Jelle Barentsz, UMC St Radboud, Health Valley Event 2010

1. J. O. Barentsz Hoofd-wetenschap Radiologie RUNMC Innovatieve imaging biedt grote kansen voor betere diagnostiek- en therapeutische produkten , [email_address]

5. Learning Objectives Multi-modality MRI 1. High resolution T2-w .: anatomy 2. D iffusion W eighted I maging: function 3. H ydrogen MR-S pectroscopy: function 4. D ynamic C ontrast E nhanced: function

6. Learning Objectives Multi-modality MRI: anatomy 1 mm

8. DWI: PCa restricted H 2 O movement Multi-modality MRI: function

9. MRS: PCa Choline/Citrate ratio ↑ Multi-modality MRI: function

10. Multi-modality MRI: vascularity DCE MRI: PCa increased vascular permeability

16. c. T. Hambrock Gleason 5 Dogs and Prostate Highly aggressive

17. At random TRUS prostate biopsies -> 64% accuracy to predict true GS Narain et al. Prostate 2001; Antumes et al. Arch Path Lab Med 2008 Gleason Score (GS) generally used predictor of aggressivity HOWEVER Clinical problem Therefore using TRUS biopsy GS can result in inappropriate therapy

18. Pearson Correlation r = 0.73 p < 0.01 DWI: Non-invasive aggression determination Hambrock Radiology accepted p.r.

19. DWI: ADC-value versus Gleason score

21. 70 yr: 5 x neg. biopsies ( 30 cores) PSA 33 ng/ml Case Next step ?

22. Localization: saturation biospy? I ntroduction Local Nodes Fusion

23. 70 yr: 6 x neg. biopsies ( 54 cores) PSA 33 ng/ml Case Next step ? Saturation biopsy (24 cores)

24. Case MR Guided biopsy

25. 3T MR-biopsy Manual biopsy gun and confirmation scan of correct needle position

26. 3T MR-biopsy Highly aggressive cancer (4+4)

27. MRGB vs multi-session TRUS 3T MR guided biopsy

28. Multi-modality MR imaging - guiding biopsy with MRI-TRUS fusion Accurate Tissue Sampling by

29. Hit the most aggressive lesion with TRUS – MR ( ADCmap) fusion

30. Learning Objectives MR-robot with guided remote control? MR-guided biopsy MIRIAM Project

32. IMRT : high dosis to DIL van Lin IJROBP 2006 IMRT: Partial boost to 90 Gy

34. 3T ERC-MRI: 2 mm close to NVB T

37. Nanoparticle Contrast (Combidex / Sinerem) MR Lymphography MRL Nodal involvement

38. USPIO

39. pre -USPIO n m p ost-USPIO

40. Patient-to-patient correlation (n=375) MD CT MRL accuracy 86% -> 91 % specificity 97% -> 93 % sensitivity 34% -> 93% NPV 89% -> 97 % Probability of correct diagnosis : MRL 91% Surgery + CT 89% Dutch study: 13 centres Heesakkers, Lancet Oncology 2008

43. Case

46. Case 1

48. Case March 2006 November 2009

49. Case 1

52. bone scan: se 46% sp 32% bs+X: se 63% sp 64% MRI: se 100% sp 88% Bone scan, PET/CT, or MRI? Lecouvet JCO 2007 T1-w. MRI DWI-MR

53. Computers: Visualize MR images Pharmacokinetic analysis MRS analysis Structured reporting CAD

54. CADx – Computer aided diagnosis

58. Vragen? Wetenschap blijft Teamwork: Debats, Fütterer, Hambrock, Heerschap, Heijmink, Hoeks, Huisman, Litjes, Scheenen, Vos, Yakar, Witjes, van Oort, van Lin, Hulsbergen UT, RUNMC, XiVent Medical Demcom, Siemens Magnamedics