title: 1.5-T magnetic resonance-guided transgluteal biopsies of the prostate in patients with clinically suspected prostate cancer: technique and feasibility.
abstract: OBJECTIVE
  The aim of this study was to examine the feasibility and safety of magnetic resonance-guided prostate biopsy (MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic lesions.
  
  
  METHODS
  This study was approved by the ethical committee. A total of 25 men with clinically suspected prostate cancer with increased prostate-specific antigen levels and at least 1 previous negative transrectal ultrasound-guided prostatic biopsy (TRUSBx) underwent diagnostic magnetic resonance (MR) imaging of the prostate. Cancer suspicious regions (CSR) were identified, and MRGBx with a transgluteal approach in a large closed-bore 1.5-T MR system was manually performed in coaxial technique, using transversal fat-suppressed T2-weighted true fast imaging with steady-state free precession sequences. Success rate, biopsy findings, side effects, procedure time, number of acquisitions for the repositioning of the needle guide, and length of the biopsy channel were documented. Follow-up was performed 24 months after the procedure.
  
  
  RESULTS
  In diagnostic MR imaging of the prostate, a total of 40 CSRs were detected in 25 patients. All MRGBx procedures were technically successful and all CSRs were biopsied. The mean number of core biopsies per CSR was 3.3 ± 1.5 (range, 1-7). Histopathological analysis revealed adenocarcinoma in 35% (14/40), acute or chronic prostatitis in 30% (12/40), adenofibromyomatous changes in 22.5% (9/40), and no identifiable pathology in 17.5% (7/40) of CSRs, with a pathological overlap for chronic prostatitis and adenofibromyomatous changes in 1 patient with biopsies in 2 CSRs. No missed prostate cancer after MR-guided biopsy in clinical follow-up was detected. Mean procedure time was 31 ± 7 minutes (range, 21-46 minutes). Side effects were hematuria (n = 7), hematospermia (n = 3), combined hematuria/hematospermia (n = 2), and infection (n=1).
  
  
  CONCLUSIONS
  Magnetic resonance-guided prostate biopsy of the prostate gland with a transgluteal approach is feasible, safe, and a promising technique for histological clarification of cancer suspicious lesions in patients with increased prostate-specific antigen levels after negative TRUSBx. Magnetic resonance-guided prostate biopsy offers a reasonable alternative to repeated TRUSBx for histological clarification of prostate cancer.
authors: Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany. bbodelle@googlemail.com
authors: Boris
authors: B
authors: Bodelle
authors: Nagy N
authors: NN
authors: Naguib
authors: Boris
authors: B
authors: Schulz
authors: Katrin
authors: K
authors: Eichler
authors: Cindy
authors: C
authors: Müller
authors: Martin-Leo
authors: ML
authors: Hansmann
authors: Renate
authors: R
authors: Hammerstingl
authors: Frank
authors: F
authors: Hübner
authors: Thomas J
authors: TJ
authors: Vogl
authors: Stephan
authors: S
authors: Zangos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002081:Buttocks / Q000473:pathology; D005240:Feasibility Studies; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity