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2304 stereotactic prostate biopsy with pre-interventional mri and live us fusion
Vol. 185, No. 4S, Supplement, Wednesday, May 18, 2011
Given the accuracy of this modality, the system can be filled with saline
METHODS: A model of the urinary tract was created with a
solution without losing the ability to diagnose a fluid leak in the system.
“bladder” (reservoir and pump) designed to move normal saline alongtwo 3mm diameter plastic tubes “ureters” at a rate mimicking urine flow,
Source of Funding:
3–5 mm/sec. In the MRI scanner, the protons of the fluid in the ‘bladder’were excited in a 90 degree axial spin. As the urine moved into theureters a 180 degree pulse was performed along the sagittal plane.
With reflux present (flow up the tubes), the fluid excited by the
STEREOTACTIC PROSTATE BIOPSY WITH
90 degree pulse would leave the reservoir, but since it is constrained by
PRE-INTERVENTIONAL MRI AND LIVE US FUSION
the tubes it would also be excited by the 180 degree pulse. Only fluids
Boris Hadaschik*, Timur Kuru, Corina Tulea, Dogu Teber, Johannes
that “see” both RF pulses are visible in the SSFSE sequencing, so only
Huber, Valentin Popeneciu, Sascha Pahernik, Heinz-Peter
Schlemmer, Markus Hohenfellner, Heidelberg, Germany
RESULTS: Performing the described modification of SSFSE
MRI, we were able to excite the fluid in the model bladder for approx-
INTRODUCTION AND OBJECTIVES: The key challenge for
imately 4 seconds, allowing the visualization of fluid reflux up the model
focal therapy of prostate cancer is to identify index lesions. In this
urinary tract without the use of contrast agents. The temporal resolution
context, we describe our initial experience with a new stereotactic
prostate biopsy system, which integrates pre-interventional MRI data
CONCLUSIONS: Using a modification of a SSFSE, we were
with periinterventional ultrasound for perineal prostate biopsies.
able to detect retrograde flow in a model ureter and bladder system
METHODS: 33 patients were stereotactically biopsied (mean
using MRI. We hope to apply this technology to allow us to detect reflex
age of 64yrs., mean PSA level of 8.2ng/ml and mean prostate vol. of
in children without contrast, catheterization or ionizing radiation.
40ml). 21 of these 33 patients had already had a negative transrectalUS-guided biopsy. All men underwent multimodal 3 Tesla MRI without
Source of Funding:
endorectal coil including diffusion weighted imaging and dynamic con-trast enhanced sequences as well as MR-spectroscopy. Suspiciouslesions were marked by radiologists with over 10 years experience inreading prostate MRI before the obtained data were transferred to the
P40 PROVIDES VALUABLE FUNCTIONAL INFORMATION
Using a custom-made biplane TRUS probe mounted on a
BEFORE AND AFTER SURGERY FOR PROBLEMATIC
stepper device, 3D ultrasound data were generated to set the anatomic
UPJ OBSTRUCTION PATIENTS WITH A NORMAL
landmarks. Then MRI and TRUS imaging data were fused manually. As
a result, the suspicious MRI lesions were superimposed onto the TRUS
Shelly X Bian*, Judy M Choi, MD, Wesley A Mayer, MD, Alvin Goh,
data. Next, 3D biopsy planning was performed including systematic
MD, Richard E Link, MD, PhD, Houston, TX
biopsies from the peripheral and transitional zones of the prostate.
INTRODUCTION AND OBJECTIVES: Evaluating patients for
Perineal biopsies were taken under live US imaging, and the location of
UPJ obstruction involves integrating both clinical symptoms and imag-
ing findings. Renal scanning can provide important functional informa-
RESULTS: 14 out of 33 patients were diagnosed with prostate
tion to help identify patients who would benefit from surgical correction.
cancer. These results showed a positive correlation between MRI
T1/2 (time from diuretic administration to 50% clearance of tracer) Ͼ 20
findings and histopathology in 22 out of 33 patients. In MRI lesions
min is the gold standard for obstruction, and improvement in T1/2 after
marked as highly suspicious, the detection rate was 100%. Evaluating
pyeloplasty indicates resolution. However, many patients present pre-
the biopsies from lesions marked as highly and as questionable sus-
operatively with symptoms but a normal T1/2 (Ͻ20min) and many
picious together, prostate cancer was detected in 27.95%. In compar-
continue to show a delayed T1/2 despite complete resolution of symp-
ison, only 8% of the additional systematic biopsies were positive.
toms postoperatively. Our goal was to explore alternative analyses of
Target registration error of the first 554 biopsy cores was 1.9 mm. For
renal scans that may augment T1/2 in diagnosing clinically significant
adverse effects, one patient experienced urinary retention. Postinter-
ventional hemorrhage or urinary tract infection did not occur.
METHODS: We retrospectively reviewed records of 96 consec-
CONCLUSIONS: Perineal stereotactic prostate biopsies guided
utive adult patients undergoing laparoscopic or robotic-assisted pyelo-
by the combination of MRI and ultrasound enable effective examination of
plasty for UPJ obstruction from 2005 to 2010 by a single surgeon. 95%
suspicious MRI lesions. Additionally, each biopsy core taken may be
were symptomatic and 5% had unilateral decreased function by imag-
documented accurately for its location in 3D. Thus, MRI data may be
ing. Pre and postoperative MAG3 lasix-washout renal scan images
validated and different treatment options stratified in depth. At the same
were available for review in 22 patients with primary unilateral UPJ
time the morbidity of the procedure was minimal.
obstruction and two kidneys. We assessed five parameters: differential
Source of Funding:
renal function (DRF), time from diuretic administration to 50% clear-ance (T1/2), time from maximum tracer uptake to 50% clearance(M1/2), percent clearance at 20 minutes (P20) and percent clearance at
40 minutes (P40). The contralateral kidney served as a control and a
NOVEL USE OF MRI TO DETECT REFLUX IN A BLADDER
paired T-test was used for analysis.
MODEL WITHOUT CATHETERS, IONIZING RADIATION, OR
RESULTS: Preoperatively, 10 patients (46%) had a T1/2 Ͼ 20
. . . OH MY!
min, 6 Ͼ 10 min (27%) and 6 Ͻ 10 min (27%). Three measures weresignificantly different between the affected and control kidney: T1/2,
Bhavin Patel*, Gordon McLorie, Anthony Atala, Robert Kraft, Steven
P20, and P40. In the affected kidney with a preoperative T1/2 Ͼ 20 min,
both T1/2 and P40 decreased significantly after surgery. In the prob-
INTRODUCTION AND OBJECTIVES: Novel scanning and pro-
lematic subset of 12 patients with a “normal” preoperative T1/2
cessing protocols have been developed to augment the diagnostic
(Ͻ20min), P40 was still significantly different between the affected and
ability of magnetic resonance imaging (MRI). Single Shot Fast Spin
control kidney (24% v. 9%, pϭ0.002) and decreased significantly
Echo pulse sequencing (SSFSE) is one such technology. It allows one
before and after corrective pyeloplasty (24% to 16%, pϭ0.036). DRF
to image directional flow independent of contrast. We propose that
did not show significant improvement postoperatively (pϾ0.05) and all
using this technology, unenhanced urine can be used as an endoge-
parameters for the unaffected kidney did not show significant change
nous tracer, allowing for the measurement of urine flow back to the
before and after pyeloplasty (pϾ0.05) as expected.
kidney. This could allow for the diagnosis of reflux without a catheter,
CONCLUSIONS: P40 appears to be a useful alternative renal
contrast agent, or ionizing radiation.
scan marker for assessing UPJ obstruction. Even in the problematic
Nutrition and Cancer Brown Kelp Modulates Endocrine Hormones in Female Sprague-Dawley Rats and in Human Luteinized Granulosa Cells1 Christine F. Skibola,*2 John D. Curry,*3 Catherine VandeVoort,† Alan Conley,** andMartyn T. Smith* *School of Public Health, University of California, Berkeley, California; and †California National PrimateResearch Center and **Department of Population H
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