizer, David Miller, Brent Hollenbeck, and Morand Piert Jeffrey MontgomeryJeffrey Montgomery More articles by this author , Matthew DavenportMatthew Davenport More articles by this author , Lakshmi KunjuLakshmi Kunju More articles by this author , Charles MeyerCharles Meyer More articles by this author , Ganesh PalapattuGanesh Palapattu More articles by this author , Todd MorganTodd Morgan More articles by this author , Alon WeizerAlon Weizer More articles by this author , David MillerDavid Miller More articles by this author , Brent HollenbeckBrent Hollenbeck More articles by this author , and Morand PiertMorand Piert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2558AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI)/trans-rectal ultrasound (TRUS) fusion prostate biopsy is an emerging technique for the diagnosis of prostate cancer. The addition of 18Fluorocholine positron emission tomography (PET) to multi-sequence MRI may further improve the detection of clinically significant primary prostate cancer, aiding accurate diagnosis. METHODS With IRB approval, PET and multi-sequence 3 Tesla MRI (including diffusion-weighted and contrast-enhanced sequences) were obtained in men referred for prostate biopsy. Targets for biopsy were selected based on visual appearance on both modalities. PET and T2-weighted (T2W) MRI volumes of the prostate were spatially registered using mutual information software. All targets, whether identified on MRI alone, PET and MRI or PET alone, were embedded into a 3-dimensional T2W MRI volume and loaded into an ultrasound system (GE Logiq E9) allowing for rigid registration of real-time TRUS with MRI using a magnetic navigation system. Targeted in addition to standard 12-core template biopsies were obtained in all patients. Histologic evaluation of all cores was performed. RESULTS At the time of this interim analysis, a total of 32 men with a mean age of 64 (range 56-77) with suspected (n=20) or previously identified (n=12) prostate cancer were included. The median PSA was 8.6 ng/ml (range 3.6-153). Targeted biopsies revealed significantly more (n=12) sites of intermediate and high risk disease (Gleason ≥3+4) than template biopsies (n=5; p < 0.01). The number of sites of low risk disease (Gleason 3+3) identified was significantly reduced for targeted biopsies (n=1) vs template biopsies (n=13; p < 0.01). One successfully targeted Gleason 4+3 cancer was identified on PET only. If targeting was judged as ‘excellent’ at the time of biopsy (41 of 62 targeted cores from 12 lesions), Gleason ≥3+4 prostate cancer was found in 85% of cores. Of the cores that identified Gleason ≥3+4 disease, the average core percent occupied by disease was 76% (range 40-100%) for targeted vs 33% (range 5-85%) for template biopsies. CONCLUSIONS Fusion PET/MRI/TRUS image registration and accurate targeted biopsy are feasible and enhance the detection of clinically significant prostate cancer (Gleason ≥3+4) missed with standard template biopsy. Since most low-grade disease (Gleason 3+3) escapes detection on PET and MRI, image-guided prostate biopsy tends to avoid the detection of low-risk disease. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e901-e902 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jeffrey Montgomery More articles by this author Matthew Davenport More articles by this author Lakshmi Kunju More articles by this author Charles Meyer More articles by this author Ganesh Palapattu More articles by this author Todd Morgan More articles by this author Alon Weizer More articles by this author David Miller More articles by this author Brent Hollenbeck More articles by this author Morand Piert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Free-hand transperineal targeted prostate biopsy with real-time fusion imaging of multiparametric magnetic resonance imaging and transrectal ultrasound: single-center experience in China.

To report our experience with free-hand transperineal targeted biopsy with real-time transrectal ultrasound (TRUS) and multiparametric magnetic resonance imaging (mpMRI) fusion images for the diagnosis of prostate cancer (PCa). A total of 62 consecutive patients suspicious of PCa at the mpMRI scan and PSA >4.0 ng/mL were recruited prospectively. Targeted biopsies (TBs) were carried out for each cancer-suspicious lesion and followed a 12-core systematic biopsy (SB) protocol. Pathological findings of TB and SB were analyzed. The age of the patients was 68.38 ± 6.57 years (range 51-79 years). The preoperative PSA value was 10.21 ± 5.57 ng/mL (range 4.5-30.1 ng/mL). Preoperative prostate volume was 34.05 ± 9.86 mL (range 19-64 mL). The PCa patients detected by SB and/or TB were 34 (54.8%). Cancer-detected rates of SB and TB cores were 7.53 and 26.2%, respectively (P < 0.001). The positive core length of SB and TB cores was 3.71 ± 2.77 mm (range 1-14 mm) and 5.00 ± 3.04 mm (range 2-17 mm), respectively (P = 0.016). The positive core percent of SB and TB cores was 28.77 ± 20.13% (range 7-100%) and 35.76 ± 18.73 (range 11-100%), respectively (P = 0.048). Moreover, clinically significant PCa cores detected by the SB and TB were 19 cores (2.6%) and 48 cores (18.5%), respectively (P < 0.001). Free-hand transperineal TB using real-time TRUS and mpMRI fusion imaging has the ability to improve sampling quality and detect more clinically significant PCa compared with SB.