TU‐A‐BRA‐02: Incorporating PET/CT Images into 3D Ultrasound‐Guided Biopsy of the Prostate

Purpose: Prostate cancer is the second leading cause of cancer mortality in American men. Systematic transrectal ultrasound (TRUS)‐guided prostate biopsy is considered as the standard method for prostate cancer detection. The current biopsy technique has a significant sampling error and can miss up to 30% of cancers. As a Result, a patient may be informed of a negative biopsy Result but may in fact be harboring an occult early‐stage cancer because the current ultrasound imaging technology has difficulty to differentiate carcinoma from benign prostate tissue and because the current TRUS‐guided biopsy is blind and random. We are developing methods to combine PET/CT with three‐dimensional (3D) ultrasound images for targeted biopsy of the prostate with the aim of improving cancer detection rate. Methods: The 3D ultrasound‐guided biopsy system consists of a 3D mechanical localization system and software workstation for image segmentation, registration, and biopsy planning. For PET imaging, we use a new molecular imaging tracer called anti‐1‐amino‐3‐18F‐fluorocyclobutane‐1‐carboxylic acid ([F18]FACBC) that has shown promising results for detecting and localizing prostate cancer in our human clinical trials. In order to plan biopsy, we developed a 3D, automatic segmentation method for the prostate ultrasound images. In order to incorporate PET/CT images into ultrasound‐guided biopsy, we developed image registration methods to fuse TRUS and PET/CT images. Results: The segmentation method was tested in ten patients with a DICE overlap ratio of 92.4% ±1.1%. The registration method has been tested in phantoms. The biopsy system was tested in prostate phantoms. Three‐dimensional ultrasound images were acquired from four human patients. We are integrating the system for PET/CT directed, 3D ultrasound‐guided, targeted biopsy in human patients. Conclusions: A PET/CT image‐directed, 3D ultrasound‐guided biopsy system has been developed for the prostate. This research is supported in part by NIH grant R01CA156775 (PI: Fei), Georgia Cancer Coalition Distinguished Clinicians and Scientists Award (PI: Fei), and the Emory Molecular and Translational Imaging Center (NIH P50CA128301).