Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany.
Radiology. 2011 Jun;259(3):903-10. doi: 10.1148/radiol.11101559. Epub 2011 Mar 1.
To examine the feasibility and safety of magnetic resonance (MR)-guided biopsy by using a transgluteal approach in patients with suspicious prostate lesions by using an MR-compatible robotic system and a 1.5-T MR system.
The study was approved by the institutional review board of University Frankfurt, and informed consent was obtained from each patient. A total of 20 patients (age range, 57.8-71.9 years; mean age, 65.1 years) underwent biopsy in a closed-bore high-field-strength MR system. Biopsy was performed with an MR-compatible pneumatically driven robotic system. T1-weighted gradient-echo fast low-angle shot and T2-weighted true fast imaging with steady-state precession sequences were used to plan and guide the intervention with a transgluteal access on the external planning computer of the assistance system. The system calculated the trajectory and then moved the guiding arm to the insertion point. The cannula was advanced manually, and biopsies were performed with the coaxial technique by using a 15-gauge pencil tip needle. Intervention time, complications, and biopsy findings were documented.
The MR-compatible robotic system did not interfere with image quality, nor did MR imaging cause dysfunction of the robot. In one patient, the interventionist caused a fail-safe system shutdown. This was due to inadvertent displacement of the guiding arm during cannula insertion. This problem was solved by increasing the displacement threshold. Accurate coaxial cannula biopsy could be performed in all subsequent patients. Sufficient histopathologic assessment was performed in 19 patients. Insufficient material was retrieved in the patient who experienced fail-safe system shutdown. The median intervention time was 39 minutes (23-65 minutes). No procedure-related complications were observed.
Preliminary results indicate that MR-guided robot-assisted biopsy is feasible and can be performed safely with highly accurate cannula placement.
使用一种兼容磁共振成像（MR）的机器人系统和 1.5T MR 系统，经直肠途径，对可疑前列腺病变患者进行 MR 引导下的活检，评估该方法的可行性和安全性。
本研究经法兰克福大学机构审查委员会批准，所有患者均签署了知情同意书。共 20 例患者（年龄 57.8~71.9 岁，平均 65.1 岁）在闭孔高场强 MR 系统中接受了活检。采用兼容磁共振成像的气动驱动机器人系统进行活检。采用 T1 加权梯度回波快速小角度激发和 T2 加权真实稳态进动快速成像序列，在辅助系统的外部规划计算机上对经直肠入路进行规划和引导。系统计算出轨迹，然后将导向臂移动到插入点。手动推进套管，采用同轴技术，使用 15 号穿刺针进行活检。记录介入时间、并发症和活检结果。
兼容磁共振成像的机器人系统未干扰图像质量，磁共振成像也未导致机器人功能障碍。在 1 例患者中，介入医师导致故障安全系统关闭。这是由于在套管插入过程中，导向臂意外移位所致。通过增加位移阈值解决了该问题。随后所有患者均能准确地进行同轴套管活检。19 例患者均进行了充分的组织病理学评估。在发生故障安全系统关闭的患者中，仅获得了少量组织标本。中位介入时间为 39 分钟（23~65 分钟）。未观察到与操作相关的并发症。
初步结果表明，MR 引导机器人辅助活检是可行的，可以安全进行，并且套管的放置非常精确。
