The addition of a sagittal image fusion improves the prostate cancer detection in a sensor-based MRI /ultrasound fusion guided targeted biopsy

• Published in: BMC urology Vol. 17; no. 1; p. 7
• Main Authors: Günzel, Karsten, Cash, Hannes, Buckendahl, John, Königbauer, Maximilian, Asbach, Patrick, Haas, Matthias, Neymeyer, Jörg, Hinz, Stefan, Miller, Kurt, Kempkensteffen, Carsten
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 13.01.2017; BioMed Central
• Subjects: Aged; Diagnosis; Humans; Image Processing, Computer-Assisted; Image-Guided Biopsy; Magnetic Resonance Imaging; Male; Middle Aged; Prostate cancer; Prostatic Neoplasms - diagnostic imaging; Prostatic Neoplasms - pathology; Retrospective Studies; Ultrasonography; Urology; Multiparametric magnetic resonance imaging; Targeted biopsy; MRI/US fusion biopsy; Prostate cancer detection
• ISSN: 1471-2490; 1471-2490
• DOI: 10.1186/s12894-016-0196-9

To explore the diagnostic benefit of an additional image fusion of the sagittal plane in addition to the standard axial image fusion, using a sensor-based MRI/US fusion platform. During July 2013 and September 2015, 251 patients with at least one suspicious lesion on mpMRI (rated by PI-RADS) were included into the analysis. All patients underwent MRI/US targeted biopsy (TB) in combination with a 10 core systematic prostate biopsy (SB). All biopsies were performed on a sensor-based fusion system. Group A included 162 men who received TB by an axial MRI/US image fusion. Group B comprised 89 men in whom the TB was performed with an additional sagittal image fusion. The median age in group A was 67 years (IQR 61-72) and in group B 68 years (IQR 60-71). The median PSA level in group A was 8.10 ng/ml (IQR 6.05-14) and in group B 8.59 ng/ml (IQR 5.65-12.32). In group A the proportion of patients with a suspicious digital rectal examination (DRE) (14 vs. 29%, p = 0.007) and the proportion of primary biopsies (33 vs 46%, p = 0.046) were significantly lower. The rate of PI-RADS 3 lesions were overrepresented in group A compared to group B (19 vs. 9%; p = 0.044). Classified according to PI-RADS 3, 4 and 5, the detection rates of TB were 42, 48, 75% in group A and 25, 74, 90% in group B. The rate of PCa with a Gleason score ≥7 missed by TB was 33% (18 cases) in group A and 9% (5 cases) in group B; p-value 0.072. An explorative multivariate binary logistic regression analysis revealed that PI-RADS, a suspicious DRE and performing an additional sagittal image fusion were significant predictors for PCa detection in TB. 9 PCa were only detected by TB with sagittal fusion (sTB) and sTB identified 10 additional clinically significant PCa (Gleason ≥7). Performing an additional sagittal image fusion besides the standard axial fusion appears to improve the accuracy of the sensor-based MRI/US fusion platform.