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ECR 2015 / C-0829
Latest Advancements in Real-time Fusion Imaging for Prostate
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Congress: ECR 2015
Poster No.: C-0829
Type: Educational Exhibit
Keywords: Image registration, Cancer, Imaging sequences, Diagnostic procedure, Ultrasound, PET, MR, Genital / Reproductive system male
Authors: G. Paoletti1, M. Silvani2, D. Confalone2, L. Lodigiani3, L. Manzoli3, S. D'Onofrio3, S. de Beni3, G. Mauri4, L. Forzoni3; 1Arezzo/IT, 2Biella/IT, 3Genoa/IT, 4Milan/IT


Prostate cancer is the most common cancer and the second most common cause of cancer deaths among men in the western countries [1]. The management of prostate cancer is a complex issue because of the difficulty in accurate staging and in predicting the speed of disease progression [2]. The current methods of prostate cancer detection include digital rectal examination (DRE), serum prostate-specific antigen (PSA) level and TRUS with random biopsy [3]. The role of Magnetic Resonance Imaging (MRI) has evolved over the past decade with the development of newer techniques to localize, stage and functionally characterize the targeted cancer [4].


Real-time  MRI-TRUS fusion (Fig. 1) has the aim to improve the accuracy of targeted biopsies and to increase the detection of prostatic cancer in patients with high PSA, negative digital rectal exploration and negative previous random prostate biopsy [5].


MRI T2 sequences  (Fig. 2) allow to identify the cancer in the prostate from a morphological point of view [6].


MRI DWI (Diffusion Weighted Imaging) is a functional sequence (Fig. 3) whose imaging characteristics depend on the microscopic mobility of water particles in the explored anatomical tissues [7].


DWI enables the calculation of the apparent diffusion coefficient (ADC), which is a value that measures water diffusion in tissues. The movement of water particles is restricted in case of tumors, leading to a reduction in the ADC value [8].


Furthermore, the role of positron emission tomography (PET) with [F-18]-fluorodeoxyglucose (FDG) for the imaging evaluation of patients with cancer has increased rapidly worldwide [9], even if it has several limitations for the detection of prostate cancer, because it frequently does not have increased glucose metabolism and the excretion of FDG into urine often interferes with detection of it [10].  


PET/Computed Tomography (CT) has a higher sensitivity than PET alone [11]. PET/CT and its, functional and anatomical information in a single examination provides a greater advantage for detecting cancer [12], so it might contribute to improve the sensitivity of prostate cancer detection.


Finally, real-time Ultrasound Imaging (Fig. 4) for guided biopsy procedures [13], Color and Power Doppler technologies (Fig. 5) for hemodynamic information of the prostate lesion [14], Strain technologies (Elastosonography) for tissue stiffness evaluation (Fig. 6) and lesion differentiation in the prostate tissue [15], and Contrast Enhanced Ultrasound (CEUS – Fig. 7) for micro-circulation assessment in the targeted region [16] can be used during TRUS examination.


The aim of this study is to show and to indicate the feasibility in clinical practice of the latest advancements of Multi-modality real-time fusion imaging with Virtual Biopsy tools for biopsy guidance enabling the combination of the above mentioned imaging modalities.


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