Ghai Sangeet, Trachtenberg John
aJoint Department of Medical Imaging, University Health Network, University of Toronto bDepartment of Surgery, Division of Urology, Princess Margaret Hospital, University Health Network, University of Toronto, Ontario, Canada.
Curr Opin Urol. 2015 May;25(3):205-11. doi: 10.1097/MOU.0000000000000160.
This review discusses the feasibility, recent advances and current status of in-bore MRI-guided interventional techniques for diagnosis and treatment of focal prostate cancer (PCa) and also explores the future applications, highlighting the emerging strategies for the treatment of PCa.
Multiparametric MRI has opened up opportunities for diagnosis and targeted therapeutics to the site of disease within the organ wherein minimizing the incidence of treatment-related toxicity of whole gland therapy. MRI-guided targeted biopsy has a higher detection rate for significant cancer and lower rate of detection of insignificant cancer. In comparison to ultrasound-guided focal therapy, in-bore treatment provides the advantage of real time thermal monitoring during treatment and assessment of treatment coverage by an enhanced scan immediately post-treatment. Preliminary results of ongoing phase I and II in-bore focal PCa treatment trials via transperineal, transrectal and transurethral routes, using different energy modalities for the ablation, have shown promising results.
Advances in multiparametric-MRI has opened up opportunities for in-bore targeted focal treatment of PCa in the correctly selected patient.
本综述讨论了用于局灶性前列腺癌(PCa)诊断和治疗的磁共振成像引导下介入技术的可行性、最新进展和现状,并探讨了其未来应用,重点介绍了PCa治疗的新兴策略。
多参数磁共振成像为器官内疾病部位的诊断和靶向治疗带来了机遇,可将全腺治疗相关毒性的发生率降至最低。磁共振成像引导下的靶向活检对显著癌的检出率更高,对非显著癌的检出率更低。与超声引导下的聚焦治疗相比,磁共振成像引导下的治疗具有在治疗期间进行实时热监测以及在治疗后立即通过增强扫描评估治疗覆盖范围的优势。正在进行的经会阴、经直肠和经尿道途径的I期和II期磁共振成像引导下局灶性PCa治疗试验的初步结果显示,使用不同能量模式进行消融取得了令人鼓舞的结果。
多参数磁共振成像的进展为正确选择的患者进行磁共振成像引导下的PCa靶向局灶治疗带来了机遇。