title: Real-time Virtual Sonography for navigation during targeted prostate biopsy using magnetic resonance imaging data.
abstract: OBJECTIVE
  To evaluate the effectiveness of the medical navigation technique, namely, Real-time Virtual Sonography (RVS), for targeted prostate biopsy.
  
  
  METHODS
  Eighty-five patients with suspected prostate cancer lesions using magnetic resonance imaging (MRI) were included in this study. All selected patients had at least one negative result on the previous transrectal biopsies. The acquired MRI volume data were loaded onto a personal computer installed with RVS software, which registers the volumes between MRI and real-time ultrasound data for real-time display. The registered MRI images were displayed adjacent to the ultrasonographic sagittal image on the same computer monitor. The suspected lesions on T2-weighted images were marked with a red circle. At first suspected lesions were biopsied transperineally under real-time navigation with RVS and then followed by the conventional transrectal and transperineal biopsy under spinal anesthesia.
  
  
  RESULTS
  The median age of the patients was 69 years (56-84 years), and the prostate-specific antigen level and prostate volume were 9.9 ng/mL (4.0-34.2) and 37.2 mL (18-141), respectively. Prostate cancer was detected in 52 patients (61%). The biopsy specimens obtained using RVS revealed 45/52 patients (87%) positive for prostate cancer. A total of 192 biopsy cores were obtained using RVS. Sixty-two of these (32%) were positive for prostate cancer, whereas conventional random biopsy revealed cancer only in 75/833 (9%) cores (P < 0.01).
  
  
  CONCLUSIONS
  Targeted prostate biopsy with RVS is very effective to diagnose lesions detected with MRI. This technique only requires additional computer and RVS software and thus is cost-effective. Therefore, RVS-guided prostate biopsy has great potential for better management of prostate cancer patients.
authors.affiliation: Department of Urology, Hitachi General Hospital, Hitachi, Ibaraki, Japan. sh-miya@umin.ac.jp
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Miyagawa
authors.forename: Satoru
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kimura
authors.forename: Takahiro
authors.initials: T
authors.lastname: Suetomi
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tsutsumi
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Irie
authors.forename: Masanao
authors.initials: M
authors.lastname: Kondoh
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Mitake
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007091:Image Processing, Computer-Assisted; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D018084:Ultrasonography, Interventional / Q000379:methods*