Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co Introduction Until recently, the diagnosis of prostate cancer (PCa) has been based on blinded, systematic, template-based sampling strategy under transrectal ultrasound (TRUS) guidance. This test has undergone considerable modification in order to improve the sampling efficiency: from the origi- nal six cores [1] to the standardized 12 cores [2, 3]. Nevertheless, 12-core TRUS biopsy conferred an incremental benefit in terms of detection; there is a wide consensus that it remains prone to errors. These principally comprise undersampling of significant and oversampling of insignificant PCa [4–6]. The introduction of multiparametric magnetic resonance imaging (mp-MRI) has made it possible to change the way in which prostate biopsy is done, allowing to direct biopsies to suspi- cious lesions rather than randomly. The subject of this chapter relates to the use of a software to assist in targeting an MRI-derived suspicious lesion. Interpretation of Multiparametric MRI The MRI acquisition and reporting by the radiologist is the initial step of all MRI targeted biopsy strategies. mp-MRI includes three components: high-resolution T2-weighted MR images (T2WI) and at least two functional MRI techniques including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) [7–9] (Fig. 1). MR spectroscopic imaging (MRSI) remains an optional technique in most centers. The use of an endorectal coil (ERC) to increase the spatial resol ution of the technique is still under debate, especially with the recent improvement in signal-to-noi se ratios achieved by the use of the 3-T scanner [10]. To describe suspected l esions diagnosed by MRI in a standardized manner, radiologists use standardized suspici on s cores and graphical templates to show locations. The most used scores UltrasoundMRI Fusion Biopsy in Prostate Gland Francesco Porpiglia, MatteoManfredi F. Porpiglia (  ), M. Manfredi Division of Urology, Department of Oncology, University ofTurin,“San Luigi”Hospital, Regione Gonzole 10, Orbassano (Turin) 10043, Italy e-mail: porpiglia@libero.it Cutting EDGE_Urology(SUN)_final.indd 33 27-Mar-18 10:00:30 AM