Fusion of MRI to 3D TRUS for mechanically-assisted targeted prostate biopsy: system design and initial clinical experience

Authors:
Derek W. Cool;Jeff Bax;Cesare Romagnoli;Aaron D. Ward;Lori Gardi;Vaishali Karnik;Jonathan Izawa;Joseph Chin;Aaron Fenster
Affiliations:
Imaging Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada and Department of Medical Imaging, University of Western Ontario, London, ON, Canada;Imaging Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada;Department of Medical Imaging, University of Western Ontario, London, ON, Canada;Lawson Health Research Institute, University of Western Ontario, London, ON, Canada;Imaging Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada;Imaging Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada;Department of Surgery, Division of Urology, University of Western Ontario, London, ON, Canada;Department of Surgery, Division of Urology, University of Western Ontario, London, ON, Canada;Imaging Laboratories, Robarts Research Institute, University of Western Ontario, London, ON, Canada and Department of Medical Imaging, University of Western Ontario, London, ON, Canada
Venue:
MICCAI'11 Proceedings of the 2011 international conference on Prostate cancer imaging: image analysis and image-guided interventions
Year:
2011

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Abstract

This paper presents a mechanically-assisted 3D transrectal ultrasound (TRUS) biopsy system with MRI-3D TRUS fusion. The 3D TRUS system employs a 4 degree-of-freedom linkage for real-time TRUS probe tracking. MRI-TRUS fusion is achieved using a surface-based nonlinear registration incorporating thin-plate splines to provide real-time overlays of suspicious MRI lesions on 3D TRUS for intrabiopsy targeted needle guidance. Clinical use of the system is demonstrated on a prospective cohort study of 25 patients with clinical findings concerning for prostate adenocarcinoma (PCa). The MRI-3D TRUS registration accuracy is quantified and compared with alternative algorithms for optimal performance. Results of the clinical study demonstrated a significantly higher rate of positive biopsy cores and a higher Gleason score cancer grading for targeted biopsies using the MRI-3D TRUS fusion as compared to the standard 12-core sextant biopsy distribution. Lesion targeted biopsy cores that were positive for PCa contained a significantly higher percentage of tumor within each biopsy sample compared to the sextant cores and in some patients resulted in identifying higher risk disease.