Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

1.5-T Magnetic Resonance–Guided Transgluteal Biopsies of the Prostate in Patients With Clinically Suspected Prostate Cancer: Technique and Feasibility

Bodelle, Boris MD*; Naguib, Nagy N. MD*†; Schulz, Boris MD*; Eichler, Katrin MD*; Müller, Cindy MD*; Hansmann, Martin-Leo MD; Hammerstingl, Renate MD*; Hübner, Frank MSc*; Vogl, Thomas J. MD*; Zangos, Stephan MD*

doi: 10.1097/RLI.0b013e31827c394b
Original Articles

Objectives The aim of this study was to examine the feasibility and safety of magnetic resonance–guided prostate biopsy (MRGBx) with a transgluteal approach in patients with cancer suspicious prostatic lesions.

Materials and Methods This study was approved by the ethical committee. A total of 25 men with clinically suspected prostate cancer with increased prostate-specific antigen levels and at least 1 previous negative transrectal ultrasound–guided prostatic biopsy (TRUSBx) underwent diagnostic magnetic resonance (MR) imaging of the prostate. Cancer suspicious regions (CSR) were identified, and MRGBx with a transgluteal approach in a large closed-bore 1.5-T MR system was manually performed in coaxial technique, using transversal fat-suppressed T2-weighted true fast imaging with steady-state free precession sequences. Success rate, biopsy findings, side effects, procedure time, number of acquisitions for the repositioning of the needle guide, and length of the biopsy channel were documented. Follow-up was performed 24 months after the procedure.

Results In diagnostic MR imaging of the prostate, a total of 40 CSRs were detected in 25 patients. All MRGBx procedures were technically successful and all CSRs were biopsied. The mean number of core biopsies per CSR was 3.3 ± 1.5 (range, 1–7). Histopathological analysis revealed adenocarcinoma in 35% (14/40), acute or chronic prostatitis in 30% (12/40), adenofibromyomatous changes in 22.5% (9/40), and no identifiable pathology in 17.5% (7/40) of CSRs, with a pathological overlap for chronic prostatitis and adenofibromyomatous changes in 1 patient with biopsies in 2 CSRs. No missed prostate cancer after MR-guided biopsy in clinical follow-up was detected. Mean procedure time was 31 ± 7 minutes (range, 21–46 minutes). Side effects were hematuria (n = 7), hematospermia (n = 3), combined hematuria/hematospermia (n = 2), and infection (n=1).

Conclusion Magnetic resonance–guided prostate biopsy of the prostate gland with a transgluteal approach is feasible, safe, and a promising technique for histological clarification of cancer suspicious lesions in patients with increased prostate-specific antigen levels after negative TRUSBx. Magnetic resonance–guided prostate biopsy offers a reasonable alternative to repeated TRUSBx for histological clarification of prostate cancer.

From the *Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany; †Department of Radiology, Alexandria University Hospital, Alexandria, Egypt; and ‡Senckenberg Department of Pathology, Goethe University of Frankfurt, Frankfurt, Germany.

Received for publication May 1, 2012; and accepted for publication, after revision, October 31, 2012.

Conflicts of interest and sources of funding: none declared.

Reprints: Boris Bodelle, MD, Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany. E-mail:

© 2013 by Lippincott Williams & Wilkins