title: Impact of real-time elastography on magnetic resonance imaging/ultrasound fusion guided biopsy in patients with prior negative prostate biopsies.
abstract: OBJECTIVE
  The fusion of multiparametric resonance imaging and ultrasound has been proven capable of detecting prostate cancer in different biopsy settings. The addition of real-time elastography promises to increase the precision of the outcome of targeted biopsies. We investigated whether real-time elastography improves magnetic resonance imaging/transrectal ultrasound fusion targeted biopsy in patients after previous negative biopsies.
  
  
  METHODS
  Prospectively 121 men underwent 3T magnetic resonance imaging. Using magnetic resonance imaging/real-time elastography fusion every suspicious lesion was characterized according to its tissue density and sampled by 2 fusion guided targeted biopsies. Additionally, all patients underwent 12-core systematic biopsy. The detection rate of clinically significant and insignificant cancers was compared between targeted und systematic biopsies. The accuracy to predict high grade prostate cancer was evaluated for with the PI-RADS scoring system and compared to the magnetic resonance imaging/real-time elastography fusion score.
  
  
  RESULTS
  Overall prostate cancer was detected in 52 patients (43%). Targeted fusion guided biopsy revealed prostate cancer in 32 men (26.4%) and systematic biopsy in 46 (38%). The proportion of clinically significant cancers was higher for targeted biopsy (90.6%) compared to systematic biopsy (73.9%). The detection rate per core was higher for targeted biopsies (14.7%) compared to systematic biopsies (6.5%, p <0.001). The prediction of biopsy result according to magnetic resonance imaging/real-time elastography fusion was better (AUC 0.86) than magnetic resonance imaging alone (AUC 0.79). Sensitivity and specificity for magnetic resonance imaging/real-time elastography fusion was 77.8% and 77.3% vs 74.1% and 62.9% for magnetic resonance imaging.
  
  
  CONCLUSIONS
  Magnetic resonance imaging/transrectal ultrasound fusion enhances the likelihood of detecting clinically significant cancers in a repeat biopsy setting. Adding real-time elastography to magnetic resonance imaging supports the characterization of cancer suspicious lesions.
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Marko
authors.initials: M
authors.lastname: Brock
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Björn
authors.initials: B
authors.lastname: Löppenberg
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Roghmann
authors.affiliation: Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany.
authors.forename: Alexandré
authors.initials: A
authors.lastname: Pelzer
authors.affiliation: Department of Urology, Klinikum Ingolstadt, Ingolstadt, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Dickmann
authors.affiliation: Radiologische Gemeinschaftspraxis Herne, Herne, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Becker
authors.affiliation: Radiologische Gemeinschaftspraxis Herne, Herne, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Martin-Seidel
authors.affiliation: Department of Pathology, Berufsgenossenschaftliche Universitätsklinik Bergmannsheil GmbH, Ruhr University Bochum, Bochum, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Sommerer
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Lena
authors.initials: L
authors.lastname: Schenk
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Rein Jüri
authors.initials: RJ
authors.lastname: Palisaar
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Noldus
authors.affiliation: Department of Urology, Marienhospital Herne, Ruhr University Bochum, Bochum, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: von Bodman
mesh_terms: D001707:Biopsy, Needle / Q000379:methods; D003199:Computer Systems; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods; D053783:Magnetic Resonance Imaging, Interventional; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging* / Q000473:pathology*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*
keywords: biopsy; elasticity imaging techniques; fusion; magnetic resonance imaging; prostatic neoplasms