Background

After a lesion has been assessed adequately on multiparametric magnetic resonance imaging (mpMRI), magnetic resonance (MR)-guided biopsy (MRGB) is the logical next step. The choice of the MRGB technique, however, is difficult.

Objective

To show the advantages and disadvantages of the three commonly used MRGB techniques—MRI-ultrasound fusion MRGB (fus-MRGB), direct in-bore MRGB (inbore-MRGB), and cognitive MRGB (cog-MRGB), and to determine when each of the techniques can be used.

Design, setting, and participants

Based on expert opinion and literature overview, the advantages, disadvantages, and challenges of fus-MRGB, inbore-MRGB, and cog-MRGB are evaluated. Further, the clinical setting of each biopsy strategy is assessed.

Surgical procedure

Based on expert opinion and literature data, the three biopsy procedures are evaluated, and the important pros and cons are determined.

Measurements

The basic concept of each biopsy technique is reviewed, which would result in a clinical recommendation. This will be shown in individual patients.

Results and limitations

The accompanying video shows how fus-MRGB and inbore-MRGB are performed in our hospital. An important advantage of fus-MRGB is its generally availability; however, it has fusion-error limitations. Although not supported by evidence, inbore-MRGB seems to be better suited for smaller lesions, but is rather expensive. Cog-MRGB is easy to use and inexpensive, but is more operator dependent as it requires knowledge about both ultrasound and MR images. Readers should be aware that our MRGB approach is largely based on expert opinion and, where possible, supported by evidence.

Conclusions

This article and the accompanying video show different MRGB techniques. The advantages and disadvantages of the three biopsy techniques, as well as the clinical setting in which each biopsy strategy is being used in our hospital, are discussed. Fus-MRGB is our first choice for prostate biopsy. Direct inbore-MRGB is used in difficult lesions but is mainly used as a “problem solver” (eg, a negative biopsy with a high suspicion for clinically significant prostate cancer). In our opinion, cog-MRGB is best for sampling larger and diffuse lesions.

Patient summary

This third surgery in motion contribution shows our approach in magnetic resonance (MR)-guided biopsy (MRGB). Fusion MRGB is our first choice for prostate biopsy. In-bore MRGB is used in selected, difficult cases, mainly as a problem solver. In our point of view, cognitive MRGB seems to be best for sampling larger lesions and diffuse processes.

中文翻译：

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多参数磁共振成像技术用于检测临床上重要的前列腺癌：泌尿科医师需要知道的。第3部分：目标活检

背景

在多参数磁共振成像（mpMRI）上对病变进行了充分评估后，下一步是合乎逻辑的磁共振（MR）引导活检（MRGB）。但是，选择MRGB技术很困难。

客观的

为了展示三种常用的MRGB技术的优缺点-MRI-超声融合MRGB（fus-MRGB），直接孔内MRGB（inbore-MRGB）和认知MRGB（cog-MRGB），并确定何时分别使用可以使用其中的一种技术。

设计，设置和参与者

基于专家意见和文献综述，评估了fus-MRGB，内孔MRGB和cog-MRGB的优缺点和挑战。此外，评估了每种活检策略的临床设置。

手术程序

根据专家意见和文献数据，对三种活检程序进行了评估，并确定了重要的利弊。

测量

审查了每种活检技术的基本概念，这将产生临床建议。这将在个别患者中显示。

结果与局限性

随附的视频显示了我们医院如何进行fus-MRGB和内孔MRGB。fus-MRGB的一个重要优点是它的普遍可用性。但是，它具有融合错误限制。尽管没有证据支持，但内孔MRGB似乎更适合较小的病灶，但价格昂贵。Cog-MRGB易于使用且价格便宜，但由于需要有关超声和MR图像的知识，因此更依赖于操作员。读者应注意，我们的MRGB方法主要基于专家意见，并在可能的情况下以证据为依据。

结论

本文和随附的视频展示了不同的MRGB技术。讨论了三种活检技术的优缺点，以及我们医院采用每种活检策略的临床环境。Fus-MRGB是我们进行前列腺活检的首选。直接孔MRGB用于困难的病灶，但主要用作“问题解决器”（例如，对临床上显着的前列腺癌高度怀疑的阴性活检）。我们认为，cog-MRGB最适合对较大和弥漫性病变进行采样。

病人总结

在运动方面的第三次手术显示了我们在磁共振（MR）引导的活检（MRGB）指导下的方法。Fusion MRGB是我们进行前列腺活检的首选。内孔MRGB用于某些困难的情况下，主要用作问题解决者。在我们看来，认知MRGB似乎最适合于对较大的病灶和弥散过程进行采样。