Optimising TNM Staging of Patients with Prostate Cancer Using WB-MRI

Abstract

Multiparametric Magnetic Resonance Imaging (mp-MRI) is the current standard of reference for the local staging of prostate cancer (PCa). On the other hand, despite the low sensitivity and specificity of Technetium Bone Scanning (BS) for the detection of bone metastases (BM) and of Body Computed Tomography CT for the detection of lymph node metastases (LNM), these techniques are routinely used, in the current clinical practice. Nevertheless, whole Body MRI (WB-MRI) and Positron Emission Tomography Computed Tomography (PET-CT) are emerging as robust tools for the staging of oncologic patients, including those with (PCa).The available techniques (BS, WB-MRI, PET, CT) for the detection of BM in oncologic patients were compared and showed striking center differences in terms of anatomic sequences and planes used. This heterogeneity and the long acquisition time of WB-MRI protocols – due to the addition of multiple anatomic sequences in different planes – questioned whether a single three dimensional (3D) sequence could replace the multiple anatomic sequences used for node and bone staging of PCa. We demonstrated that WB-MRI is a credible tool for the detection of bone and node metastasis.The second question addressed the possibility to obtain a complete TNM staging of PCa in a single MRI session. A WB-MRI protocol was developed to enable complete, T (local), N (regional) and M (distant) staging of PCa in a single session, in less than an hour. This ‘all-in-one’ protocol proved to be as efficient as the sum of exams currently in use for the staging of PCa (ie: mp-MRI of the prostate for ‘T’ staging, Thoraco-abdominal CT for ‘N’ staging and bone scintigraphy for ‘M’ staging).

Two cases of oligometastatic castration‐resistant prostate cancer detected by diffusion‐weighted whole‐body imaging with background body signal suppression

“…The detectability of bone and lymph node metastasis with whole‐body MRI is superior to that with CT, and whole‐body MRI can be an alternative modality to BS and CT in staging diagnosis . Whole‐body MRI has several merits that include the ability to perform repeated tests over time, cost‐effectiveness in our country, no radiation exposure, no use of contrast material, and comprehensiveness with one examination for bone, other organs, and lymph nodes.…”

“…The advantage of DWIBS is the strong contrast of positive signals against normal tissues; thus, DWIBS is useful for identifying primary and metastatic lesions. DWIBS can also detect osteolytic changes, lymph node metastasis, and visceral metastasis in addition to osteoblastic changes . We encountered cases of CRPC wherein we could not detect osteolytic bone metastasis in the sacrum with CT (Fig.…”

“…DWIBS can also detect osteolytic changes, lymph node metastasis, and visceral metastasis in addition to osteoblastic changes. [8][9][10] We encountered cases of CRPC wherein we could not detect osteolytic bone metastasis in the sacrum with CT ( Fig. 1a), without the results of DWIBS ( Fig.…”

The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer

“…Some studies have shown higher sensitivity of WB-MRI compared to 18FDG-PET-CT for the detection of both focal and diffuse bone involvement. 105 WB-MRI is now being developed for routine clinical use in prostate cancer 106 . In a study assessing the diagnostic accuracy of WB-MRI in newly diagnosed intermediate-risk and highrisk disease 20 , the mean sensitivity and specificity for N1 disease were 1.00 and 0.96, respectively, whereas for M1b disease, the mean sensitivity and specificity were 0.90 and 0.88, respectively.…”

Belgian Radiology Research in Full Power!

“…She obtained her MD from the University of Ioannina, Greece, and following that she worked as a radiology resident at Université de Liège . After three years, she arrived at Université Catholique de Louvain in Brussels to commence her PhD thesis titled ‘’One step TNM staging of patients with high risk prostate cancer using MRI” [ 5 ]. Dr. Pasoglou was awarded the prestigious ESUI Vision Award 2015 for her work ‘’Whole-body 3D T1-weighted MR imaging in patients with prostate cancer: feasibility and evaluation in screening for metastatic disease’’.…”