MR-compatible Assistance System for Biopsy in a High-Field-Strength System: Initial Results in Patients with Suspicious Prostate Lesions 1

PURPOSE 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. MATERIALS AND METHODS 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. RESULTS 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. CONCLUSION Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.

[1]  H Iseki,et al.  Development of an MRI-compatible needle insertion manipulator for stereotactic neurosurgery. , 1995, Journal of image guided surgery.

[2]  H. Gruber,et al.  Value of transrectal ultrasound in preoperative staging of prostate cancer. , 1999, Minerva urologica e nefrologica = The Italian journal of urology and nephrology.

[3]  M. Vannier,et al.  Navigation in diagnosis and therapy. , 1999, European journal of radiology.

[4]  R Cormack,et al.  Real-time magnetic resonance imaging-guided brachytherapy in the treatment of selected patients with clinically localized prostate cancer. , 2000, Journal of endourology.

[5]  A. D'Amico,et al.  Transperineal magnetic resonance image guided prostate biopsy. , 2000, The Journal of urology.

[6]  N Hata,et al.  Feasibility of transperineal prostate biopsy under interventional magnetic resonance guidance. , 2000, Urology.

[7]  J. Vilanova,et al.  The value of endorectal MR imaging to predict positive biopsies in clinically intermediate-risk prostate cancer patients , 2001, European Radiology.

[8]  R Bruce,et al.  CT-integrated robot for interventional procedures: preliminary experiment and computer-human interfaces. , 2001, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[9]  K. Cleary,et al.  Image-guided robotic delivery system for precise placement of therapeutic agents. , 2001, Journal of controlled release : official journal of the Controlled Release Society.

[10]  A. D'Amico,et al.  MR imaging-guided prostate biopsy with surgical navigation software: device validation and feasibility. , 2001, Radiology.

[11]  I. Kaplan,et al.  Real time MRI-ultrasound image guided stereotactic prostate biopsy. , 2002, Magnetic resonance imaging.

[12]  W. Kaiser,et al.  ROBITOM- ROBOT FOR BIOPSY AND THERAPY OF THE MAMMA , 2002 .

[13]  Bernd Hamm,et al.  Patients with a history of elevated prostate-specific antigen levels and negative transrectal US-guided quadrant or sextant biopsy results: value of MR imaging. , 2002, Radiology.

[14]  M. Bock,et al.  An MRI-Compatible Surgical Robot for Precise Radiological Interventions , 2003, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[15]  J. A. Derbyshire,et al.  System for MR image-guided prostate interventions: canine study. , 2003, Radiology.

[16]  J. Crowley,et al.  Prevalence of prostate cancer among men with a prostate-specific antigen level < or =4.0 ng per milliliter. , 2004, The New England journal of medicine.

[17]  S. Zangos,et al.  MR-guided transgluteal biopsies with an open low-field system in patients with clinically suspected prostate cancer: technique and preliminary results , 2004, European Radiology.

[18]  K. Ahrar,et al.  Various approaches for CT-guided percutaneous biopsy of deep pelvic lesions: anatomic and technical considerations. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[19]  J. Kurhanewicz,et al.  Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients with elevated prostate specific antigen levels and prior negative biopsy findings: early experience. , 2005, Radiology.

[20]  B. Kiefer,et al.  Prostate biopsy in the supine position in a standard 1.5-T scanner under real time MR-imaging control using a MR-compatible endorectal biopsy device , 2006, European Radiology.

[21]  D. Beyersdorff,et al.  MR imaging-guided prostate biopsy with a closed MR unit at 1.5 T: initial results. , 2005, Radiology.

[22]  Thomas J. Vogl,et al.  MR-compatible assistance system for punction in a high-field system: device and feasibility of transgluteal biopsies of the prostate gland , 2007, European Radiology.

[23]  D. Stoianovici,et al.  Interventional robotic systems: Applications and technology state‐of‐the‐art , 2006, Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy.

[24]  R Kikinis,et al.  Robot-assisted needle placement in open MRI: System architecture, integration and validation , 2007, Computer aided surgery : official journal of the International Society for Computer Aided Surgery.

[25]  Robert E Lenkinski,et al.  Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging--initial results. , 2007, Radiology.

[26]  M. Bock,et al.  INNOMOTION for Percutaneous Image-Guided Interventions , 2008, IEEE Engineering in Medicine and Biology Magazine.

[27]  Thomas Hambrock,et al.  Thirty-Two-Channel Coil 3T Magnetic Resonance-Guided Biopsies of Prostate Tumor Suspicious Regions Identified on Multimodality 3T Magnetic Resonance Imaging: Technique and Feasibility , 2008, Investigative radiology.

[28]  H. Hricak,et al.  Clinical stage T1c prostate cancer: evaluation with endorectal MR imaging and MR spectroscopic imaging. , 2009, Radiology.

[29]  Jason A Koutcher,et al.  Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. , 2009, Radiology.

[30]  C. Barceló-Vidal,et al.  Peripheral zone prostate cancer in patients with elevated PSA levels and low free-to-total PSA ratio: detection with MR imaging and MR spectroscopy. , 2009, Radiology.

[31]  A. Jemal,et al.  Cancer Statistics, 2009 , 2009, CA: a cancer journal for clinicians.

[32]  L. Tanoue.  Cancer Statistics, 2009 , 2010 .