Interventional Radiology - Technical Note
Technical note: MRI-TRUS fusion for electrode positioning during irreversible electroporation for treatment of prostate cancer
Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute for Urologic Research, Berlin, Germany
Diagn Interv Radiol ; : -
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Purpose: In this technical note an approach for image-guided positioning of electrodes for irreversible electroporation (IRE) in patients with prostate cancer using a magnetic resonance imaging transrectal ultrasound (MRI-TRUS) fusion technique is introduced.
Material and Methods :In ten consecutive patients with biopsy-proven prostate cancer 3 to 4 19 G electrodes were inserted into the prostate using a transperineal access. MR images of the prostate acquired before IRE were fused with transrectal ultrasound images acquired during IRE. The position of the ultrasound probe was tracked via a sensor and corresponding MR images were calculated in real-time. Whilst MR images allowed delineation of the target volume the position of the electrodes could be visualized on ultrasound images; the distance between individual electrode pairs was measured. Based on these measurements the software installed on the IRE unit was able to calculate the voltage necessary to generate the electric field for ablation. Using contrast-enhanced ultrasound changes in perfusion within the ablation zone after IRE were documented.
Results: In all patients treated with IRE using the described technique allowed positioning of the electrodes around the target volume under image guidance. The target lesion and a safety margin were covered within the estimated ablation zone.
Conclusion: This manuscript offers the description of a technical approach using a MRI-TRUS fusion technique for image-guided positioning of electrodes for IRE. This approach combines the advantages of good visualization of the target lesion on MR imaging with the ability of ultrasound to acquire imaging in real-time with a mobile device.