scholarly journals Whole-body magnetic resonance imaging (WB-MRI) with diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) in prostate cancer: Prevalence and clinical significance of incidental findings

Author(s):  
Soma Kumasaka ◽  
Shunichi Motegi ◽  
Yuka Kumasaka ◽  
Tatsuya Nishikata ◽  
Masami Otomo ◽  
...  

Abstract Background Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) is now recommended as a first-line staging modality in prostate cancer patients, and the widespread use of DWIBS may lead to an increased frequency of incidental findings. The aim of this study is to evaluate the prevalence and clinical significance of incidental findings detected on whole-body magnetic resonance imaging (WB-MRI) with DWIBS in patients with prostate cancer. Methods Data from 124 patients (age, 76.5 ± 5.6 years; range, 60–90) with pathologically confirmed prostate cancer, who underwent WB-MRI between December 2016 and April 2020, were retrospectively analyzed. Findings unrelated to prostate cancer were considered as incidental findings and categorized into two groups based on their clinical implications, as follow: imaging follow-up or additional examinations was required (significant incidental findings) and no need to additional work-up (non-significant incidental findings). A Chi-square test was performed to compare the differences in the prevalence of significant incidental findings based on age (≤ 75 and > 75 years old). Results A total of 334 incidental findings were found, with 8.1% (n = 27) as significant incidental findings and 91.9% (n = 307) as non-significant incidental findings. Significant incidental findings were more frequent in patients over 75 years old than those of 75 years old or younger (28.6% vs 11.1%, p = 0.018). Nineteen of the 27 significant incidental findings (70.4%) were observed on non-DWIBS sequences. Conclusion Clinically significant incidental findings, which required imaging follow-up or additional examinations, were commonly observed in patients with prostate cancer on WB-MRI/DWIBS.

2021 ◽  
pp. 20210459
Author(s):  
Soma Kumasaka ◽  
Shunichi Motegi ◽  
Yuka Kumasaka ◽  
Tatsuya Nishikata ◽  
Masami Otomo ◽  
...  

Objective: Diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) is now recommended as a first-line staging modality in prostate cancer patients, and the widespread use of DWIBS may lead to an increased frequency of incidental findings. The aim of this study was to evaluate the prevalence and clinical significance of incidental findings on whole-body magnetic resonance imaging (WB-MRI) with DWIBS. Methods: Data from 124 patients with prostate cancer (age, 76.5 ± 5.6 years), who underwent 1.5 T WB-MRI with STIR, TSE-T2, TSE-T1, In/Out GRE, and DWIBS sequences, were retrospectively analyzed. Findings unrelated to prostate cancer were considered as incidental findings and categorized into two groups based on their clinical implications, as follow: imaging follow-up or additional examinations was required (significant incidental findings) and no need to additional work-up (non-significant incidental findings). A Chi-square test was performed to compare the differences in the prevalence of significant incidental findings based on age (≤75 and>75 years old). Results: A total of 334 incidental findings were found, with 8.1% (n = 27) as significant incidental findings. Significant incidental findings were more frequent in patients over 75 years old than those of 75 years old or younger (28.6% vs  11.1%, p = 0.018). Conclusion: Clinically significant incidental findings, which required imaging follow-up or additional examinations, were commonly observed in prostate cancer patients on WB-MRI/DWIBS. Advances in knowledge: Some incidental findings were clinically significant which may lead to changes in treatment strategy. Checking the entire organ carefully for abnormalities, and reporting any incidental findings detected are important.


2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Paola Pricolo ◽  
Eleonora Ancona ◽  
Paul Summers ◽  
Jorge Abreu-Gomez ◽  
Sarah Alessi ◽  
...  

Abstract Background The METastasis Reporting and Data System for Prostate Cancer (MET-RADS-P) guidelines are designed to enable reproducible assessment in detecting and quantifying metastatic disease response using whole-body magnetic resonance imaging (WB-MRI) in patients with advanced prostate cancer (APC). The purpose of our study was to evaluate the inter-observer agreement of WB-MRI examination reports produced by readers of different expertise when using the MET-RADS-P guidelines. Methods Fifty consecutive paired WB-MRI examinations, performed from December 2016 to February 2018 on 31 patients, were retrospectively examined to compare reports by a Senior Radiologist (9 years of experience in WB-MRI) and Resident Radiologist (after a 6-months training) using MET-RADS-P guidelines, for detection and for primary/dominant and secondary response assessment categories (RAC) scores assigned to metastatic disease in 14 body regions. Inter-observer agreement regarding RAC score was evaluated for each region by using weighted-Cohen’s Kappa statistics (K). Results The number of metastatic regions reported by the Senior Radiologist (249) and Resident Radiologist (251) was comparable. For the primary/dominant RAC pattern, the agreement between readers was excellent for the metastatic findings in cervical, dorsal, and lumbosacral spine, pelvis, limbs, lungs and other sites (K:0.81–1.0), substantial for thorax, retroperitoneal nodes, other nodes and liver (K:0.61–0.80), moderate for pelvic nodes (K:0.56), fair for primary soft tissue and not assessable for skull due to the absence of findings. For the secondary RAC pattern, agreement between readers was excellent for the metastatic findings in cervical spine (K:0.93) and retroperitoneal nodes (K:0.89), substantial for those in dorsal spine, pelvis, thorax, limbs and pelvic nodes (K:0.61–0.80), and moderate for lumbosacral spine (K:0.44). Conclusions We found inter-observer agreement between two readers of different expertise levels to be excellent in bone, but mixed in other body regions. Considering the importance of bone metastases in patients with APC, our results favor the use of MET-RADS-P in response to the growing clinical need for monitoring of metastasis in these patients.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Sola Adeleke ◽  
Arash Latifoltojar ◽  
Harbir Sidhu ◽  
Myria Galazi ◽  
Taimur T. Shah ◽  
...  

Abstract Background Accurate whole-body staging following biochemical relapse in prostate cancer is vital in determining the optimum disease management. Current imaging guidelines recommend various imaging platforms such as computed tomography (CT), Technetium 99 m (99mTc) bone scan and 18F-choline and recently 68Ga-PSMA positron emission tomography (PET) for the evaluation of the extent of disease. Such approach requires multiple hospital attendances and can be time and resource intensive. Recently, whole-body magnetic resonance imaging (WB-MRI) has been used in a single visit scanning session for several malignancies, including prostate cancer, with promising results, providing similar accuracy compared to the combined conventional imaging techniques. The LOCATE trial aims to investigate the application of WB-MRI for re-staging of patients with biochemical relapse (BCR) following external beam radiotherapy and brachytherapy in patients with prostate cancer. Methods/design The LOCATE trial is a prospective cohort, multi-centre, non-randomised, diagnostic accuracy study comparing WB-MRI and conventional imaging. Eligible patients will undergo WB-MRI in addition to conventional imaging investigations at the time of BCR and will be asked to attend a second WB-MRI exam, 12-months following the initial scan. WB-MRI results will be compared to an enhanced reference standard comprising all the initial, follow-up imaging and non-imaging investigations. The diagnostic performance (sensitivity and specificity analysis) of WB-MRI for re-staging of BCR will be investigated against the enhanced reference standard on a per-patient basis. An economic analysis of WB-MRI compared to conventional imaging pathways will be performed to inform the cost-effectiveness of the WB-MRI imaging pathway. Additionally, an exploratory sub-study will be performed on blood samples and exosome-derived human epidermal growth factor receptor (HER) dimer measurements will be taken to investigate its significance in this cohort. Discussion The LOCATE trial will compare WB-MRI versus the conventional imaging pathway including its cost-effectiveness, therefore informing the most accurate and efficient imaging pathway. Trial registration LOCATE trial was registered on ClinicalTrial.gov on 18th of October 2016 with registration reference number NCT02935816.


2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 8084-8084
Author(s):  
T. Itoyama ◽  
T. Shibuya ◽  
T. Koga ◽  
M. Kitagawa ◽  
T. Yoshida ◽  
...  

8084 Background: FDG-PET is thought to be an important staging tool in lymphomas. However, high cost and exposure to radioactive agents are of disadvantage. Diffusion weighted whole body magnetic resonance imaging with background body signal suppression (DWIBS) is recently reported to be a new way of magnetic resonance imaging which can make FDG-PET-like imaging possible to detect tumors (Takahara et al; Radiation Medicine 22: 275–282, 2004). This study is aimed to compare accuracy and clinical significance of DWIBS to FDG - PET. Methods: We examined 19 lymphoma (Ly) patients (pts) by using both DWIBS and FDG -PET at the time of diagnosis before therapy. There were follicular Ly in 3 pts, nodal marginal zone Ly in 1, diffuse large B-cell Ly in 9 including primary stomach Ly in 2, peripheral T -cell Ly in 4, and MALT Ly of stomach (GI-MALT) in 2. DWIBS was performed with a 1.5 -Tesla system as previously reported (Ochiai et al; Nichidoku -Iho 50: 86–98, 2005). Clinical staging was made according to the Ann Arbor classification. Results: Both DWIBS and FDG -PET had positive findings in 18 of 19 pts except for a case of GI -MALT. In nodal lesions, DWIBS was positive in 16 pts at 66 sites compared to 16 pts at 68 sites with FDG -PET. DWIBS was negative in 3 pts at 5 sites in spleen, hilar and mediastinal lymphnodes where positive in FDG -PET. DWIBS was positive in 2 pts at 4 sites in iliac and inguinal lymphnodes that are negative in FDG -PET. In extranodal lesions, DWIBS was positive in 12 pts at 17 sites as compared to 12 pts at 18 sites with FDG -PET. Involvement of bone and stomach were equally identified at 8 sites. DWIBS was negative in 2 pts at 2 sites in liver and pleura with FDG -PET positive. Small skin lesions were clearly identified on DWIBS. Discordance of clinical staging was not observed between DWIBS and FDG -PET. Conclusions: Although some discrepancy was seen between DWIBS and FDG -PET, there was no disadvantage of DWIBS compared to FDG -PET. Furthermore, DWIBS has no risk of radiation exposure and is even advantageous to detect lesions with FDG -PET negative. We conclude DWIBS is a new useful tool to assess tumor spread in lymphomas. No significant financial relationships to disclose.


2015 ◽  
Vol 49 (1) ◽  
pp. 10-16 ◽  
Author(s):  
David Laszlo Tarnoki ◽  
Adam Domonkos Tarnoki ◽  
Antje Richter ◽  
Kinga Karlinger ◽  
Viktor Berczi ◽  
...  

Abstract Background. Whole-body magnetic resonance imaging (WB-MRI) and angiography (WB-MRA) has become increasingly popular in population-based research. We evaluated retrospectively the frequency of potentially relevant incidental findings throughout the body. Materials and methods. 22 highly health-conscious managers (18 men, mean age 47±9 years) underwent WBMRI and WB-MRA between March 2012 and September 2013 on a Discovery MR750w wide bore 3 Tesla device (GE Healthcare) using T1 weighted, short tau inversion recovery (STIR) and diffusion weighted imaging (DWI) acquisitions according to a standardized protocol. Results. A suspicious (pararectal) malignancy was detected in one patient which was confirmed by an endorectal sonography. Incidental findings were described in 20 subjects, including hydrocele (11 patients), benign bony lesion (7 patients) and non-specific lymph nodes (5 patients). Further investigations were recommended in 68% (ultrasound: 36%, computed tomography: 28%, mammography: 9%, additional MRI: 9%). WB-MRA were negative in 16 subjects. Vascular normal variations were reported in 23%, and a 40% left proximal common carotid artery stenosis were described in one subject. Conclusions. WB-MRI and MRA lead to the detection of clinically relevant diseases and unexpected findings in a cohort of healthy adults that require further imaging or surveillance in 68%. WB-MR imaging may play a paramount role in health screening, especially in the future generation of (epi)genetic based screening of malignant and atherosclerotic disorders. Our study is the first which involved a highly selected patient group using a high field 3-T wide bore magnet system with T1, STIR, MRA and whole-body DWI acquisitions as well.


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