Bone Metastasis of Prostate Cancer: Comparing Readout-Segmented EPI (RESOLVE) Whole-Body DWI with ECT
Qingsong Yang1, Zhen Wang1, Luguang Chen1, Yukun Chen1, Chao Ma1, Caixia fu2, Xu Yan3, Hui Liu3, and Jianping Lu1

1Radiology Department, Changhai Hospital, Shanghai, China, People's Republic of, 2Application Department, Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China, People's Republic of, 3MR Collaboration NE Asia, Siemens Healthcare, Shanghai, China, People's Republic of

Synopsis

Bone metastasis is a leading cause of morbidity and mortality for patients with metastatic prostate cancer. Early detection of bone metastasis plays a key role in the assessment of treatment methods and prognosis. This study aims to evaluate the diagnostic efficiency of readout-segmented whole body diffusion weighted imaging in the detection of bone metastases for patients with newly diagnosed high-risk or biochemical recurrent prostate cancer. The result shows that RESOLVE whole-body DWI has higher sensitivity, specificity and accuracy in bone metastasis detection than bone scintigraphy using 99mTc-MDP (BS).

Introduction and purpose

Bone metastasis is a leading cause of morbidity and mortality for patients with metastatic prostate cancer. Early detection of bone metastasis plays a key role in the assessment of treatment methods and prognosis. Although currently bone scintigraphy serves as the standard method to detect bone metastasis, whole-body MRI has been shown to be more sensitive. However, research on homogeneous tumor entities by using MRI is still uncommon. This study aims to evaluate the diagnostic efficiency of readout-segmented whole body diffusion weighted imaging and bone scintigraphy using 99mTc-MDP (BS) in the detection of bone metastases for patients with newly diagnosed high-risk or biochemical recurrent prostate cancer.

Materials and methods

From June 2014 to December 2014, 63 consecutive patients with newly diagnosed high-risk or biochemically recurrent prostate cancer were recruited for this prospective study. All patients underwent both readout-segmented EPI [1] for whole body diffusion weighted imaging (RESOLVE WB-DWI) on a 3T MRI scanner (MAGNETOM Skyra, Siemens Healthcare, Erlangen, Germany) and bone scintigraphy completed with target scan. RESOLVE WB-DWI used the following parameters: TR/TE = 7500/68ms, FOV = 430 x 340 mm2, scan matrix = 176 x 176, slice thickness = 5mm, b = 0, 800 s/mm2, diffusion mode = 3D diagonal, 4 or 5 steps (depending on the patient’s height) with coverage from head to pelvis, total scan time =~21 mins. The MRI target scans included T2WI (STIR), T1WI and contrast enhanced T1WI if suspected lesions were found. Both examinations were completed within 10 days after the patients were included in this study. Patient- and lesion-based analyses were each performed by two experienced radiologists. All patients received a follow up exam after 4-6 months with RESOLVE WB-DWI or BS which were considered as the best valuable comparator (BVC) to evaluate the WB-DWI and BS diagnosis for sensitivity, specificity and accuracy. The chi-square test was used for the significant differential analysis.

Results

Based on the BVC, 20 patients (32%) had bone metastasis. In patient-based analysis, RESOLVE WB-DWI showed 18 true-positive findings while BS had only 12 true-positive findings. Three patients were diagnosed with uncountable bone metastases. In these patients, DWI showed more bone metastases than BS. When using lesion-based analysis, these patients were analyzed separately. RESOLVE WB-DWI showed earlier detection of bone metastasis than BS, as demonstrated in figure 1. For the 27 bone metastasis lesions which could be verified, RESOLVE WB-DWI was able to show 25 true-positive lesions and BS showed 16 true-positive lesions. The sensitivity, specificity, and accuracy of WB-DWI and BS for detecting bone metastases based on patients were 90.00% and 60.00%, 97.50% and 80.00%, and 95.00% and 73.33%, respectively (p<0.05). The sensitivity, specificity, and the accuracy of WB-DWI and BS for detecting bone metastases based on lesions were 92.59% and 59.26%, 97.78% and 77.78%, 95.83% and 70.83% , respectively (p<0.05).

Conclusions

RESOLVE whole-body DWI shows higher sensitivity, specificity and accuracy than BS in bone metastasis detection, and is capable of early detection and discovers more bone metastases lesions caused by prostate cancer.

Acknowledgements

No acknowledgement found.

References

[1] DA Porter et.al., MRM, 62:468-475 (2009)

Figures

Figure 1: BS, WB-DWI and T2W images of one patient with prostate cancer. BS images (A) showed no suspicious lesion. WB-DWI (B) showed suspicious bone metastatic lesion within T7, the WB-T2W image (C) confirmed the existence of the lesion. WB-DWI and T2W images were acquired 1 day after BS was done. Four month later, the repeated BS showed the bone metastatic lesion within T7 (D), the WB-DWI (E) and T2WI (F) of the same time point showed a larger lesion than 4 months ago.



Proc. Intl. Soc. Mag. Reson. Med. 24 (2016)
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