Wimper Yvonne, Fütterer Jurgen J, Bomers Joyce G R
Department of Medical Imaging, Radboud University Medical Centre, Geert Grooteplein 10, 6525 GA Nijmegen, The Netherlands.
Life (Basel). 2022 Feb 17;12(2):302. doi: 10.3390/life12020302.
Magnetic resonance imaging (MRI)-guided therapy for prostate cancer (PCa) aims to reduce the treatment-associated comorbidity of existing radical treatment, including radical prostatectomy and radiotherapy. Although active surveillance has been used as a conservative method to reduce overtreatment, there is a growing demand for less morbidity and personalized (focal) treatment. The development of multiparametric MRI was of real importance in improving the detection, localization and staging of PCa. Moreover, MRI has been useful for lesion targeting within the prostate, as it is used in the guidance of prostate biopsies, by means of cognitive registration, MRI-ultrasound fusion guidance or direct in-bore MRI-guidance. With regard to PCa therapies, MRI is used for precise probe placement into the lesion and to accurately monitor the treatment in real-time. Moreover, advances in MR-compatible thermal ablation allow for noninvasive real-time temperature mapping during treatment. In this review, we present an overview of the current status of MRI-guided therapies in PCa, focusing on cryoablation, focal laser ablation, high intensity focused ultrasound and transurethral ultrasound ablation. We explain the important role of MRI in the evaluation of the completeness of the ablation and during follow-up. Finally, we will discuss the challenges and future development inherent to these new technologies.
磁共振成像（MRI）引导下的前列腺癌（PCa）治疗旨在降低现有根治性治疗（包括根治性前列腺切除术和放射治疗）相关的合并症。尽管主动监测已被用作一种减少过度治疗的保守方法，但对降低发病率和个性化（局部）治疗的需求日益增加。多参数MRI的发展对于改善PCa的检测、定位和分期具有重要意义。此外，MRI在前列腺内病变靶向方面很有用，因为它通过认知配准、MRI-超声融合引导或直接在孔内MRI引导用于前列腺活检的引导。关于PCa治疗，MRI用于将精确探头放置到病变中并实时准确监测治疗。此外，磁共振兼容热消融技术的进步使得在治疗过程中能够进行无创实时温度映射。在本综述中，我们概述了PCa中MRI引导治疗的现状，重点关注冷冻消融、局部激光消融、高强度聚焦超声和经尿道超声消融。我们解释了MRI在评估消融完整性和随访期间的重要作用。最后，我们将讨论这些新技术固有的挑战和未来发展。
