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Updated: Jul 8, 2025
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Multiparametric bone MRI targeting aides lesion selection for CT-guided sclerotic bone biopsies in metastatic
Ricardo Donners1,2, Ines Figueiredo3, Daniel Westaby3
1Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK. ricardo.donners@usb.ch.
Background:
Bone biopsies in metastatic castrate-resistant prostate cancer (mCRPC) patients can be challenging. This study's objective was to prospectively validate a multiparametric bone MRI (mpBMRI) algorithm to facilitate target lesion selection in mCRPC patients with sclerotic bone disease for subsequent CT-guided bone biopsies.
Methods:
20 CT-guided bone biopsies were prospectively performed between 02/2021 and 11/2021 in 17 mCRPC patients with only sclerotic bone disease. Biopsy targets were selected based on MRI, including diffusion-weighted (DWI) and T1-weighted VIBE Dixon MR images, allowing for calculation of the apparent diffusion coefficient (ADC) and the relative fat-fraction (rFF), respectively. Bone marrow with high DWI signal, ADC < 1100 µm2/s and rFF < 20% was the preferred biopsy target. Tumor content and NGS-feasibility was assessed by a pathologist. Prognostic routine laboratory blood parameters, target lesion size, biopsy tract length, visual CT density, means of HU, ADC and rFF were compared between successful and unsuccessful biopsies (p < 0.05 = significant).
Results:
Overall, 17/20 (85%) biopsies were tumor-positive and next-generation genomic sequencing (NGS) was feasible in 13/18 (72%) evaluated samples. Neither laboratory parameters, diameter, tract length nor visual CT density grading showed significant differences between a positive versus negative or NGS feasible versus non-feasible biopsy results (each p > 0.137). Lesion mean HU was 387 ± 187 HU in NGS feasible and 493 ± 218 HU in non-feasible biopsies (p = 0.521). For targets fulfilling all MRI selection algorithm criteria, 13/14 (93%) biopsies were tumor-positive and 10/12 (83%) provided NGS adequate tissue.
Conclusions:
Multiparametric bone MRI can facilitate target lesion selection for subsequent CT-guided bone biopsy in mCPRC patients with sclerotic metastases.
Trial Registration:
Committee for Clinical Research of the Royal Marsden Hospital registration number SE1220.
Insights
Multiparametric bone MRI aids in selecting biopsy targets for metastatic castrate-resistant prostate cancer (mCRPC) patients. This approach improves tumor detection and next-generation sequencing feasibility in sclerotic bone metastases.
Area of Science:
- Oncology
- Radiology
- Pathology
Background:
- Bone biopsies in metastatic castrate-resistant prostate cancer (mCRPC) present significant challenges.
- Sclerotic bone disease in mCRPC requires precise methods for accurate tissue sampling.
- Target lesion selection is critical for successful diagnostic bone biopsies in mCRPC.
Purpose of the Study:
- To prospectively validate a multiparametric bone MRI (mpBMRI) algorithm.
- To assess the algorithm's efficacy in facilitating target lesion selection for CT-guided bone biopsies.
- To evaluate the impact of mpBMRI on tumor positivity and NGS feasibility in mCRPC patients.
Main Methods:
- Prospective CT-guided bone biopsies in 17 mCRPC patients with sclerotic bone disease.
- Biopsy targets selected using mpBMRI, including diffusion-weighted imaging (DWI) and T1-weighted VIBE Dixon sequences.
- Analysis of apparent diffusion coefficient (ADC) and relative fat-fraction (rFF) to guide target selection.
Main Results:
- 85% of biopsies were tumor-positive, with 72% yielding adequate tissue for next-generation genomic sequencing (NGS).
- Lesions meeting all MRI criteria (high DWI signal, ADC < 1100 µm²/s, rFF < 20%) resulted in 93% tumor positivity and 83% NGS adequacy.
- No significant differences in routine lab parameters, lesion size, or CT density between successful and unsuccessful biopsies.
Conclusions:
- Multiparametric bone MRI effectively facilitates target lesion selection for CT-guided bone biopsies in mCRPC.
- The validated mpBMRI algorithm enhances diagnostic yield and NGS feasibility in patients with sclerotic bone metastases.
- This imaging approach offers a valuable tool for improving biopsy accuracy in challenging mCRPC cases.
