Susil Robert C, Ménard Cynthia, Krieger Axel, Coleman Jonathan A, Camphausen Kevin, Choyke Peter, Fichtinger Gabor, Whitcomb Louis L, Coleman C Norman, Atalar Ergin
Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
J Urol. 2006 Jan;175(1):113-20. doi: 10.1016/S0022-5347(05)00065-0.
We investigated the accuracy and feasibility of a system that provides transrectal needle access to the prostate concurrent with 1.5 Tesla MRI which previously has not been possible.
In 5 patients with previously diagnosed prostate cancer, MRI guided intraprostatic placement of gold fiducial markers (4 procedures) and/or prostate biopsy (3 procedures) was performed using local anesthesia.
Mean procedure duration was 76 minutes and all patients tolerated the intervention well. Procedure related adverse events included self-limited hematuria and hematochezia following 3 of 8 procedures (all resolved in less than 1 week). Mean needle placement accuracy was 1.9 mm for the fiducial marker placement studies and 1.8 mm for the biopsy procedures. Mean fiducial marker placement accuracy was 4.8 mm and the mean fiducial marker placement accuracy transverse to the needle direction was 2.6 mm. All patients who underwent the procedure were able to complete their course of radiotherapy without delay or complication.
While studies of clinical usefulness are warranted, transrectal 1.5 T MRI guided prostate biopsy and fiducial marker placement is feasible using this system, providing new opportunities for image guided diagnostic and therapeutic prostate interventions.
我们研究了一种系统的准确性和可行性，该系统可在1.5特斯拉磁共振成像（MRI）的同时经直肠进行前列腺穿刺针穿刺，而此前这是无法实现的。
对5例先前诊断为前列腺癌的患者，在局部麻醉下使用MRI引导进行前列腺内金标记物置入（4例）和/或前列腺活检（3例）。
平均手术时间为76分钟，所有患者对该干预耐受良好。与手术相关的不良事件包括8例手术中的3例出现自限性血尿和便血（均在1周内缓解）。标记物置入研究的平均针置入精度为1.9毫米，活检手术的平均针置入精度为1.8毫米。标记物置入的平均精度为4.8毫米，与针方向垂直的标记物置入平均精度为2.6毫米。所有接受该手术的患者均能够毫无延迟或并发症地完成放疗疗程。
虽然有必要进行临床实用性研究，但使用该系统经直肠1.5T MRI引导下进行前列腺活检和标记物置入是可行的，为影像引导下的前列腺诊断和治疗干预提供了新机会。
