Keywords:
Anatomy, Urinary Tract / Bladder, Oncology, MR, MR-Functional imaging, Ultrasound, Biopsy, Diagnostic procedure, Technical aspects, Tissue characterisation, Inflammation, Pathology
Authors:
R. Marcello, G. Assegnati, A. Righi, S. Signore, A. Di Blasi; Roma/IT
DOI:
10.1594/ecr2018/C-1573
Methods and materials
70 patients receiving biopsy with PSA value between 4.5 and 10 ng /ml with suspected PSA ratio,
negative for Digital Rectal Examination (DRE) and Trans-Rectal Ultrasound (TR-US).
From January 2016 to February 2017,
a working group including the Urology Unit of the S.
Eugenio Hospital ASL Roma 2 and the Diagnostic and Interventional Radiology Unit of S.
Filippo Neri Hospital ASL Roma 1,
performed 70 prostate biopsies in patients with clinical suspicion of Prostatic Cancer.
57/70 patients were evaluated with 12 randomized cores.
13/70 were selected with mpMRI targeted biopsy or fusion with 2/5 cores on index lesion with PIRADS score between 3 and 5 since in this group of patients the Random biopsy was not tolerable or at high risk of bleeding because all of them were on ASA drug therapy.
All 70 patients showed a PSA score between the value of 5 and 10,
a Ratio of less than 20 and a negative DRE result.
MpMRI examinations was carried out with Philips Achieva 1.5 T scanner equipped with surface coil and high-resolution thin-layer sequences (3 mm thk.).The sequences used were as follows: T2W in axial,
sagittal and coronal views; axial T2W fat-sat; DWI with b-value set at 0-500-1000 and ADC Maps; DCE-T1W fat sat and perfusion curve processing (Gadobenate dimeglumine 0.1 ml / Kg body weight).
After acquisition of all sequences the images were sent to a dedicated Workstation for Post Processing and display of perfusion data.
The suspected lesions of greater volume (Index Lesion according to PI-RADS V2) with PI-RADS score between 3 and 5 were considered the "Target" to be submitted to a FI targeted biopsy.
FI was carried out with Esaote My Lab - Twice Ultrasound scanner equipped with a Bi-planar probe and a suitable software for FI that allowed the "matching" of the two methods both using images in DICOM format.
Between 3 and 5 cores of the lesion of interest were obtained by trans-perineal route with 18 G cutting needle and local anesthesia