Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, United States.
Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, United States.
Magn Reson Med. 2022 Dec;88(6):2609-2620. doi: 10.1002/mrm.29399. Epub 2022 Aug 17.
To develop techniques and establish a workflow using hyperpolarized carbon-13 ( C) MRI and the pyruvate-to-lactate conversion rate (k ) biomarker to guide MR-transrectal ultrasound fusion prostate biopsies.
The integrated multiparametric MRI (mpMRI) exam consisted of a 1-min hyperpolarized C-pyruvate EPI acquisition added to a conventional prostate mpMRI exam. Maps of k values were calculated, uploaded to a picture archiving and communication system and targeting platform, and displayed as color overlays on T -weighted anatomic images. Abdominal radiologists identified C research biopsy targets based on the general recommendation of focal lesions with k >0.02(s ), and created a targeting report for each study. Urologists conducted transrectal ultrasound-guided MR fusion biopsies, including the standard H-mpMRI targets as well as 12-14 core systematic biopsies informed by the research C-k targets. All biopsy results were included in the final pathology report and calculated toward clinical risk.
This study demonstrated the safety and technical feasibility of integrating hyperpolarized C metabolic targeting into routine H-mpMRI and transrectal ultrasound fusion biopsy workflows, evaluated via 5 men (median age 71 years, prostate-specific antigen 8.4 ng/mL, Cancer of the Prostate Risk Assessment score 2) on active surveillance undergoing integrated scan and subsequent biopsies. No adverse event was reported. Median turnaround time was less than 3 days from scan to C-k targeting, and scan-to-biopsy time was 2 weeks. Median number of C targets was 1 (range: 1-2) per patient, measuring 1.0 cm (range: 0.6-1.9) in diameter, with a median k of 0.0319 s (range: 0.0198-0.0410).
This proof-of-concept work demonstrated the safety and feasibility of integrating hyperpolarized C MR biomarkers to the standard mpMRI workflow to guide MR-transrectal ultrasound fusion biopsies.
开发技术并建立使用 13 碳（ 13 C）磁共振成像和丙酮酸向乳酸转化速率（ k）生物标志物指导磁共振经直肠超声融合前列腺活检的工作流程。
整合的多参数磁共振成像（mpMRI）检查包括 1 分钟的极化 13 C-丙酮酸 EPI 采集，外加常规前列腺 mpMRI 检查。计算 k 值图，上传至图像存档和通信系统以及靶向平台，并显示为 T2 加权解剖图像上的彩色叠加。腹部放射科医生根据 k 值＞0.02（ s）的局灶性病变的一般建议，识别 13 C研究活检目标，并为每项研究创建一个靶向报告。泌尿科医生进行经直肠超声引导的磁共振融合活检，包括标准的 H-mpMRI 目标以及 12-14 个核心系统活检，这些活检目标由研究 13 C-k 目标提供信息。所有活检结果均包含在最终的病理报告中，并计算为临床风险。
这项研究通过对 5 名主动监测患者（中位年龄 71 岁，前列腺特异性抗原 8.4ng/ml，前列腺癌风险评估评分 2 分）进行的整合扫描和随后的活检，证明了将极化 13 C代谢靶向整合到常规 H-mpMRI 和经直肠超声融合活检工作流程中的安全性和技术可行性。没有不良事件报告。从扫描到 13 C-k 靶向的中位周转时间不到 3 天，扫描到活检的时间为 2 周。每位患者的 13 C 目标中位数为 1（范围：1-2），直径为 1.0cm（范围：0.6-1.9），k 值中位数为 0.0319 s（范围：0.0198-0.0410）。
这项概念验证工作证明了将极化 13 C MR 生物标志物整合到标准的 mpMRI 工作流程中以指导磁共振经直肠超声融合活检的安全性和可行性。
