Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Urology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Abdom Radiol (NY). 2016 May;41(5):877-88. doi: 10.1007/s00261-016-0681-3.
Prostate cancer is the most commonly diagnosed noncutaneous cancer and second-leading cause of death in men. Many patients with clinically organ-confined prostate cancer undergo definitive treatment of the whole gland including radical prostatectomy, radiation therapy, and cryosurgery. Active surveillance is a growing alternative option for patients with documented low-volume, low-grade prostate cancer. With recent advances in software and hardware of MRI, multiparametric MRI of the prostate has been shown to improve the accuracy in detecting and characterizing clinically significant prostate cancer. Targeted biopsy is increasingly utilized to improve the yield of MR-detected, clinically significant prostate cancer and to decrease in detection of indolent prostate cancer. MR-guided targeted biopsy techniques include cognitive MR fusion TRUS biopsy, in-bore transrectal targeted biopsy using robotic transrectal device, and in-bore direct MR-guided transperineal biopsy with a software-based transperineal grid template. In addition, advances in MR compatible thermal ablation technology allow accurate focal or regional delivery of optimal thermal energy to the biopsy-proved, MRI-detected tumor, utilizing cryoablation, laser ablation, high-intensity focused ultrasound ablation under MR guidance and real-time or near simultaneous monitoring of the ablation zone. Herein we present a contemporary review of MR-guided targeted biopsy techniques of MR-detected lesions as well as MR-guided focal or regional thermal ablative therapies for localized naïve and recurrent cancerous foci of the prostate.
前列腺癌是最常见的非皮肤癌，也是男性死亡的第二大主要原因。许多临床局限于前列腺的前列腺癌患者接受了整个腺体的确定性治疗，包括根治性前列腺切除术、放射治疗和冷冻手术。对于有记录的低体积、低级别前列腺癌患者，主动监测是一种不断发展的替代选择。随着 MRI 软件和硬件的最新进展，前列腺多参数 MRI 已被证明可提高检测和特征化临床显著前列腺癌的准确性。靶向活检越来越多地用于提高 MRI 检测到的、具有临床意义的前列腺癌的检出率，并降低惰性前列腺癌的检出率。MR 引导的靶向活检技术包括认知 MR 融合 TRUS 活检、使用机器人经直肠设备进行的腔内经直肠靶向活检，以及基于软件的经会阴网格模板进行的腔内直接 MR 引导经会阴活检。此外，MR 兼容热消融技术的进步允许使用冷冻消融、激光消融、MR 引导下高强度聚焦超声消融，将最佳热能精确地递送至活检证实的 MRI 检测到的肿瘤，并实时或近乎同时监测消融区，从而实现准确的局灶性或区域性治疗。本文就 MRI 检测到的病变的 MR 引导靶向活检技术以及用于治疗前列腺局灶性或区域性复发性癌症的 MR 引导热消融治疗方法进行了综述。
