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. 2019 Jun;92(1098):20180918.
doi: 10.1259/bjr.20180918. Epub 2019 Apr 24.

Establishing MRI-guided prostate intervention at a UK Centre

Alexander J King  1 , Tim Dudderidge  1 , Angela Darekar  1 , Katya Schimitz  1 , Rory Heard  1 , Chris Everitt  1 , Robert Chambers  1 , David Breen  1
Affiliations

Establishing MRI-guided prostate intervention at a UK Centre

Alexander J King et al. Br J Radiol. 2019 Jun.

Abstract

Objectives: To describe our preliminary experience in establishing an MRI suite capable to deliver targeted prostate biopsy and cryoablation.

Methods: This article includes a description of the necessary infrastructure alterations, scanning sequence suggestions, anaesthetic advice, and practical procedural considerations. We aim to examine the anticipated issues most UK centres would encounter and offer our experience in overcoming them. During this process we will also explore some of the technical aspects of MRI-guided prostate biopsy and cryoablation.

Results: The clinical indication, treatment rationale, intervention strategy, and initial clinical outcomes are described for our first series of patients.

Conclusion: MRI-guided prostate intervention provides many theoretical advantages over traditional TRUS guidance. This article demonstrates some of the complexities encountered in establishing this technique in a UK centre, and the proposed solutions.

Advances in knowledge: This article gives an account of establishing the first MRI intervention suite in the UK. It demonstrates some of the logistical considerations, and offers the unit's early experience.

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Figures

Figure 1.
Figure 1.
Plan view of scan room layout and pedestal.
Figure 2.
Figure 2.
Urethral warming catheter, tubing and pump.
Figure 3.
Figure 3.
(A) Perineal access device, with central square slot for placement of a perineal grid, if required. (B) The grid can be placed beneath the inferior aspect of the coil to aid perineal access.
Figure 4.
Figure 4.
Probe tip blooming artefact in axial plane.
Figure 5
Figure 5
. (A) Still images form ‘fluoro’ sequences permit almost real time depth and angulation perception. MRI also permits delineation of the target lesion and confirmation of accurate sampling (sagittal and coronal planes). (B) MPR of extended left anterior hemiablation. Note iceball void incorportating left gland (long arrow) with periurethral protection from urethral catheter (short arrow).
Figure 6.
Figure 6.
‘Hydrodissection’ of the rectum by injecting saline into the rectoprostatic space.
Figure 7.
Figure 7.
Ablated tissue involution over time. Note how the residual transition zone appears to shift leftwards as the ablated tissue contracts.
See this image and copyright information in PMC

References

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