There are two complex issues that drive the clinical need to change current paradigms for prostate cancer (PCa): The inability to predict aggressiveness of a given cancer, which in turn leads to over treatment, and the increasing evidence that disease progression in men with seemingly low-risk PCa is due to inadequate biopsy sampling. Recent trends indicate that the treatment of patients with localized PCa is shifting more and more towards either active surveillance or focal therapy. Technical solutions to address these challenges, and their validation in clinic, are lacking. We are working to address these challenges by integrating innovative MR image acquisition and analysis with the MR targeted biopsy platform we developed in the previous cycle. We are developing a diagnostic biomedical imaging platform to detect, characterize and diagnose prostate cancer and will provide new opportunities to understand the aggressiveness and heterogeneity of prostate cancer and ultimately allow for development and testing of new predictive markers in focal therapy. Our projects are:
Platform for validating novel imaging biomarkers with molecular and routine pathology. We are developing methods of assessment of tumor heterogeneity by supplementing mpMRI with new hypoxia and multi b value MR imaging and add molecular profiling to the pathology options for core biopsy tissue, thus provide a unique platform for imaging, biopsy and both routine and molecular pathology. We will correlate genomic diversity with MR imaging parameters. We will propose novel motion compensation techniques combined with hypoxia imaging that will be applied jointly with the multi-b-value diffusion weighted imaging (DWI) for improved characterization of PCa. These novel-imaging approaches will be validated in biopsy and cryotherapy patient cohorts. (Contact: Clare M. Tempany, Fiona Fennessy)
Platform for focal cryoablation of PCa with accurate temperature mapping and motion compensation. Our goal is to develop and evaluate thermometry methods to monitor MR-guided focal cryoablation for localized prostate cancer, by internal ice ball thermometry using a “voxelwise thermal history” method. We will develop and test a new method for tracking the prostate gland motion, using active MR tracking coils embedded in a urethral warming catheter, investigate Ultrashort TE (UTE) MRI to monitor the internal thermal dosimetry within the ice-ball, and develop and evaluate software for voxel-wise thermal history tracking during all stages of the procedure. (Contact: Junichi Tokuda)
Informatics solution in support of targeted prostate biopsy and focal therapy for localized prostate cancer. This aim will have three tasks: 1) develop software tools to support structured PCa reporting and image registration for biopsy and focal therapy applications; 2) investigate and implement improved practices for structured data collection and provenance, prepare and disseminate curated validation datasets to facilitate validation of the role of mpMRI in cancer characterization and the evaluation of image registration accuracy/reliability; 3) investigate methods for non-rigid registration to enable recovery of prostate gland deformation for treatment response assessment and propose and apply methodologies for statistical assessment of the reliability of the registration tools. All three projects are interconnected, and leverage unique resources provided by this Center. In addition to developing novel technologies, we are creating a platform for collecting validation imaging datasets annotated with the analysis results, molecular and pathology markers, to build a unique resource for investigating the role of imaging and development of novel image analysis tools for prostate cancer. (Contact: Andriy Fedorov)
Software and Documentation
3D Slicer, a comprehensive open source platform for medical image analysis, contains several modules that have been contributed by us for Image-Guided Prostate Interventions. These include:
- BRAINSFitIGT: Image Registration for MR-Guided Prostate Biopsy
- SliceTracker: 3D Slicer Extension for Tracking Prostate Motion during MR-guided Prostate Biopsies
- N4ITKBiasFieldCorrection: MR Inhomogeneity Correction
- MultiVolumeImporter: Importing Multi-Volume Datasets
- PkModeling: Pharmacokinetic Modeling of DCE MRI Data using Tofts Model
- MultiVolumeExplorer: Visualization and Exploration of Multi-Volume Data
- MR-guided Prostate Interventions with 3D Slicer and the NA-MIC Kit
Data
- MR-guided Prostate Biopsy pre- and intra-procedural MRI Registration Evaluation Dataset
- Prostate MR Image Database
Presentations
These presentations have been selected as tutorials for readers interested in learning about the clinical science and technology of the Prostate Core.
- Preliminary Accuracy Evaluation of 3T MRI-guided Transperineal Prostate Biopsy with Grid Template. (Tokuda, ISMRM 2011)
- Hierarchical Image Registration for Improved Sampling during 3T MRI-guided Transperineal Targeted Prostate Biopsy. (Fedorov, ISMRM 2011)
- 3T MRI-guided Transperineal Targeted Prostate Biopsy: Setup and Workflow. (Fedorov, IGT Workshop 2011)
- Adjustable Sleeve Template Assembly Device for Joint MR/US-guided Diagnosis and Treatment of Prostate Cancer: Initial Design and Feasibility Valuation. (Fedorov, IGT Workshop 2012)
- Quantification of intra-procedural gland motion during transperineal MRI-guided prostate biopsy. (Fedorov, ISMRM 2013)
- Clinically Optimized Manipulator for In-bore MRI-guided Transperineal Prostate Biopsy. (Iordachita, Biorob 2014)
- Problems in MR that really need quantum mechanics: The density matrix approach. | Outstanding Teacher Award. (Mulkern, ISMRM 2014)