Zusammenfassung
In den letzen Jahren spielt die MRT in der Diagnostik und Therapie des Prostatakarzinoms
eine immer wichtigere Rolle. Die MRT erlaubt neben der Abgrenzung der anatomischen
Strukturen auch die Lokalisation möglicher Tumoren durch die Verwendung von T 2-gewichteten
Sequenzen, der Spektroskopie sowie dynamischer Untersuchungen. Die gute Abgrenzbarkeit
der Tumoren erlaubt eine sichere Durchführung von Prostatainterventionen, wie Biopsien,
Brachytherapie oder verschiedenen lokalen Thermotherapien. Durch den zusätzlichen
Einsatz von Robotersystemen kann die Genauigkeit der Interventionen erhöht werden.
Aufgrund der Vorteile der MR-Bildgebung ist zu erwarten, dass MR-gesteuerte Prostatainterventionen
in der Zukunft eine zunehmende Rolle spielen werden.
Abstract
In recent years MR imaging has played an increasingly important role in the diagnosis
and treatment of prostate cancer. MR imaging of the prostate allows clear delineation
of the anatomic structures and prostate tumors using T 2-weighted images combined
with spectroscopy and dynamic examinations. The advantages of MRI make it possible
to perform interventions, like biopsies, brachytherapy or different local therapies
of the prostate gland. MRI robotic assistance will improve the accuracy of the interventions.
Due to the advantages of MR imaging, MR-guided prostate interventions will play a
greater role in the future.
Key words
prostate - ablation procedures - biopsy - interventional MR - interventional procedures
Literatur
1
Sakr W A, Grignon D J, Crissman J D et al.
High grade prostatic intraepithelial neoplasia (HGPIN) and prostatic adenocarcinoma
between the ages of 20 – 69: an autopsy study of 249 cases.
In vivo.
1994;
8
439-443
2
Mueller-Lisse U L, Hofstetter A.
Urologische Diagnostik des Prostatakarzinoms.
Radiologe.
2003;
43
432-440
3
Andriole G L, Crawford E D, Grubb 3 rd R L et al.
Mortality results from a randomized prostate-cancer screening trial.
The New England journal of medicine.
2009;
360
1310-1319
4
Naughton C K, Miller D C, Mager D E et al.
A prospective randomized trial comparing 6 versus 12 prostate biopsy cores: impact
on cancer detection.
J Urol.
2000;
164
388-392
5
Tempany C, Straus S, Hata N et al.
MR-guided prostate interventions.
J Magn Reson Imaging.
2008;
27
356-367
6
Stewart C S, Leibovich B C, Weaver A L et al.
Prostate cancer diagnosis using a saturation needle biopsy technique after previous
negative sextant biopsies.
J Urol.
2001;
166
86-91
; discussion 91 – 82
7
Pegios W, Bentas W, Wittmann L et al.
Kernspintomographisches Staging des Prostatakarzinoms mittels kombinierter Endorektal-Body-Phased-Array-Spule
und histopathologische Korrelation.
Fortschr Röntgenstr.
2003;
175
1660-1666
8
Engelbrecht M R, Jager G J, Laheij R J et al.
Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis.
Eur Radiol.
2002;
12
2294-2302
9
Stanka M, Eltze E, Semjonow A et al.
Spektroskopische Bildgebung (1 H-MR-CSI) der Prostata: Sequenzoptimierung und Korre-lation
mit histopathologischen Untersuchungen.
Fortschr Röntgenstr.
2000;
172
623-629
10
Scheidler J, Vogel M, Gross P et al.
Kombinierte MRT und MRS beim Prostatakarzinom: Beschleunigung und Verbesserung durch
Suszeptibilitätsangleichung.
Fortschr Röntgenstr.
2009;
181
531-535
11
Wiesinger B, Lichy M P, Nagele U et al.
MR-Befundmuster der Prostata bei Patienten mit CPP Syndrom (chronic pelvic pain syndrome).
Fortschr Röntgenstr.
2008;
180
621-630
12
Franiel T, Ludemann L, Taupitz M et al.
Pharmakokinetische MRT der Prostata: Parameter zur Unterscheidung von Low-grade- und
High-grade-Prostatakarzinomen.
Fortschr Röntgenstr.
2009;
181
536-542
13
Kemper J, Sinkus R, Lorenzen J et al.
MR-Elastographie der Prostata: Erste In-vivo-Anwendung.
Fortschr Röntgenstr.
2004;
176
1094-1099
14
Prando A, Kurhanewicz J, Borges A P et al.
Prostatic biopsy directed with endorectal MR spectroscopic imaging findings in patients
with elevated prostate specific antigen levels and prior negative biopsy findings:
early experience.
Radiology.
2005;
236
903-910
15
Kaplan I, Oldenburg N E, Meskell P et al.
Real time MRI-ultrasound image guided stereotactic prostate biopsy.
Magn Reson Imaging.
2002;
20
295-299
16
Gupta S, Nguyen H, Morello F et al.
Various Approaches for CT-guided Percutaneous Biopsy of Deep Pelvic Lesions: Anatomic
and Technical Considerations.
Radiographics.
2004;
24
175-189
17
D’Amico A V, Tempany C M, Cormack R et al.
Transperineal magnetic resonance image guided prostate biopsy.
J Urol.
2000;
164
385-387
18
Hata N, Jinzaki M, Kacher D et al.
MR imaging-guided prostate biopsy with surgical navigation software: device validation
and feasibility.
Radiology.
2001;
220
263-268
19
Zangos S, Eichler K, Engelmann K et al.
MR-guided transgluteal biopsies with an open low-field system in patients with clinically
suspected prostate cancer: technique and preliminary results.
Eur Radiol.
2005;
15
174-182
20
Beyersdorff D, Winkel A, Hamm B et al.
MR imaging-guided prostate biopsy with a closed MR unit at 1.5T: initial results.
Radiology.
2005;
234
576-581
21
Engelhard K, Hollenbach H P, Kiefer B et al.
Prostate biopsy in the supine position in a standard 1.5-T scanner under real time
MR-imaging control using a MR-compatible endorectal biopsy device.
Eur Radiol.
2006;
16
1237-1243
22
Zangos S, Herzog C, Eichler K et al.
MR-compatible assistance system for punction in a high-field system: device and feasibility
of transgluteal biopsies of the prostate gland.
Eur Radiol.
2007;
17
1118-1124
23
Lewin J S, Duerk J L, Jain V R et al.
Needle localization in MR-guided biopsy and aspiration: effects of field strength,
sequence design, and magnetic field orientation.
Am J Roentgenol.
1996;
166
1337-1345
24
Adam G, Bucker A, Nolte-Ernsting C et al.
Interventional MR imaging: percutaneous abdominal and skeletal biopsies and drainages
of the abdomen.
Eur Radiol.
1999;
9
1471-1478
25
Cormack R A, D’Amico A V, Hata N et al.
Feasibility of transperineal prostate biopsy under interventional magnetic resonance
guidance.
Urology.
2000;
56
663-664
26
Zangos S, Kiefl D, Eichler K et al.
MRT-gezielte perkutane Biopie bei unklaren fokalen Leberläsionen: Technik und Ergebnisse.
Fortschr Röntgenstr.
2003;
175
688-694
27
Franiel T, Fritzsche F, Staack A et al.
[Histopathologic quality of prostate core biopsy specimens: comparison of an MR-compatible
biopsy needle and a ferromagnetic biopsy needle used for ultrasound-guided prostate
biopsy] Histopathologische Qualität von Prostatazylindern: Vergleich einer MR-kompatiblen
Biopsienadel mit einer im Ultraschall eingesetzten ferromagnetischen Biopsienadel.
Fortschr Röntgenstr.
2006;
178
1212-1218
28
Duckwiler G, Lufkin R B, Hanafee W N.
MR-directed needle biopsies.
Radiol Clin North Am.
1989;
27
255-263
29
Hambrock T, Futterer J J, Huisman H J et al.
Thirty-two-channel coil 3 T magnetic resonance-guided biopsies of prostate tumor suspicious
regions identified on multimodality 3 T magnetic resonance imaging: technique and
feasibility.
Invest Radiol.
2008;
43
686-694
30
Van Gellekom M P, Moerland M A, Battermann J J et al.
MRI-guided prostate brachytherapy with single needle method – a planning study.
Radiother Oncol.
2004;
71
327-332
31
Prada P J, Gonzalez H, Fernandez J et al.
High-dose-rate intensity modulated brachytherapy with external-beam radiotherapy improves
local and biochemical control in patients with high-risk prostate cancer.
Clin Transl Oncol.
2008;
10
415-421
32
D’Amico A V, Cormack R, Tempany C M et al.
Real-time magnetic resonance image-guided interstitial brachytherapy in the treatment
of select patients with clinically localized prostate cancer.
Int J Radiat Oncol Biol Phys.
1998;
42
507-515
33
Chen L, Price R A, Wang Jr L et al.
MRI-based treatment planning for radiotherapy: dosimetric verification for prostate
IMRT.
International journal of radiation oncology, biology, physics.
2004;
60
636-647
34
Tanaka O, Hayashi S, Matsuo M et al.
MRI-based preplanning in low-dose-rate prostate brachytherapy.
Radiother Oncol.
2008;
88
115-120
35
Polo A, Cattani F, Vavassori A et al.
MR and CT image fusion for postimplant analysis in permanent prostate seed implants.
International journal of radiation oncology, biology, physics.
2004;
60
1572-1579
36
Menard C, Susil R C, Choyke P et al.
MRI-guided HDR prostate brachytherapy in standard 1.5 T scanner.
Int J Radiat Oncol Biol Phys.
2004;
59
1414-1423
37
Susil R C, Camphausen K, Choyke P et al.
System for prostate brachytherapy and biopsy in a standard 1.5T MRI scanner.
Magn Reson Med.
2004;
52
683-687
38
Hurwitz M D, Cormack R, Tempany C M et al.
Three-dimensional real-time magnetic resonance-guided interstitial prostate brachytherapy
optimizes radiation dose distribution resulting in a favorable acute side effect profile
in patients with clinically localized prostate cancer.
Techniques in urology.
2000;
6
89-94
39
Albert M, Tempany C M, Schultz D et al.
Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided
prostate brachytherapy with or without neoadjuvant external beam radiation therapy.
Cancer.
2003;
98
949-954
40
Nguyen P L, Chen M H, D’Amico A V et al.
Magnetic resonance image-guided salvage brachytherapy after radiation in select men
who initially presented with favorable-risk prostate cancer: a prospective phase 2
study.
Cancer.
2007;
110
1485-1492
41
Vogl T J, Straub R, Lehnert T et al.
Perkutane Thermoablation von Lungenmetastasen – Erfahrungen mit dem Einsatz der LITT,
der Radiofrequenzablation (RFA) und Literaturübersicht[Percutaneous Thermoablation
of Pulmonary Metastases.
Fortschr Röntgenstr.
2004;
176
1658-1666
42
Vogl T J, Mack M G, Muller P K et al.
Interventional MR: interstitial therapy.
Eur Radiol.
1999;
9
1479-1487
43
Peters R D, Chan E, Trachtenberg J et al.
Magnetic resonance thermometry for predicting thermal damage: an application of interstitial
laser coagulation in an in vivo canine prostate model.
Magn Reson Med.
2000;
44
873-883
44
Nau W H, Diederich C J, Ross A B et al.
MRI-guided interstitial ultrasound thermal therapy of the prostate: a feasibility
study in the canine model.
Med Phys.
2005;
32
733-743
45
Josan S, Bouley D M, Bosch van den M et al.
MRI-guided cryoablation: In vivo assessment of focal canine prostate cryolesions.
J Magn Reson Imaging.
2009;
30
169-176
46
Tazaki H, Deguchi N, Baba S et al.
Magnetic resonance imaging following microwave thermotherapy, laser ablation and transurethral
resection in patients with BPH.
Urologe A.
1995;
34
105-109
47
Mueller-Lisse U G, Thoma M, Faber S et al.
Coagulative interstitial laser-induced thermotherapy of benign prostatic hyperplasia:
online imaging with a T 2-weighted fast spin-echo MR sequence – experience in six
patients.
Radiology.
1999;
210
373-379
48
Chen J C, Moriarty J A, Derbyshire J A et al.
Prostate cancer: MR imaging and thermometry during microwave thermal ablation-initial
experience.
Radiology.
2000;
214
290-297
49
Pauly K B, Diederich C J, Rieke V et al.
Magnetic resonance-guided high-intensity ultrasound ablation of the prostate.
Top Magn Reson Imaging.
2006;
17
195-207
50
Kettenbach J, Kronreif G, Figl M et al.
Robot-assisted biopsy using computed tomography-guidance: initial results from in
vitro tests.
Invest Radiol.
2005;
40
219-228
51
Felden A, Vagner J, Hinz A et al.
ROBITOM-robot for biopsy and therapy of the mamma.
Biomed Tech.
2002;
47
2-5
52
Hempel E, Fischer H, Gumb L et al.
An MRI-compatible surgical robot for precise radiological interventions.
Comput Aided Surg.
2003;
8
180-191
53
Dimaio S P, Pieper S, Chinzei K et al.
Robot-assisted needle placement in open MRI: System architecture, integration and
validation.
Comput Aided Surg.
2007;
12
15-24
54
Susil R C, Krieger A, Derbyshire J A et al.
System for MR image-guided prostate interventions: canine study.
Radiology.
2003;
228
886-894
55
Fischer G S, DiMaio S P, Iordachita I I et al.
Robotic assistant for transperineal prostate interventions in 3 T closed MRI.
Med Image Comput Comput Assist Interv Int Conf Med Image Comput Comput Assist Interv.
2007;
10
425-433
Dr. Stephan Zangos
Institut für Diagnostische und Interventionelle Radiologie, J.-W.-Goethe-Universität
Frankfurt
Theodor-Stern-Kai 7
60596 Frankfurt
Phone: ++ 49/63 01/72 77
Fax: ++ 49/63 01/72 58
Email: Zangos@em.uni-frankfurt.de