Clinical Feasibility of MRI-guided In-Bore Prostate Biopsies at 0.55T

Clinical Feasibility of MRI-guided In-Bore Prostate Biopsies at 0.55T | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Feasibility of MRI-guided In-Bore Prostate Biopsies at 0.55T Tejinder Kaur, Yun Jiang, Nicole Seiberlich, Hero Hussain, Shane Wells, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5375637/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 11 Jan, 2025 Read the published version in Abdominal Radiology → Version 1 posted 7 You are reading this latest preprint version Abstract Objective In-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner. Materials and Methods Nineteen participants (68 ± 10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported. Results Seventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.95 ± 1.29 cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10%-100%. 20% of the lesions were benign. Compared with the previous biopsy results, 11.7% of participants had a GG upgrade, 17.6% had an upgrade in positive core volume, 17.6% had negative biopsies and 47% of biopsy-naïve participants had new cancer detections. No upgrade was observed in 5.8% cases. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77 ± 21 minutes for transrectal and 74 ± 22 minutes for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14 minutes, respectively. Conclusion Identifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner. Prostate biopsy MRI Prostate cancer Transrectal Percutaneous In-bore Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Prostate cancer (PCa) represents 14.9% of all new cancer cases and is the fifth leading cause of cancer death in the United States [ 1 ]. Multiparametric MRI (mpMRI) has revolutionized PCa diagnosis [ 2 – 4 ], promoting a clinical shift towards incorporating targeted biopsy strategies. MRI-guided biopsies are performed by either fusing areas of suspicious foci identified using MRI images with real-time ultrasound guidance images, or directly in the MRI scanner (in-bore). Both methods have been shown to reduce detection of indolent, low-risk diseases [ 5 , 6 ] and are cost-effective compared to traditional TRUS-guided biopsies [ 7 – 9 ]. MRI-Ultrasound fusion biopsy, with or without systematic sampling, is the preferred method in current clinical practice for its lower cost and ease of workflow. However, the approach is susceptible to inaccuracies from the co-registration process and operator skill with ultrasound targeting. These limitations, coupled with the high prevalence of suspicious lesions, often lead to complex scenarios where patients may have repeated negative biopsies [ 10 – 13 ] despite high suspicion on MRI (PIRADS Categories 4 or 5 observations), elevated PSA levels, and ongoing cancer suspicion. These patients should undergo thorough review and be considered for either repeated biopsies or close surveillance as up to 44% of clinically significant prostate cancers (csPCa) can be detected at later stages [ 10 ]. PCa aggressiveness is assessed before treatment using predictive models which include demographic data, PSA levels, digital rectal exam results, and biopsy findings (ISUP grade, number of positive cores in samples), making biopsy an essential component of patient management [ 11 , 12 ]. In-bore MRI-guided biopsy enhances procedural accuracy by allowing direct visualization of lesions, biopsy needles, and needle trajectories during the procedure [ 13 – 16 ]. However, long procedures occupying multiple time slots, and relatively high costs associated with MRI have limited its wide clinical adoption. For percutaneous procedures, the inherent limitation of fitting the biopsy devices and the patient in the scanner is another challenge. The current generation of lower field scanners at 0.55T have several features that could facilitate in-bore MRI-guided prostate interventions. Images acquired at lower field have reduced susceptibility artifacts from biopsy devices and implants. The scanner has a wider bore (80 cm) that could allow easier access for instruments into the scanner for percutaneous access. Moreover, lower field scanners tend to have lower operational costs compared to conventional scanners at 1.5T or 3T [ 17 , 18 ]. These factors could increase the availability of in-bore biopsies, making them more accessible. Currently, dedicating busy scanners to interventions is operationally challenging.[ 19 ] However, prostate imaging is generally performed at 3T due to signal-to-noise ratio (SNR) or contrast-to-noise ratio (CNR) advantages [ 4 ], and lesion visualization and successful biopsy at lower field cannot be assumed. The goal of this study is to test the hypothesis that lesion visualization, and accurate in-bore MRI-guided prostate biopsy is feasible using a 0.55T scanner. Materials and Methods Study Design The study was approved by the Institutional Review Board (IRB) and complied with the Health Insurance Portability and Accountability Act. Written informed consent was obtained from all participants. In this prospective study, indications for performing in-bore biopsies included multiple previous negative MRI-Ultrasound fusion biopsies or patient reluctance to undergo a template biopsy. Percutaneous biopsies were performed for patients who lacked a rectum or based on the operator’s preference. The current study included 19 men with 22 lesions referred by urologists between May 2023 and October 2024 for in-gantry targeted biopsy, with an additional systematic biopsy performed in 3 cases. The study design is outlined in Fig. 1 . PSA levels, PSA density, lesion sizes, histopathological ISUP grade, GG upgrade, cancer detection rate, positive percentage volume, skin to target distances, and durations to reach the first biopsy core and the overall procedure were reported. Table 1 presents the patient demographics and characteristics. MRI System and Imaging Protocols A 0.55T MRI scanner (Magnetom Free.Max, Siemens Healthineers, Erlangen, Germany) was used in this study. The system has a bore diameter of 80 cm. During the biopsy, T2-weighted TSE images were first obtained to identify the suspicious focus. These images were compared to pre-procedure clinical diagnostic scans acquired at 1.5T or 3T for lesion localization (15 patients had previous 3T scans, 3 patients had both 3T and 1.5T scans and 1 patient had only a 1.5T scan). Images acquired using single-shot TSE (HASTE), T2-weighted TSE, or balanced steady-state free precession (bSSFP) sequences, as chosen by the operator during the procedure, were used to guide the biopsy needle to the suspicious lesion. All imaging parameters are listed in Table 2 . The procedure was performed without intravenous contrast. Table 1: Patient and lesion characteristics for transrectal and percutaneous biopsies. Patient Characteristic Average Number Overall Transrectal Percutaneous Total Patients 17 4 13 Age (y) 69 ± 10 68 ± 4 69 ± 9 PSA (ng/mL) 10.2 ± 6 8.9 ± 11 10.1 ± 7.5 Prostate Volume 68 ± 64 69 ± 45 58 ± 44 PSA density 0.22 ± 0.2 0.11 ± 0.1 0.27 ± 0.3 Lesions visible at MRI 20 5 15 Lesion size(cm) 1.9 ± 1.2 1.6 ± 0.7 2.0 ± 1.3 PI-RADS v2.1 3,4,5 4,5 3,4,5 PSA- Prostate Specific Antigen, PI-RADS v2.1- Prostate Imaging Reporting and Data System version 2.1 In-bore MRI-guided Biopsy Transrectal Biopsy: All transrectal biopsies were performed by a single operator (22 years of radiology experience at the time of biopsy). Prebiopsy rectal swabbing and antibiotic prophylaxis with cephalosporins were given in all transrectal cases. One dose of antibiotic was given prior to biopsy and the other was given 12 hours after the first dose. Participants were positioned prone and headfirst into the scanner. A 57 x 29 cm 12-channel phased array coil was placed on the dorsal side of the patient’s pelvis. 1% Lidocaine gel was applied to the rectal surface adjacent to the prostate. The rectal sleeve/directing system was inserted into the rectum and connected to the robotic positioning device (Soteria Medical, Arnhem, Netherlands) (Fig. 2 a). Initial T2 weighted images were acquired in both axial and sagittal planes to locate the needle guide and the target lesion. The robotic software was calibrated, determining the coordinates of the target lesion in relation to the needle guide. The needle guide was then adjusted based on the target location, with movements calculated and controlled using the software system associated with the robot. Robot movements involve manipulation of the intrarectal device in the left/right, head to foot, and anterior posterior directions [ 20 ]. After initial movements, repeat T2 weighted or bSSFP scans were obtained to confirm the guide positioning with respect to the lesion. Further adjustments and imaging were performed as necessary per the judgement of the operators. Once desired positioning was achieved, a core sample was obtained using an 18 G semi-automatic MRI-compatible core biopsy needle of length 150 mm or 175 mm, and a 20 mm “throw” (In Vivo/Philips, Gainesville, FL, or ITP, Völklingen, Germany) advanced through the robotic arm. For additional passes, the sleeve was repositioned for targeting by making smaller operator-controlled adjustments of the robotic arm. Two to four cores were obtained from each lesion. Parameter T2wTSE (Prebiopsy) ssTSE (HASTE) T2wTSE (Intraprocedural) bSSFP (True FISP) Acquisition Time 5 min 58 secs 58 secs 46 secs 1 min 14 secs Thickness (mm) 3.5 3 3.5 4.5 TR (ms) 3320 935 6640 6.44 TE (ms) 127 48 126 3.22 Matrix 231x271 154x192 224x141 224x157 FOV (mm) 220x220 220x220 243x243 250x250 Clinical purpose Pre-biopsy lesion localization Tumor and needle localization Tumor and needle localization Tumor and needle localization Table 2: The scanning parameters used during prostate biopsy at 0.55T. TR - Repetition Time, TE - Time to Echo, FOV - Field of View, T2wTSE - T2 Weighted Turbo Spin-Echo, ssTSE - Single-Shot Turbo Spin-Echo, HASTE - Half Table 5: Average total procedure time was 77 ± 21 minutes for transrectal and 74 ± 22 minutes for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14 minutes, respectively. Single-target biopsies averaged 59 ± 18 minutes (transrectal) and 66 ± 12.5 minutes (percutaneous), while multiple targets averaged 107 minutes and 99 ± 17 minutes, respectively. An additional 11 minutes were required for a systematic add-on. # Approach Number of lesions Number of cores Total procedure time (minutes) Time to first core (minutes) 1 Transrectal 2 2,2 107 32 2 Transrectal 1 2 66 46 3 Transrectal 1 3 75 65 4 Transrectal 1 3 60 35 5 Percutaneous 1 4 64 22 6 Percutaneous 1 4 115 75 7 Percutaneous 1 4 45 40 8 Percutaneous 1 3 45 37 9 Percutaneous 2 4,3 112 82 10 Percutaneous 1 4 83 55 11 Percutaneous 1 5 82 70 12 Percutaneous 1 4 79 60 13 Percutaneous 2 3,3 87 68 14 Percutaneous 1 3 66 53 15 Percutaneous 1 3 62 52 16 Percutaneous 1 4 66 54 17 Percutaneous 1 3 59 53 Percutaneous transgluteal biopsy: The percutaneous transgluteal biopsies were performed in participants who did not have rectums, or in whom a direct percutaneous approach was preferred due to contraindication of a transrectal approach or lack of tolerance of the rectal probe. Procedures were performed by two operators (primary operator with 17–23 years’ experience, assisted by a second operator with 22 years’ experience). Moderate sedation, consisting of midazolam and fentanyl, was used. The patient was placed in a prone position and two 45 x 27 cm 6-channel phased array coils were positioned over the patient’s pelvis, approximately 2–3 cm apart, allowing and creating an aperture at the expected entry site (Fig. 2 b). Single-shot T2w imaging (HASTE) was performed with fluid-filled thin column markers taped in place over the gluteal region to help identify an entry point. The patient was prepped and draped in the usual sterile fashion, including covering the coils with sterile drapes. The skin at the entry point was anesthetized with 1% lidocaine. A 16 G introducer cannula with a trocar (ITP, Völklingen, Germany) was selected to pair with an 18G, 175 mm semi-automatic biopsy device (In Vivo/Philips, Gainesville, FL or ITP, Völklingen, Germany) such that the throw from the biopsy needle would extend 2 cm beyond the cannula. Multiple core samples were acquired from various regions of the lesions by making slight adjustments to the introducer's position between each pass. Three patients underwent an additional systematic biopsy, and GG for each participant was determined based on the highest-grade core. Statistical analysis: Continuous variables including age, PSA levels, PSA density etc. were summarized using means and standard deviations (SD). Categorical variables, like lesion type, location, etc. were summarized by presenting frequency counts and corresponding percentages to provide a clear representation of the distribution across different categories. Results Clinical data Nineteen participants with a mean age of 68 ± 10 years were enrolled between May 2023 and October 2024. The mean PSA level of all participants was 11.7 ± 12 ng/mL (range 1.5–50.6 ng/mL), and the mean prostate volume was 66.1 ± 45 mL (range 24–133 mL). Previous 3T and 1.5T diagnostic scans showed 6 PI-RADS 4 lesions, 12 PI-RADS 5 lesions, and 3 PI-RADS 3 lesions. A total of 73% of lesions (16 of 22) were in the peripheral zone (PZ), and the remaining 27% (6 of 22) were in the transition zone (TZ). Notably, 11 lesions were apical, and 6 were anterior in location. Seventeen study participants successfully underwent the procedure. One participant could not undergo the procedure due to chronic contractures, and in another, the 5 mm lesion was not visible on the current scan. Out of 17 procedures, 4 were robot-assisted transrectal and 13 were percutaneous transgluteal. A total of 20 lesions were biopsied in these 17 participants along with a 6-core systematic sampling in 3 participants. Lesions were successfully identified on T2-weighted imaging and matched with pre-biopsy imaging in all patients. The average lesion size was 1.6 ± 0.7 cm at 3T and 1.5 ± 0.6 cm at 0.55T for the transrectal approach, and 1.9 ± 1.4 cm at both 3T and 0.55T for the percutaneous approach. In all patients who underwent the procedure, biopsies were successfully obtained from within the lesion, as evidenced by intraprocedural imaging showing the needle within the target lesion. No intra- or post-procedural complications were encountered. Table 3 presents percutaneous biopsy data, with an average skin-to-target distance of 11.25 ± 1.8 cm and needle lengths of 2.18 ± 1.1 cm in subcutaneous fat, 3.02 ± 1.1 cm in muscle, and 4.79 ± 1.1 cm in pelvic fat. The intra-prostatic length averaged 1.26 ± 0.4 cm. Figure 3 depicts a representative targeted transrectal biopsy in a 68-year-old patient. Prebiopsy diagnostic 3T images reveal a left anterior TZ lesion (a-c). The lesion was visualized at 0.55T (d) and targeted using the robotic arm and an 18G fully automatic biopsy device (e-f). Figure 4 shows percutaneous targeting of a left apical lesion in a patient without a rectum with a 16 G introducer and an 18G biopsy device. It yielded a GG2 clinically significant cancer with a 100% positive core (a-c). Pathology data Of 17 biopsied participants, 14 had positive core volumes for cancer, ranging from 10%-100%. Overall cancer detection rate in cases was 82.3% (14 out of 17). Of the 17 participants, 9 had previous prostate biopsies (7 MR-US fusion-guided transperineal, 1 MR-US fusion-guided transrectal, and 1 TRUS-guided systematic), while the remaining 8 were biopsy-naïve. Out of 20 lesions, 16 were positive for malignancy (80% total; 35% GG2, 25% GG1, 10% GG5, 5% GG4, and 6% GG3), 1 was benign high-grade prostatic intraepithelial neoplasia (HGPIN) (5%) and 3 were benign prostatic tissue (15%). Compared with previous biopsy results, 11.7% (2/17) of participants had a GG upgrade and 17.6% (3/17) showed an increase in positive core volume, while 5.8% (1/17) showed no upgrade and 17.6% (3/17) had negative or benign findings. Among biopsy-naïve participants, 47% (8/17) had new cancer detected. The highest diagnostic yield was obtained from the first core sample in 7 lesions, the second core in 4 lesions, and the third core in another 5 lesions. Table 4 summarizes the prebiopsy PIRADS score, route of biopsy, result of biopsy, and comparison with previous biopsy results. One participant, a 73-year-old male, was found to have a new clinically significant cancer (GG2) in the left anterior transition zone (TZ) during an in-bore MRI-guided biopsy at 0.55T. This lesion was missed on two prior 3T MRIs and one 1.5T MRI over 5.5 years due to susceptibility artifacts from a hip prosthesis. Despite four previous systematic and MRI-Ultrasound fusion biopsies targeting a contralateral PI-RADS 4 lesion that only revealed HGPIN or low-volume cancer (< 10%), the lesion in the left anterior TZ remained undetected due to its anterior gland location. The identification and successful biopsy of this lesion at 0.55T resolved a long-standing discrepancy between rising PSA levels and prior benign or low-grade biopsy results, leading to radical prostatectomy. Figure 5 shows this patient's clinical course over 5.5 years (a). Images show a 3T MRI with a PI-RADS 4 lesion in the right PZ, which, when biopsied at 0.55T, yielded HGPIN (b, c). A left hip implant caused significant obscuration of the left TZ and PZ on the 3T images. Subsequent 0.55T images revealed an additional clinically significant lesion in the left TZ (d, e). Table 5 summarizes the procedure times. Average total procedure time was 77 ± 21 minutes for transrectal and 74 ± 22 minutes for percutaneous biopsies, with times to first core at 45 ± 15 and 53 ± 14 minutes, respectively. Single-target biopsies averaged 59 ± 18 minutes (transrectal) and 66 ± 12.5 minutes (percutaneous), while multiple targets averaged 107 minutes and 99 ± 17 minutes, respectively. An additional 11 minutes were required for a systematic add-on. Discussion This study demonstrates that lesion identification for prostate biopsy planning, and intra-procedural biopsy guidance are feasible at 0.55T. This initial experience consists of 4 transrectal biopsies and 13 percutaneous biopsies. As a result of these procedures, the diagnosis and management of 13 out of 17 participants were impacted, which included 8 new cancer diagnoses, 2 upgrades in the GS, and 3 increases in the percentage of positive core volume. Thirteen out of 17 participants (76.4%) and 14 out of 20 lesions (70%) had high volume disease (defined as ≥ 50% positive core) following the in-bore biopsies [ 21 , 22 ]. The current detection rate is higher than that of previous studies using MRI-guided in-bore biopsies at higher fields (1.5T or 3T) [ 23 ] [ 24 ] [ 25 ], likely because the approach thus far has been used for problem-solving in high suspicion cases. Nonetheless, these findings suggest that in-bore biopsies at 0.55T are feasible, accurate, and can positively impact patient management. This study also shows some potential benefits of performing in-bore prostate biopsies with a lower field, wide-bore scanner. The reduced susceptibility artifacts at this field strength from an implanted device enabled the detection and biopsy of a suspicious TZ lesion that was not visible at higher fields, as seen in the patient with an in situ left hip implant. Additionally, the 80 cm bore represents an approximate increase of 14% in diameter and 31% in available entry area compared to a 70 cm bore size, offering additional space for the patient and equipment inside the bore. For percutaneous biopsies specifically, the larger bore size offers extra room for instruments inside the bore, approximating the space provided in CT-guided biopsies. This potentially decreases the need for moving the patient in and out of the scanner to access the biopsy device, though the choice for advancing the needle in the bore is operator dependent. Procedure times were long as this is the first experience of the team at this field strength and imaging and biopsy protocols had to be established. Improved image acquisition time during intraprocedural scanning, due to lack of need for parameter adjustment, and increased team experience with the scanner and procedures could lead to substantial future reduction in time with subsequent biopsies. Lack of properly matched MR-compatible introducer and biopsy needle pairs was also a major contributor to the extension of procedure time, and improvements in this realm could help reduce the length of procedures. In-bore MRI-guided biopsies can be performed using transrectal, percutaneous transgluteal, or transperineal approaches. The transperineal approach has been considered to offer a lower risk of infectious complications [ 26 , 27 ]. However, a recent randomized controlled trial found no significant difference in infectious and non-infectious complications between transrectal and transperineal biopsy methods [ 28 ]. This study employed both percutaneous and transrectal approaches, which do not require general anesthesia, unlike the transperineal approach. The transrectal method aligns with standard TRUS-guided and fusion biopsy techniques, while the percutaneous transgluteal route was chosen for patients with a history of anorectal surgeries and based on operator preference. This percutaneous transgluteal approach mirrors existing CT and CT-fluoroscopic techniques used for other solid organ and lymph node biopsies. This strategy has numerous potential advantages, including a very familiar procedural approach and an existing advanced clinical skillset for interventional radiologists and the ability to utilize conscious sedation rather than general anesthesia (GA). Further, the percutaneous transgluteal approach does not require any additional hardware (i.e., grid) or advanced software that are necessary for a transperineal approach. Collectively, these potential advantages could expedite widespread adoption of MRI-guided intervention, including prostate biopsy [ 29 ]. This study has several limitations. First, for an initial feasibility experience, a small number of participants were included. A statistical comparison to prior experience at 1.5T or 3T is not possible due to lack of matched participants, and the small number of cases. Future work on the comparison of targeting accuracy, and procedure times is needed to fully compare the three field strengths for the purpose of intervention. Second, although the study achieved a high cancer detection rate and successfully biopsied lesions as small as 0.7 cm in diameter, the contrast between the lesion and its surrounding normal tissue, especially in the transition zone and during rapid intraprocedural scans, was lower than that observed in images acquired at higher magnetic field strengths. Improving contrast between lesion and its surrounding tissues would be further explored to improve these procedures. Third, as noted above, the procedural durations in this study were longer than those reported in previous studies [ 30 , 31 ], likely due to the initial experience with performing in-bore procedures at 0.55 T, the optimization of acquisition settings for these procedures and the procurement of MRI-compatible biopsy devices. In conclusion, this study demonstrated the utility of MRI-guided prostate interventions at 0.55T, particularly as a problem-solving tool in challenging cases such as those with high suspicion lesions or a rising PSA but negative repeated biopsies, as well as in patients without a rectum who are unable to undergo transrectal biopsy. In-bore prostate biopsies performed at 0.55T not only provide direct verification of needle placement within the suspicious focus, similar to the procedure using high field scanners, but also enable the visibility of lesions that might go undetected due to susceptibility artifact caused by implants. Additionally, the wider bore of the scanner offers more space for biopsy devices, especially for the percutaneous approach. The successful implementation of biopsy techniques at 0.55 T may broaden access to this procedure for a wider patient population. Declarations Competing Interests receive research support from Siemens Healthineers, Germany Author Contribution T.K. wrote main manuscript, prepared figures and tablesY.J. edited main manuscript, figures and tablesN.S. edited main manuscript, figures and tablesH.H. edited main manuscript, figures and tablesS.W. edited main manuscript, figures and tablesJ.W. edited main manuscript, figures and tablesE.C. edited main manuscript, figures and tablesV.G edited main manuscript, figures and tables Acknowledgement Illustrations 2a and 2b were created by Biomedical Illustrator & Animator Danielle Dobbs at the University of Michigan. References Cancer of the Prostate - Cancer Stat Facts. SEER n.d. https://seer.cancer.gov/statfacts/html/prost.html (accessed May 17, 2024). Ahmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet Lond Engl 2017;389:815–22. https://doi.org/10.1016/S0140-6736(16)32401-1. Rouvière O, Puech P, Renard-Penna R, Claudon M, Roy C, Mège-Lechevallier F, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019;20:100–9. https://doi.org/10.1016/S1470-2045(18)30569-2. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging – Reporting and Data System: 2015, Version 2. Eur Urol 2016;69:16–40. https://doi.org/10.1016/j.eururo.2015.08.052. Marks L, Young S, Natarajan S. MRI–ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 2013;23:43–50. https://doi.org/10.1097/MOU.0b013e32835ad3ee. Siddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015;313:390–7. https://doi.org/10.1001/jama.2014.17942. Barnett CL, Davenport MS, Montgomery JS, Wei JT, Montie JE, Denton BT. Cost-effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer. BJU Int 2018;122:50–8. https://doi.org/10.1111/bju.14151. Pahwa S, Schiltz NK, Ponsky LE, Lu Z, Griswold MA, Gulani V. Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men. Radiology 2017;285:157–66. https://doi.org/10.1148/radiol.2017162181. Yun H, Kim J, Gandhe A, Nelson B, Hu JC, Gulani V, et al. Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results. JAMA Netw Open 2023;6:e2344856. https://doi.org/10.1001/jamanetworkopen.2023.44856. Kornienko K, Reuter M, Maxeiner A, Günzel K, Kittner B, Reimann M, et al. Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy. Sci Rep 2022;12:13603. https://doi.org/10.1038/s41598-022-17260-6. Recchimuzzi DZ, Diaz de Leon A, Pedrosa I, Travalini D, Latin H, Goldberg K, et al. Direct MRI-guided In-Bore Targeted Biopsy of the Prostate: A Step-by-Step How To and Lessons Learned. Radiogr Rev Publ Radiol Soc N Am Inc 2024;44:e230142. https://doi.org/10.1148/rg.230142. Murgic J, Stenmark MH, Halverson S, Blas K, Feng FY, Hamstra DA. The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer. Radiat Oncol Lond Engl 2012;7:127. https://doi.org/10.1186/1748-717X-7-127. Costa DN, Goldberg K, Leon AD de, Lotan Y, Xi Y, Aziz M, et al. Magnetic Resonance Imaging-guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate. Eur Urol Oncol 2019;2:397–404. https://doi.org/10.1016/j.euo.2018.08.022. van Luijtelaar A, Bomers J, Fütterer J. A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients. Expert Rev Anticancer Ther 2019;19:705–16. https://doi.org/10.1080/14737140.2019.1641086. Wegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO, et al. Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol 2017;71:517–31. https://doi.org/10.1016/j.eururo.2016.07.041. Prince M, Foster BR, Kaempf A, Liu J-J, Amling CL, Isharwal S, et al. In-Bore Versus Fusion MRI-Targeted Biopsy of PI-RADS Category 4 and 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting. AJR Am J Roentgenol 2021;217:1123–30. https://doi.org/10.2214/AJR.20.25207. Hori M, Hagiwara A, Goto M, Wada A, Aoki S. Low-Field Magnetic Resonance Imaging. Invest Radiol 2021;56:669–79. https://doi.org/10.1097/RLI.0000000000000810. Khodarahmi I, Brinkmann IM, Lin DJ, Bruno M, Johnson PM, Knoll F, et al. New-Generation Low-Field Magnetic Resonance Imaging of Hip Arthroplasty Implants Using Slice Encoding for Metal Artifact Correction: First In Vitro Experience at 0.55 T and Comparison With 1.5 T. Invest Radiol 2022;57:517–26. https://doi.org/10.1097/rli.0000000000000866. Masoom SN, Sundaram KM, Ghanouni P, Fütterer J, Oto A, Ayyagari R, et al. Real-Time MRI-Guided Prostate Interventions. Cancers 2022;14:1860. https://doi.org/10.3390/cancers14081860. Das CJ, Netaji A, Razik A, Verma S. MRI-Targeted Prostate Biopsy: What Radiologists Should Know. Korean J Radiol 2020;21:1087–94. https://doi.org/10.3348/kjr.2019.0817. Schaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, et al. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw JNCCN 2023;21:1067–96. https://doi.org/10.6004/jnccn.2023.0050. Yang DD, Muralidhar V, Mahal BA, Vastola ME, Boldbaatar N, Labe SA, et al. Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer. Urol Oncol Semin Orig Investig 2020;38:735.e9-735.e15. https://doi.org/10.1016/j.urolonc.2020.05.023. Yacoub JH, Verma S, Moulton JS, Eggener S, Oto A. Imaging-guided Prostate Biopsy: Conventional and Emerging Techniques. RadioGraphics 2012;32:819–37. https://doi.org/10.1148/rg.323115053. Vilanova JC, Pérez de Tudela A, Puig J, Hoogenboom M, Barceló J, Planas M, et al. Robotic-assisted transrectal MRI-guided biopsy. Technical feasibility and role in the current diagnosis of prostate cancer: an initial single-center experience. Abdom Radiol 2020;45:4150–9. https://doi.org/10.1007/s00261-020-02665-6. Rembak-Szynkiewicz J, Wojcieszek P, Hebda A, Mazgaj P, Badziński A, Stasik-Pres G, et al. In-bore MR prostate biopsy - initial experience. Endokrynol Pol 2022;73:712–24. https://doi.org/10.5603/EP.a2022.0042. Bennett HY, Roberts MJ, Doi S a. R, Gardiner RA. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect 2016;144:1784–91. https://doi.org/10.1017/S0950268815002885. Pradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar MI, MacLennan S, et al. Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis. J Urol 2021;205:653–63. https://doi.org/10.1097/JU.0000000000001399. Mian BM, Feustel PJ, Aziz A, Kaufman RP, Bernstein A, Avulova S, et al. Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial. J Urol 2024;211:205–13. https://doi.org/10.1097/JU.0000000000003788. Bera K, Ramaiya N, Paspulati RM, Nakamoto D, Tirumani SH. 3.0-T MR-guided transgluteal in-bore-targeted prostate biopsy under local anesthesia in patients without rectal access: a single-institute experience and review of literature. Abdom Radiol 2024. https://doi.org/10.1007/s00261-024-04183-1. Egbers N, Schwenke C, Maxeiner A, Teichgräber U, Franiel T. MRI-guided core needle biopsy of the prostate: acceptance and side effects. Diagn Interv Radiol 2015;21:215. https://doi.org/10.5152/dir.2014.14372. Meermeier NP, Foster BR, Liu J-J, Amling CL, Coakley FV. Impact of Direct MRI-Guided Biopsy of the Prostate on Clinical Management. Am J Roentgenol 2019;213:371–6. https://doi.org/10.2214/AJR.18.21009. Table 4 Table 4 is available in the Supplementary Files section. Additional Declarations Competing interest reported. receive research support from Siemens Healthineers, Germany Supplementary Files Table4.docx Cite Share Download PDF Status: Published Journal Publication published 11 Jan, 2025 Read the published version in Abdominal Radiology → Version 1 posted Editorial decision: Revision requested 16 Dec, 2024 Reviews received at journal 13 Dec, 2024 Reviewers agreed at journal 26 Nov, 2024 Reviewers invited by journal 15 Nov, 2024 Editor assigned by journal 07 Nov, 2024 Submission checks completed at journal 07 Nov, 2024 First submitted to journal 01 Nov, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5375637","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":379179720,"identity":"1b516b16-6d1d-4859-aa80-685c4291eaed","order_by":0,"name":"Tejinder Kaur","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Tejinder","middleName":"","lastName":"Kaur","suffix":""},{"id":379179721,"identity":"eea04f46-3db4-49da-aeed-bb803c7572e4","order_by":1,"name":"Yun Jiang","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Yun","middleName":"","lastName":"Jiang","suffix":""},{"id":379179722,"identity":"b5d8a13f-489f-4807-8c41-ceed4c1005db","order_by":2,"name":"Nicole Seiberlich","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Nicole","middleName":"","lastName":"Seiberlich","suffix":""},{"id":379179723,"identity":"6de23887-a909-49a4-a833-75ae8f8c8f75","order_by":3,"name":"Hero Hussain","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Hero","middleName":"","lastName":"Hussain","suffix":""},{"id":379179724,"identity":"fad488a8-d090-431e-b181-ae7c6a600f49","order_by":4,"name":"Shane Wells","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Shane","middleName":"","lastName":"Wells","suffix":""},{"id":379179725,"identity":"df143294-ff9e-4940-bac7-c7c86a117caa","order_by":5,"name":"John Wei","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"John","middleName":"","lastName":"Wei","suffix":""},{"id":379179726,"identity":"12d25be6-ebb1-48ff-9be4-02b573952540","order_by":6,"name":"Elaine Caoili","email":"","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":false,"prefix":"","firstName":"Elaine","middleName":"","lastName":"Caoili","suffix":""},{"id":379179727,"identity":"88c09328-e910-46e6-bb0c-7198817f061e","order_by":7,"name":"Vikas Gulani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIie3PMUvDQBTA8RcC5/LarCmx8SucZIz4XYLQLAkUuhRxSDm4STorfgk/QuVBXJwlEgf9CNIlLaX1mtA4XeooeP/h7h2833AAJtNfzGb1dQpgzT7UU81W1pxHCKodwX9HoCXA3IYcoAbwZxZ9VWtC50HI62IaAn+l2XIMF8PHhYYQI683J3Tfn2SZvMTAy0h4dzAKdGQgTjLPuiWEIpJlKmlPpI1AUQcRq5UiZ4pM0m1Ldlri2Cx3sSLkithp1pJFFxmFvSzG80J9IcljHOz/gvwquNcQ5uTBW7UJfb+IP5fJTej3SzXg9HI415A6S/7M2Fy8Y71uc2zBZDKZ/nXffJxdcGH4ZY0AAAAASUVORK5CYII=","orcid":"","institution":"University of Michigan–Ann Arbor","correspondingAuthor":true,"prefix":"","firstName":"Vikas","middleName":"","lastName":"Gulani","suffix":""}],"badges":[],"createdAt":"2024-11-01 22:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5375637/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5375637/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00261-024-04783-x","type":"published","date":"2025-01-11T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":70962733,"identity":"6fe3621d-b07f-43ed-a49a-8aaa7b4eab39","added_by":"auto","created_at":"2024-12-09 15:41:25","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":408713,"visible":true,"origin":"","legend":"\u003cp\u003eParticipant and lesion characteristics for transrectal and percutaneous biopsies.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/9958805135b539ff49cca134.jpg"},{"id":70962732,"identity":"85c2206b-cd1a-4342-8a87-5bfd1883544c","added_by":"auto","created_at":"2024-12-09 15:41:25","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":415444,"visible":true,"origin":"","legend":"\u003cp\u003eBiopsy approaches. Transrectal approach using a robotic targeting device (a). Percutaneous approach via a transgluteal route by using 2 coil arrays placed adjacent to each other, and an introducer introduced through the gap between coils under aseptic conditions (b).\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/3096a444331f58ebb87e102f.jpg"},{"id":70962735,"identity":"4e8b89b7-6a2f-4c37-be1c-25ad50104d17","added_by":"auto","created_at":"2024-12-09 15:41:26","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":878268,"visible":true,"origin":"","legend":"\u003cp\u003e68-year-old with PSA 6.3 ng/mL and PSA density 0.05 ng/mL\u003csup\u003e2\u003c/sup\u003e with a PI-RADS 5 observation in left Transition Zone (TZ) (a-c). Transrectal prostate biopsy was performed with robotic positioning device under MRI guidance with an 18 G biopsy device (d-f).\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/3a1ccafe14817ef148da6b28.jpg"},{"id":70962736,"identity":"36fbc4d1-267f-4e74-8008-a6dab8cf1dae","added_by":"auto","created_at":"2024-12-09 15:41:26","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":470686,"visible":true,"origin":"","legend":"\u003cp\u003eA 77-year-old participant with a PSA of 3.57 ng/mL and PSA density of 0.06 ng/mL\u003csup\u003e2\u003c/sup\u003e, presenting with a PI-RADS 5 observation in the left transition zone (TZ) (a, b). A percutaneous prostate biopsy was performed using a 16G introducer and an 18G biopsy device under MRI guidance (c).\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/d1627222e5afb1953234eaa6.jpg"},{"id":70963465,"identity":"ad389764-be91-4804-81a6-a9547f2ba023","added_by":"auto","created_at":"2024-12-09 15:49:25","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":933641,"visible":true,"origin":"","legend":"\u003cp\u003eStudy participant with rising PSA levels over 5.5 years underwent four biopsies and three MRIs before the in-bore MRI-guided biopsy at 0.55T (a). Axial T2-weighted image from a 3T diagnostic scan in 2021 showing a previously biopsied PI-RADS 4 observation (white arrow). This lesion was successfully targeted at 0.55T, yielding HGPIN (b, c). A high-risk observation (yellow arrow) detected during scanning, with reduced artifact from the left hip implant (blue asterisk), was biopsied and yielded an intermediate-grade, high-volume cancer (d, e). The participant subsequently underwent a radical prostatectomy.\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/2a531110fbbd0d731a5276a1.jpg"},{"id":73694179,"identity":"35472eef-868d-4038-bf46-3c7759430dd7","added_by":"auto","created_at":"2025-01-13 16:11:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3838795,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/ba9caa53-db28-44c2-a631-e12c64246d2d.pdf"},{"id":70962738,"identity":"eadcdb56-a436-45ce-8599-10c96ef7531b","added_by":"auto","created_at":"2024-12-09 15:41:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23748,"visible":true,"origin":"","legend":"","description":"","filename":"Table4.docx","url":"https://assets-eu.researchsquare.com/files/rs-5375637/v1/b74e799a804097f0e96002e6.docx"}],"financialInterests":"Competing interest reported. receive research support from Siemens Healthineers, Germany","formattedTitle":"Clinical Feasibility of MRI-guided In-Bore Prostate Biopsies at 0.55T","fulltext":[{"header":"Introduction","content":"\u003cp\u003eProstate cancer (PCa) represents 14.9% of all new cancer cases and is the fifth leading cause of cancer death in the United States [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Multiparametric MRI (mpMRI) has revolutionized PCa diagnosis [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], promoting a clinical shift towards incorporating targeted biopsy strategies. MRI-guided biopsies are performed by either fusing areas of suspicious foci identified using MRI images with real-time ultrasound guidance images, or directly in the MRI scanner (in-bore). Both methods have been shown to reduce detection of indolent, low-risk diseases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and are cost-effective compared to traditional TRUS-guided biopsies [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. MRI-Ultrasound fusion biopsy, with or without systematic sampling, is the preferred method in current clinical practice for its lower cost and ease of workflow. However, the approach is susceptible to inaccuracies from the co-registration process and operator skill with ultrasound targeting. These limitations, coupled with the high prevalence of suspicious lesions, often lead to complex scenarios where patients may have repeated negative biopsies [\u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] despite high suspicion on MRI (PIRADS Categories 4 or 5 observations), elevated PSA levels, and ongoing cancer suspicion. These patients should undergo thorough review and be considered for either repeated biopsies or close surveillance as up to 44% of clinically significant prostate cancers (csPCa) can be detected at later stages [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePCa aggressiveness is assessed before treatment using predictive models which include demographic data, PSA levels, digital rectal exam results, and biopsy findings (ISUP grade, number of positive cores in samples), making biopsy an essential component of patient management [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn-bore MRI-guided biopsy enhances procedural accuracy by allowing direct visualization of lesions, biopsy needles, and needle trajectories during the procedure [\u003cspan additionalcitationids=\"CR14 CR15\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, long procedures occupying multiple time slots, and relatively high costs associated with MRI have limited its wide clinical adoption. For percutaneous procedures, the inherent limitation of fitting the biopsy devices and the patient in the scanner is another challenge.\u003c/p\u003e \u003cp\u003eThe current generation of lower field scanners at 0.55T have several features that could facilitate in-bore MRI-guided prostate interventions. Images acquired at lower field have reduced susceptibility artifacts from biopsy devices and implants. The scanner has a wider bore (80 cm) that could allow easier access for instruments into the scanner for percutaneous access. Moreover, lower field scanners tend to have lower operational costs compared to conventional scanners at 1.5T or 3T [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These factors could increase the availability of in-bore biopsies, making them more accessible. Currently, dedicating busy scanners to interventions is operationally challenging.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHowever, prostate imaging is generally performed at 3T due to signal-to-noise ratio (SNR) or contrast-to-noise ratio (CNR) advantages [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], and lesion visualization and successful biopsy at lower field cannot be assumed. The goal of this study is to test the hypothesis that lesion visualization, and accurate in-bore MRI-guided prostate biopsy is feasible using a 0.55T scanner.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy Design\u003c/h2\u003e\n \u003cp\u003eThe study was approved by the Institutional Review Board (IRB) and complied with the Health Insurance Portability and Accountability Act. Written informed consent was obtained from all participants. In this prospective study, indications for performing in-bore biopsies included multiple previous negative MRI-Ultrasound fusion biopsies or patient reluctance to undergo a template biopsy. Percutaneous biopsies were performed for patients who lacked a rectum or based on the operator\u0026rsquo;s preference. The current study included 19 men with 22 lesions referred by urologists between May 2023 and October 2024 for in-gantry targeted biopsy, with an additional systematic biopsy performed in 3 cases. The study design is outlined in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. PSA levels, PSA density, lesion sizes, histopathological ISUP grade, GG upgrade, cancer detection rate, positive percentage volume, skin to target distances, and durations to reach the first biopsy core and the overall procedure were reported. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the patient demographics and characteristics.\u003c/p\u003e\n \u003cdiv align=\"left\" class=\"colspec\"\u003e\u003cbr\u003eMRI System and Imaging Protocols\u003c/div\u003e\n \u003cp\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cp\u003eA 0.55T MRI scanner (Magnetom Free.Max, Siemens Healthineers, Erlangen, Germany) was used in this study. The system has a bore diameter of 80 cm. During the biopsy, T2-weighted TSE images were first obtained to identify the suspicious focus. These images were compared to pre-procedure clinical diagnostic scans acquired at 1.5T or 3T for lesion localization (15 patients had previous 3T scans, 3 patients had both 3T and 1.5T scans and 1 patient had only a 1.5T scan). Images acquired using single-shot TSE (HASTE), T2-weighted TSE, or balanced steady-state free precession (bSSFP) sequences, as chosen by the operator during the procedure, were used to guide the biopsy needle to the suspicious lesion. All imaging parameters are listed in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e. The procedure was performed without intravenous contrast.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1:\u003c/strong\u003e Patient and lesion characteristics for transrectal and percutaneous biopsies.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Characteristic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAverage Number Overall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransrectal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercutaneous\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eTotal Patients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eAge (y)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e69 \u0026plusmn; 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e68 \u0026plusmn; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e69 \u0026plusmn; 9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003ePSA (ng/mL)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e10.2 \u0026plusmn; 6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e8.9 \u0026plusmn; 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e10.1 \u0026plusmn; 7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eProstate Volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e68 \u0026plusmn; 64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e69 \u0026plusmn; 45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e58 \u0026plusmn; 44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003ePSA density\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e0.22 \u0026plusmn; 0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e0.11 \u0026plusmn; 0.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e0.27 \u0026plusmn; 0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eLesions visible at MRI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003eLesion size(cm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e1.9 \u0026plusmn; 1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e1.6 \u0026plusmn; 0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e2.0 \u0026plusmn; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003ePI-RADS v2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e3,4,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e4,5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25%;\"\u003e\n \u003cp\u003e3,4,5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003ePSA- Prostate Specific Antigen, PI-RADS v2.1- Prostate Imaging Reporting and Data System version 2.1\u003c/p\u003e\n\u003ch3\u003eIn-bore MRI-guided Biopsy\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003eTransrectal Biopsy:\u003c/h2\u003e\n \u003cp\u003eAll transrectal biopsies were performed by a single operator (22 years of radiology experience at the time of biopsy). Prebiopsy rectal swabbing and antibiotic prophylaxis with cephalosporins were given in all transrectal cases. One dose of antibiotic was given prior to biopsy and the other was given 12 hours after the first dose.\u003c/p\u003e\n \u003cp\u003eParticipants were positioned prone and headfirst into the scanner. A 57 x 29 cm 12-channel phased array coil was placed on the dorsal side of the patient\u0026rsquo;s pelvis. 1% Lidocaine gel was applied to the rectal surface adjacent to the prostate. The rectal sleeve/directing system was inserted into the rectum and connected to the robotic positioning device (Soteria Medical, Arnhem, Netherlands) (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003ea). Initial T2 weighted images were acquired in both axial and sagittal planes to locate the needle guide and the target lesion. The robotic software was calibrated, determining the coordinates of the target lesion in relation to the needle guide. The needle guide was then adjusted based on the target location, with movements calculated and controlled using the software system associated with the robot. Robot movements involve manipulation of the intrarectal device in the left/right, head to foot, and anterior posterior directions [\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e]. After initial movements, repeat T2 weighted or bSSFP scans were obtained to confirm the guide positioning with respect to the lesion. Further adjustments and imaging were performed as necessary per the judgement of the operators. Once desired positioning was achieved, a core sample was obtained using an 18 G semi-automatic MRI-compatible core biopsy needle of length 150 mm or 175 mm, and a 20 mm \u0026ldquo;throw\u0026rdquo; (In Vivo/Philips, Gainesville, FL, or ITP, V\u0026ouml;lklingen, Germany) advanced through the robotic arm. For additional passes, the sleeve was repositioned for targeting by making smaller operator-controlled adjustments of the robotic arm. Two to four cores were obtained from each lesion.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"426\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2wTSE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Prebiopsy)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e\u003cstrong\u003essTSE (HASTE)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eT2wTSE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Intraprocedural)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ebSSFP (True FISP)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eAcquisition Time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e5 min 58 secs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e58 secs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e46 secs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e1 min 14 secs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eThickness (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eTR (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e3320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e6640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e6.44\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eTE (ms)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e127\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e3.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eMatrix\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e231x271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e154x192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e224x141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e224x157\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eFOV (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003e220x220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e220x220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003e243x243\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003e250x250\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eClinical purpose\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.7354%;\"\u003e\n \u003cp\u003ePre-biopsy\u003c/p\u003e\n \u003cp\u003elesion localization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eTumor and needle localization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 27.1663%;\"\u003e\n \u003cp\u003eTumor and needle localization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18.0328%;\"\u003e\n \u003cp\u003eTumor and needle localization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2:\u003c/strong\u003e The scanning parameters used during prostate biopsy at 0.55T.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eTR - Repetition Time, TE - Time to Echo, FOV - Field of View, T2wTSE -\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eT2 Weighted Turbo Spin-Echo, ssTSE - Single-Shot Turbo Spin-Echo, HASTE - Half\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1732551487.png\"\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003cstrong\u003eTable 5:\u003c/strong\u003e Average total procedure time was 77 \u0026plusmn; 21 minutes for transrectal and 74 \u0026plusmn; 22 minutes for percutaneous biopsies, with times to first core at 45 \u0026plusmn; 15 and 53 \u0026plusmn; 14 minutes, respectively. Single-target biopsies averaged 59 \u0026plusmn; 18 minutes (transrectal) and 66 \u0026plusmn; 12.5 minutes (percutaneous), while multiple targets averaged 107 minutes and 99 \u0026plusmn; 17 minutes, respectively. An additional 11 minutes were required for a systematic add-on.\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"754\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e#\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApproach\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of lesions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of cores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal procedure time (minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTime to first core (minutes)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003eTransrectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e2,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003eTransrectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003eTransrectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003eTransrectal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e75\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 4.77454%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30.7692%;\"\u003e\n \u003cp\u003ePercutaneous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21.7507%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 14.3236%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15.5172%;\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.8647%;\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003ch3\u003ePercutaneous transgluteal biopsy:\u003c/h3\u003e\n\u003cp\u003eThe percutaneous transgluteal biopsies were performed in participants who did not have rectums, or in whom a direct percutaneous approach was preferred due to contraindication of a transrectal approach or lack of tolerance of the rectal probe. Procedures were performed by two operators (primary operator with 17\u0026ndash;23 years\u0026rsquo; experience, assisted by a second operator with 22 years\u0026rsquo; experience). Moderate sedation, consisting of midazolam and fentanyl, was used. The patient was placed in a prone position and two 45 x 27 cm 6-channel phased array coils were positioned over the patient\u0026rsquo;s pelvis, approximately 2\u0026ndash;3 cm apart, allowing and creating an aperture at the expected entry site (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003eb). Single-shot T2w imaging (HASTE) was performed with fluid-filled thin column markers taped in place over the gluteal region to help identify an entry point. The patient was prepped and draped in the usual sterile fashion, including covering the coils with sterile drapes. The skin at the entry point was anesthetized with 1% lidocaine. A 16 G introducer cannula with a trocar (ITP, V\u0026ouml;lklingen, Germany) was selected to pair with an 18G, 175 mm semi-automatic biopsy device (In Vivo/Philips, Gainesville, FL or ITP, V\u0026ouml;lklingen, Germany) such that the throw from the biopsy needle would extend 2 cm beyond the cannula. Multiple core samples were acquired from various regions of the lesions by making slight adjustments to the introducer\u0026apos;s position between each pass. Three patients underwent an additional systematic biopsy, and GG for each participant was determined based on the highest-grade core.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical analysis:\u003c/h2\u003e\n \u003cp\u003eContinuous variables including age, PSA levels, PSA density etc. were summarized using means and standard deviations (SD). Categorical variables, like lesion type, location, etc. were summarized by presenting frequency counts and corresponding percentages to provide a clear representation of the distribution across different categories.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\"\u003e\n \u003ch2\u003eClinical data\u003c/h2\u003e\n \u003cp\u003eNineteen participants with a mean age of 68\u0026thinsp;\u0026plusmn;\u0026thinsp;10 years were enrolled between May 2023 and October 2024. The mean PSA level of all participants was 11.7\u0026thinsp;\u0026plusmn;\u0026thinsp;12 ng/mL (range 1.5\u0026ndash;50.6 ng/mL), and the mean prostate volume was 66.1\u0026thinsp;\u0026plusmn;\u0026thinsp;45 mL (range 24\u0026ndash;133 mL). Previous 3T and 1.5T diagnostic scans showed 6 PI-RADS 4 lesions, 12 PI-RADS 5 lesions, and 3 PI-RADS 3 lesions. A total of 73% of lesions (16 of 22) were in the peripheral zone (PZ), and the remaining 27% (6 of 22) were in the transition zone (TZ). Notably, 11 lesions were apical, and 6 were anterior in location.\u003c/p\u003e\n \u003cp\u003eSeventeen study participants successfully underwent the procedure. One participant could not undergo the procedure due to chronic contractures, and in another, the 5 mm lesion was not visible on the current scan. Out of 17 procedures, 4 were robot-assisted transrectal and 13 were percutaneous transgluteal. A total of 20 lesions were biopsied in these 17 participants along with a 6-core systematic sampling in 3 participants. Lesions were successfully identified on T2-weighted imaging and matched with pre-biopsy imaging in all patients. The average lesion size was 1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 cm at 3T and 1.5\u0026thinsp;\u0026plusmn;\u0026thinsp;0.6 cm at 0.55T for the transrectal approach, and 1.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.4 cm at both 3T and 0.55T for the percutaneous approach. In all patients who underwent the procedure, biopsies were successfully obtained from within the lesion, as evidenced by intraprocedural imaging showing the needle within the target lesion. No intra- or post-procedural complications were encountered. Table \u003cspan\u003e3\u003c/span\u003e presents percutaneous biopsy data, with an average skin-to-target distance of 11.25\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 cm and needle lengths of 2.18\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 cm in subcutaneous fat, 3.02\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 cm in muscle, and 4.79\u0026thinsp;\u0026plusmn;\u0026thinsp;1.1 cm in pelvic fat. The intra-prostatic length averaged 1.26\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 cm.\u003c/p\u003e\n \u003cdiv\u003eFigure \u003cspan\u003e3\u003c/span\u003e depicts a representative targeted transrectal biopsy in a 68-year-old patient. Prebiopsy diagnostic 3T images reveal a left anterior TZ lesion (a-c). The lesion was visualized at 0.55T (d) and targeted using the robotic arm and an 18G fully automatic biopsy device (e-f).\u003c/div\u003e\n \u003cp\u003eFigure \u003cspan\u003e4\u003c/span\u003e shows percutaneous targeting of a left apical lesion in a patient without a rectum with a 16 G introducer and an 18G biopsy device. It yielded a GG2 clinically significant cancer with a 100% positive core (a-c).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\"\u003e\n \u003ch2\u003ePathology data\u003c/h2\u003e\n \u003cp\u003eOf 17 biopsied participants, 14 had positive core volumes for cancer, ranging from 10%-100%. Overall cancer detection rate in cases was 82.3% (14 out of 17). Of the 17 participants, 9 had previous prostate biopsies (7 MR-US fusion-guided transperineal, 1 MR-US fusion-guided transrectal, and 1 TRUS-guided systematic), while the remaining 8 were biopsy-na\u0026iuml;ve. Out of 20 lesions, 16 were positive for malignancy (80% total; 35% GG2, 25% GG1, 10% GG5, 5% GG4, and 6% GG3), 1 was benign high-grade prostatic intraepithelial neoplasia (HGPIN) (5%) and 3 were benign prostatic tissue (15%). Compared with previous biopsy results, 11.7% (2/17) of participants had a GG upgrade and 17.6% (3/17) showed an increase in positive core volume, while 5.8% (1/17) showed no upgrade and 17.6% (3/17) had negative or benign findings. Among biopsy-na\u0026iuml;ve participants, 47% (8/17) had new cancer detected. The highest diagnostic yield was obtained from the first core sample in 7 lesions, the second core in 4 lesions, and the third core in another 5 lesions. Table\u0026nbsp;\u003cspan\u003e4\u003c/span\u003e summarizes the prebiopsy PIRADS score, route of biopsy, result of biopsy, and comparison with previous biopsy results. One participant, a 73-year-old male, was found to have a new clinically significant cancer (GG2) in the left anterior transition zone (TZ) during an in-bore MRI-guided biopsy at 0.55T. This lesion was missed on two prior 3T MRIs and one 1.5T MRI over 5.5 years due to susceptibility artifacts from a hip prosthesis. Despite four previous systematic and MRI-Ultrasound fusion biopsies targeting a contralateral PI-RADS 4 lesion that only revealed HGPIN or low-volume cancer (\u0026lt;\u0026thinsp;10%), the lesion in the left anterior TZ remained undetected due to its anterior gland location. The identification and successful biopsy of this lesion at 0.55T resolved a long-standing discrepancy between rising PSA levels and prior benign or low-grade biopsy results, leading to radical prostatectomy. Figure\u0026nbsp;\u003cspan\u003e5\u003c/span\u003e shows this patient\u0026apos;s clinical course over 5.5 years (a). Images show a 3T MRI with a PI-RADS 4 lesion in the right PZ, which, when biopsied at 0.55T, yielded HGPIN (b, c). A left hip implant caused significant obscuration of the left TZ and PZ on the 3T images. Subsequent 0.55T images revealed an additional clinically significant lesion in the left TZ (d, e).\u003c/p\u003e\n \u003cdiv\u003e\u003c/div\u003e\n \u003cp\u003eTable\u0026nbsp;5 summarizes the procedure times. Average total procedure time was 77\u0026thinsp;\u0026plusmn;\u0026thinsp;21 minutes for transrectal and 74\u0026thinsp;\u0026plusmn;\u0026thinsp;22 minutes for percutaneous biopsies, with times to first core at 45\u0026thinsp;\u0026plusmn;\u0026thinsp;15 and 53\u0026thinsp;\u0026plusmn;\u0026thinsp;14 minutes, respectively. Single-target biopsies averaged 59\u0026thinsp;\u0026plusmn;\u0026thinsp;18 minutes (transrectal) and 66\u0026thinsp;\u0026plusmn;\u0026thinsp;12.5 minutes (percutaneous), while multiple targets averaged 107 minutes and 99\u0026thinsp;\u0026plusmn;\u0026thinsp;17 minutes, respectively. An additional 11 minutes were required for a systematic add-on.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study demonstrates that lesion identification for prostate biopsy planning, and intra-procedural biopsy guidance are feasible at 0.55T. This initial experience consists of 4 transrectal biopsies and 13 percutaneous biopsies. As a result of these procedures, the diagnosis and management of 13 out of 17 participants were impacted, which included 8 new cancer diagnoses, 2 upgrades in the GS, and 3 increases in the percentage of positive core volume. Thirteen out of 17 participants (76.4%) and 14 out of 20 lesions (70%) had high volume disease (defined as \u0026ge;\u0026thinsp;50% positive core) following the in-bore biopsies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The current detection rate is higher than that of previous studies using MRI-guided in-bore biopsies at higher fields (1.5T or 3T) [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e], likely because the approach thus far has been used for problem-solving in high suspicion cases. Nonetheless, these findings suggest that in-bore biopsies at 0.55T are feasible, accurate, and can positively impact patient management.\u003c/p\u003e \u003cp\u003eThis study also shows some potential benefits of performing in-bore prostate biopsies with a lower field, wide-bore scanner. The reduced susceptibility artifacts at this field strength from an implanted device enabled the detection and biopsy of a suspicious TZ lesion that was not visible at higher fields, as seen in the patient with an in situ left hip implant. Additionally, the 80 cm bore represents an approximate increase of 14% in diameter and 31% in available entry area compared to a 70 cm bore size, offering additional space for the patient and equipment inside the bore. For percutaneous biopsies specifically, the larger bore size offers extra room for instruments inside the bore, approximating the space provided in CT-guided biopsies. This potentially decreases the need for moving the patient in and out of the scanner to access the biopsy device, though the choice for advancing the needle in the bore is operator dependent.\u003c/p\u003e \u003cp\u003eProcedure times were long as this is the first experience of the team at this field strength and imaging and biopsy protocols had to be established. Improved image acquisition time during intraprocedural scanning, due to lack of need for parameter adjustment, and increased team experience with the scanner and procedures could lead to substantial future reduction in time with subsequent biopsies. Lack of properly matched MR-compatible introducer and biopsy needle pairs was also a major contributor to the extension of procedure time, and improvements in this realm could help reduce the length of procedures.\u003c/p\u003e \u003cp\u003eIn-bore MRI-guided biopsies can be performed using transrectal, percutaneous transgluteal, or transperineal approaches. The transperineal approach has been considered to offer a lower risk of infectious complications [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, a recent randomized controlled trial found no significant difference in infectious and non-infectious complications between transrectal and transperineal biopsy methods [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. This study employed both percutaneous and transrectal approaches, which do not require general anesthesia, unlike the transperineal approach. The transrectal method aligns with standard TRUS-guided and fusion biopsy techniques, while the percutaneous transgluteal route was chosen for patients with a history of anorectal surgeries and based on operator preference. This percutaneous transgluteal approach mirrors existing CT and CT-fluoroscopic techniques used for other solid organ and lymph node biopsies. This strategy has numerous potential advantages, including a very familiar procedural approach and an existing advanced clinical skillset for interventional radiologists and the ability to utilize conscious sedation rather than general anesthesia (GA). Further, the percutaneous transgluteal approach does not require any additional hardware (i.e., grid) or advanced software that are necessary for a transperineal approach. Collectively, these potential advantages could expedite widespread adoption of MRI-guided intervention, including prostate biopsy [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study has several limitations. First, for an initial feasibility experience, a small number of participants were included. A statistical comparison to prior experience at 1.5T or 3T is not possible due to lack of matched participants, and the small number of cases. Future work on the comparison of targeting accuracy, and procedure times is needed to fully compare the three field strengths for the purpose of intervention. Second, although the study achieved a high cancer detection rate and successfully biopsied lesions as small as 0.7 cm in diameter, the contrast between the lesion and its surrounding normal tissue, especially in the transition zone and during rapid intraprocedural scans, was lower than that observed in images acquired at higher magnetic field strengths. Improving contrast between lesion and its surrounding tissues would be further explored to improve these procedures. Third, as noted above, the procedural durations in this study were longer than those reported in previous studies [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], likely due to the initial experience with performing in-bore procedures at 0.55 T, the optimization of acquisition settings for these procedures and the procurement of MRI-compatible biopsy devices.\u003c/p\u003e \u003cp\u003eIn conclusion, this study demonstrated the utility of MRI-guided prostate interventions at 0.55T, particularly as a problem-solving tool in challenging cases such as those with high suspicion lesions or a rising PSA but negative repeated biopsies, as well as in patients without a rectum who are unable to undergo transrectal biopsy. In-bore prostate biopsies performed at 0.55T not only provide direct verification of needle placement within the suspicious focus, similar to the procedure using high field scanners, but also enable the visibility of lesions that might go undetected due to susceptibility artifact caused by implants. Additionally, the wider bore of the scanner offers more space for biopsy devices, especially for the percutaneous approach. The successful implementation of biopsy techniques at 0.55 T may broaden access to this procedure for a wider patient population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003ereceive research support from Siemens Healthineers, Germany\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eT.K. wrote main manuscript, prepared figures and tablesY.J. edited main manuscript, figures and tablesN.S. edited main manuscript, figures and tablesH.H. edited main manuscript, figures and tablesS.W. edited main manuscript, figures and tablesJ.W. edited main manuscript, figures and tablesE.C. edited main manuscript, figures and tablesV.G edited main manuscript, figures and tables\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u003c/h2\u003e\n\u003cp\u003eIllustrations 2a and 2b were created by Biomedical Illustrator \u0026amp; Animator Danielle Dobbs at the University of Michigan.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCancer of the Prostate - Cancer Stat Facts. SEER n.d. https://seer.cancer.gov/statfacts/html/prost.html (accessed May 17, 2024).\u003c/li\u003e\n\u003cli\u003eAhmed HU, El-Shater Bosaily A, Brown LC, Gabe R, Kaplan R, Parmar MK, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet Lond Engl 2017;389:815\u0026ndash;22. https://doi.org/10.1016/S0140-6736(16)32401-1.\u003c/li\u003e\n\u003cli\u003eRouvi\u0026egrave;re O, Puech P, Renard-Penna R, Claudon M, Roy C, M\u0026egrave;ge-Lechevallier F, et al. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019;20:100\u0026ndash;9. https://doi.org/10.1016/S1470-2045(18)30569-2.\u003c/li\u003e\n\u003cli\u003eWeinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, et al. PI-RADS Prostate Imaging \u0026ndash; Reporting and Data System: 2015, Version 2. Eur Urol 2016;69:16\u0026ndash;40. https://doi.org/10.1016/j.eururo.2015.08.052.\u003c/li\u003e\n\u003cli\u003eMarks L, Young S, Natarajan S. MRI\u0026ndash;ultrasound fusion for guidance of targeted prostate biopsy. Curr Opin Urol 2013;23:43\u0026ndash;50. https://doi.org/10.1097/MOU.0b013e32835ad3ee.\u003c/li\u003e\n\u003cli\u003eSiddiqui MM, Rais-Bahrami S, Turkbey B, George AK, Rothwax J, Shakir N, et al. Comparison of MR/ultrasound fusion-guided biopsy with ultrasound-guided biopsy for the diagnosis of prostate cancer. JAMA 2015;313:390\u0026ndash;7. https://doi.org/10.1001/jama.2014.17942.\u003c/li\u003e\n\u003cli\u003eBarnett CL, Davenport MS, Montgomery JS, Wei JT, Montie JE, Denton BT. Cost-effectiveness of magnetic resonance imaging and targeted fusion biopsy for early detection of prostate cancer. BJU Int 2018;122:50\u0026ndash;8. https://doi.org/10.1111/bju.14151.\u003c/li\u003e\n\u003cli\u003ePahwa S, Schiltz NK, Ponsky LE, Lu Z, Griswold MA, Gulani V. Cost-effectiveness of MR Imaging-guided Strategies for Detection of Prostate Cancer in Biopsy-Naive Men. Radiology 2017;285:157\u0026ndash;66. https://doi.org/10.1148/radiol.2017162181.\u003c/li\u003e\n\u003cli\u003eYun H, Kim J, Gandhe A, Nelson B, Hu JC, Gulani V, et al. Cost-Effectiveness of Annual Prostate MRI and Potential MRI-Guided Biopsy After Prostate-Specific Antigen Test Results. JAMA Netw Open 2023;6:e2344856. https://doi.org/10.1001/jamanetworkopen.2023.44856.\u003c/li\u003e\n\u003cli\u003eKornienko K, Reuter M, Maxeiner A, G\u0026uuml;nzel K, Kittner B, Reimann M, et al. Follow-up of men with a PI-RADS 4/5 lesion after negative MRI/Ultrasound fusion biopsy. Sci Rep 2022;12:13603. https://doi.org/10.1038/s41598-022-17260-6.\u003c/li\u003e\n\u003cli\u003eRecchimuzzi DZ, Diaz de Leon A, Pedrosa I, Travalini D, Latin H, Goldberg K, et al. Direct MRI-guided In-Bore Targeted Biopsy of the Prostate: A Step-by-Step How To and Lessons Learned. Radiogr Rev Publ Radiol Soc N Am Inc 2024;44:e230142. https://doi.org/10.1148/rg.230142.\u003c/li\u003e\n\u003cli\u003eMurgic J, Stenmark MH, Halverson S, Blas K, Feng FY, Hamstra DA. The role of the maximum involvement of biopsy core in predicting outcome for patients treated with dose-escalated radiation therapy for prostate cancer. Radiat Oncol Lond Engl 2012;7:127. https://doi.org/10.1186/1748-717X-7-127.\u003c/li\u003e\n\u003cli\u003eCosta DN, Goldberg K, Leon AD de, Lotan Y, Xi Y, Aziz M, et al. Magnetic Resonance Imaging-guided In-bore and Magnetic Resonance Imaging-transrectal Ultrasound Fusion Targeted Prostate Biopsies: An Adjusted Comparison of Clinically Significant Prostate Cancer Detection Rate. Eur Urol Oncol 2019;2:397\u0026ndash;404. https://doi.org/10.1016/j.euo.2018.08.022.\u003c/li\u003e\n\u003cli\u003evan Luijtelaar A, Bomers J, F\u0026uuml;tterer J. A comparison of magnetic resonance imaging techniques used to secure biopsies in prostate cancer patients. Expert Rev Anticancer Ther 2019;19:705\u0026ndash;16. https://doi.org/10.1080/14737140.2019.1641086.\u003c/li\u003e\n\u003cli\u003eWegelin O, van Melick HHE, Hooft L, Bosch JLHR, Reitsma HB, Barentsz JO, et al. Comparing Three Different Techniques for Magnetic Resonance Imaging-targeted Prostate Biopsies: A Systematic Review of In-bore versus Magnetic Resonance Imaging-transrectal Ultrasound fusion versus Cognitive Registration. Is There a Preferred Technique? Eur Urol 2017;71:517\u0026ndash;31. https://doi.org/10.1016/j.eururo.2016.07.041.\u003c/li\u003e\n\u003cli\u003ePrince M, Foster BR, Kaempf A, Liu J-J, Amling CL, Isharwal S, et al. In-Bore Versus Fusion MRI-Targeted Biopsy of PI-RADS Category 4 and 5 Lesions: A Retrospective Comparative Analysis Using Propensity Score Weighting. AJR Am J Roentgenol 2021;217:1123\u0026ndash;30. https://doi.org/10.2214/AJR.20.25207.\u003c/li\u003e\n\u003cli\u003eHori M, Hagiwara A, Goto M, Wada A, Aoki S. Low-Field Magnetic Resonance Imaging. Invest Radiol 2021;56:669\u0026ndash;79. https://doi.org/10.1097/RLI.0000000000000810.\u003c/li\u003e\n\u003cli\u003eKhodarahmi I, Brinkmann IM, Lin DJ, Bruno M, Johnson PM, Knoll F, et al. New-Generation Low-Field Magnetic Resonance Imaging of Hip Arthroplasty Implants Using Slice Encoding for Metal Artifact Correction: First In Vitro Experience at 0.55 T and Comparison With 1.5 T. Invest Radiol 2022;57:517\u0026ndash;26. https://doi.org/10.1097/rli.0000000000000866.\u003c/li\u003e\n\u003cli\u003eMasoom SN, Sundaram KM, Ghanouni P, F\u0026uuml;tterer J, Oto A, Ayyagari R, et al. Real-Time MRI-Guided Prostate Interventions. Cancers 2022;14:1860. https://doi.org/10.3390/cancers14081860.\u003c/li\u003e\n\u003cli\u003eDas CJ, Netaji A, Razik A, Verma S. MRI-Targeted Prostate Biopsy: What Radiologists Should Know. Korean J Radiol 2020;21:1087\u0026ndash;94. https://doi.org/10.3348/kjr.2019.0817.\u003c/li\u003e\n\u003cli\u003eSchaeffer EM, Srinivas S, Adra N, An Y, Barocas D, Bitting R, et al. Prostate Cancer, Version 4.2023, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Cancer Netw JNCCN 2023;21:1067\u0026ndash;96. https://doi.org/10.6004/jnccn.2023.0050.\u003c/li\u003e\n\u003cli\u003eYang DD, Muralidhar V, Mahal BA, Vastola ME, Boldbaatar N, Labe SA, et al. Impact of percent positive biopsy cores on cancer-specific mortality for patients with high-risk prostate cancer. Urol Oncol Semin Orig Investig 2020;38:735.e9-735.e15. https://doi.org/10.1016/j.urolonc.2020.05.023.\u003c/li\u003e\n\u003cli\u003eYacoub JH, Verma S, Moulton JS, Eggener S, Oto A. Imaging-guided Prostate Biopsy: Conventional and Emerging Techniques. RadioGraphics 2012;32:819\u0026ndash;37. https://doi.org/10.1148/rg.323115053.\u003c/li\u003e\n\u003cli\u003eVilanova JC, P\u0026eacute;rez de Tudela A, Puig J, Hoogenboom M, Barcel\u0026oacute; J, Planas M, et al. Robotic-assisted transrectal MRI-guided biopsy. Technical feasibility and role in the current diagnosis of prostate cancer: an initial single-center experience. Abdom Radiol 2020;45:4150\u0026ndash;9. https://doi.org/10.1007/s00261-020-02665-6.\u003c/li\u003e\n\u003cli\u003eRembak-Szynkiewicz J, Wojcieszek P, Hebda A, Mazgaj P, Badziński A, Stasik-Pres G, et al. In-bore MR prostate biopsy - initial experience. Endokrynol Pol 2022;73:712\u0026ndash;24. https://doi.org/10.5603/EP.a2022.0042.\u003c/li\u003e\n\u003cli\u003eBennett HY, Roberts MJ, Doi S a. R, Gardiner RA. The global burden of major infectious complications following prostate biopsy. Epidemiol Infect 2016;144:1784\u0026ndash;91. https://doi.org/10.1017/S0950268815002885.\u003c/li\u003e\n\u003cli\u003ePradere B, Veeratterapillay R, Dimitropoulos K, Yuan Y, Omar MI, MacLennan S, et al. Nonantibiotic Strategies for the Prevention of Infectious Complications following Prostate Biopsy: A Systematic Review and Meta-Analysis. J Urol 2021;205:653\u0026ndash;63. https://doi.org/10.1097/JU.0000000000001399.\u003c/li\u003e\n\u003cli\u003eMian BM, Feustel PJ, Aziz A, Kaufman RP, Bernstein A, Avulova S, et al. Complications Following Transrectal and Transperineal Prostate Biopsy: Results of the ProBE-PC Randomized Clinical Trial. J Urol 2024;211:205\u0026ndash;13. https://doi.org/10.1097/JU.0000000000003788.\u003c/li\u003e\n\u003cli\u003eBera K, Ramaiya N, Paspulati RM, Nakamoto D, Tirumani SH. 3.0-T MR-guided transgluteal in-bore-targeted prostate biopsy under local anesthesia in patients without rectal access: a single-institute experience and review of literature. Abdom Radiol 2024. https://doi.org/10.1007/s00261-024-04183-1.\u003c/li\u003e\n\u003cli\u003eEgbers N, Schwenke C, Maxeiner A, Teichgr\u0026auml;ber U, Franiel T. MRI-guided core needle biopsy of the prostate: acceptance and side effects. Diagn Interv Radiol 2015;21:215. https://doi.org/10.5152/dir.2014.14372.\u003c/li\u003e\n\u003cli\u003eMeermeier NP, Foster BR, Liu J-J, Amling CL, Coakley FV. Impact of Direct MRI-Guided Biopsy of the Prostate on Clinical Management. Am J Roentgenol 2019;213:371\u0026ndash;6. https://doi.org/10.2214/AJR.18.21009.\u003cstrong\u003e\u003cu\u003e\u003c/u\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 4","content":"\u003cp\u003eTable 4 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Prostate biopsy, MRI, Prostate cancer, Transrectal, Percutaneous, In-bore","lastPublishedDoi":"10.21203/rs.3.rs-5375637/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5375637/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eIn-bore MRI-guided biopsy allows direct visualization of suspicious lesions, biopsy needles, and trajectories, allowing accurate sampling when MRI-ultrasound fusion biopsy is not feasible. However, its use has been limited. Wide-bore, lower-field, and lower-cost scanners could help address these issues, but their feasibility for prostate biopsy is unknown. The purpose of our study was to evaluate the feasibility of in-bore MRI-guided prostate biopsy using a large-bore (80cm), 0.55T scanner.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003e Nineteen participants (68\u0026thinsp;\u0026plusmn;\u0026thinsp;10 years) with suspected prostate cancer (PCa) were recruited for this Institutional Review Board (IRB) approved study (May 2023 -October 2024). Prebiopsy diagnostic scans and intra-procedural T2-weighted images were used for lesion localization. PSA levels, lesion sizes, cancer detection rates, positive core volume percentage, ISUP (International Society of Urological Pathology) grade groups (GG), positive volume cores, skin to target distances, and procedure durations were reported.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eSeventeen participants underwent biopsies (four transrectal, thirteen percutaneous). Two participants were excluded. Twenty lesions (mean size 1.95\u0026thinsp;\u0026plusmn;\u0026thinsp;1.29 cm) were biopsied which showed various GG cancers (GG1, GG2, GG3, GG4, and GG5), with positive cores ranging from 10%-100%. 20% of the lesions were benign. Compared with the previous biopsy results, 11.7% of participants had a GG upgrade, 17.6% had an upgrade in positive core volume, 17.6% had negative biopsies and 47% of biopsy-na\u0026iuml;ve participants had new cancer detections. No upgrade was observed in 5.8% cases. One new cancer was detected near a hip prosthesis due to reduced imaging artifacts. Average total procedure time was 77\u0026thinsp;\u0026plusmn;\u0026thinsp;21 minutes for transrectal and 74\u0026thinsp;\u0026plusmn;\u0026thinsp;22 minutes for percutaneous biopsies, with times to first core at 45\u0026thinsp;\u0026plusmn;\u0026thinsp;15 and 53\u0026thinsp;\u0026plusmn;\u0026thinsp;14 minutes, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eIdentifying and accurately targeting suspicious prostate lesions is feasible using a 0.55T MRI scanner.\u003c/p\u003e","manuscriptTitle":"Clinical Feasibility of MRI-guided In-Bore Prostate Biopsies at 0.55T","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 15:41:20","doi":"10.21203/rs.3.rs-5375637/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-16T13:36:05+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-13T18:06:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"245115966667755183483887167704429912270","date":"2024-11-26T22:58:26+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-15T20:21:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-11-07T13:44:36+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-11-07T05:53:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Abdominal Radiology","date":"2024-11-01T21:59:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"dd2fba22-3a49-4318-96c9-e58a0518017f","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-13T16:05:16+00:00","versionOfRecord":{"articleIdentity":"rs-5375637","link":"https://doi.org/10.1007/s00261-024-04783-x","journal":{"identity":"abdominal-radiology","isVorOnly":false,"title":"Abdominal Radiology"},"publishedOn":"2025-01-11 15:58:06","publishedOnDateReadable":"January 11th, 2025"},"versionCreatedAt":"2024-12-09 15:41:20","video":"","vorDoi":"10.1007/s00261-024-04783-x","vorDoiUrl":"https://doi.org/10.1007/s00261-024-04783-x","workflowStages":[]},"version":"v1","identity":"rs-5375637","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5375637","identity":"rs-5375637","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}