Cutting Edge Urology

T his PDF belongs to matthew.hooson@springer.co 34 • CUTTING EDGE - UROLOGY are the 1–5-point Likert scale (based on radiologist’s subjective score) or the prostate imaging reporting and data system (PI-RADS) score (based on determined criteria) [11–13]. In particular, concerning PI-RADS score, the interreader agreem nt performs well, and the inter-reader repro- ducibility improves with increasing experience. MRI-Guided Targeted Biopsy An MRI targeted biopsy can be performed in three ways: in-bore MRI targeted biopsy, MRI/US fusion visual targeted biopsy, and MRI/US fusion software-based targeted biopsy. These three approaches are all informed by tumor location diagnosed by the MRI. It is just the manner in which the target volume is “represented” to the operator that differentiates them. Concerning in-bore MRI targeted biopsies, needles are introduced only into the areas of interest by p erforming a transrecta l or transperineal biopsy. Serial MRI scans are performed to confirm biop sy needle placeme nt (Fig. 2). Multiple studies demonstrated that in-bore MRI tar- geted biopsies ar e feasible w ith a median detection rate significantly higher than random biopsies. Moreover, this appr oach reduces the number of sampled cores with a real-time feedback of its placement, allowing a high likelihood of hit target [14, 15]. Nevertheless, in-bore MRI targeted biopsy is time-consuming and costly, not commonly available, and performed in prone position under general anesthesia. The simplest targeted strategy concerns the use of MRI/US fusion visual targeted biopsies directed to the suspicious areas highlighted on the MRI. The first step, as in the other strategies, is Fig. 1: Images from a 59-year-old male with serum PSA 7.92 ng/mL, and one previous biopsy underwent an mp-MRI. The MRI demonstrated a PI-RADS 5 right posterior apex to mid-peripheral zone lesion ( white arrow ) on axial T2W ( a ), DWI ( b ), ADC ( c ), and DCE ( d, e ). MRI/US fusion software-based targeted biopsy demonstrated Glea on score 7 (3 + 4) prostate cancer (67% in three cores). Cutting EDGE_Urology(SUN)_final.indd 34 27-Mar-18 10:00:30 AM