title: Targeted MRI/TRUS fusion-guided biopsy in men with previous prostate biopsies using a novel registration software and multiparametric MRI PI-RADS scores: first results.
abstract: OBJECTIVE
  To evaluate a novel system for MRI/TRUS fusion-guided biopsy for detection of prostate cancer (PCa) in patients with previous negative prostate biopsy and determine diagnostic accuracy when using the Prostate Imaging Reporting and Data System (PI-RADS) for multiparametric magnetic resonance imaging (mpMRI) as proposed by the European Society of Urogenital Radiology.
  
  
  METHODS
  Thirty-nine men with clinical suspicion of PCa and history of previous prostate biopsy underwent mpMRI on a 3-T MRI. In total, 72 lesions were evaluated by the consensus of two radiologists. PI-RADS scores for each MRI sequence, the sum of the PI-RADS scores and the global PI-RADS were determined. MRI/TRUS fusion-guided targeted biopsy was performed using the BioJet™ software combined with a transrectal ultrasound system. Image fusion was based on rigid registration. PI-RADS scores of the dominant lesion were compared with histopathological results. Diagnostic accuracy was determined using receiver operating characteristic curve analysis.
  
  
  RESULTS
  MRI/TRUS fusion-guided biopsy was reliable and successful for 71 out of 72 lesions. The global PI-RADS score of the dominant lesion was significantly higher in patients with PCa (4.0 ± 1.3) compared to patients with negative histopathology (2.6 ± 0.8; p = 0.0006). Using a global PI-RADS score cut-off ≥4, a sensitivity of 85 %, a specificity of 82 % and a negative predictive value of 92 % were achieved.
  
  
  CONCLUSIONS
  The described fusion system is dependable and efficient for targeted MRI/TRUS fusion-guided biopsy. mpMRI PI-RADS scores combined with a novel real-time MRI/TRUS fusion system facilitate sufficient diagnosis of PCa with high sensitivity and specificity.
authors.affiliation: Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany. Tewes.Susanne@mh-hannover.de.
authors.forename: Susanne
authors.initials: S
authors.lastname: Tewes
authors.affiliation: Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Hueper
authors.affiliation: Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Hartung
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Imkamp
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Thomas R W
authors.initials: TR
authors.lastname: Herrmann
authors.affiliation: Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Weidemann
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Renckly
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Kuczyk
authors.affiliation: Institute for Radiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Wacker
authors.affiliation: Department of Urology and Urologic Oncology, Hannover Medical School, Carl-Neuberg Str. 1, 30625, Hannover, Germany.
authors.forename: Inga
authors.initials: I
authors.lastname: Peters
mesh_terms: D000368:Aged; D019160:Endosonography / Q000379:methods*; D006801:Humans; D061705:Image-Guided Biopsy / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D053783:Magnetic Resonance Imaging, Interventional / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011467:Prostate / Q000000981:diagnostic imaging / Q000473:pathology; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012372:ROC Curve; D012007:Rectum; D015203:Reproducibility of Results; D012984:Software
keywords: MRI/TRUS fusion-guided biopsy; Multiparametric MRI; PI-RADS scoring; Prostate cancer