La resonancia magnética en el nuevo paradigma del diagnóstico del cáncer de próstata

Prostate MRI: practical guidelines for interpreting and reporting according to PI-RADS version 2.1

The increasing precision of multiparametric magnetic resonance imaging of the prostate, together with greater experience and standardization in its interpretation, has given this technique an important role in the management of prostate cancer, the most prevalent non-cutaneous cancer in men. This article reviews the concepts in PI-RADS version 2.1 for estimating the probability and zonal location of significant tumors of the prostate, using a practical approach that includes current considerations about the prerequisites for carrying out the test and recommendations for interpreting the findings. It emphasizes benign findings that can lead to confusion and the criteria for evaluating the probability of local spread, which must be included in the structured report.

Value of 18F-Choline PET/MRI hybrid technique on the therapeutic approach for patients with prostate cancer treated with prostatectomy and rising prostate specific antigen levels below 1 ng/ml

OBJECTIVE

To assess the detection rate of ¹⁸F-Choline PET/MRI and subsequent changes in therapy approach for patients with prostate cancer treated by prostatectomy and with rising levels of PSA <1 ng/ml.

METHODS

Prospective study with our first 36 patients with prostatectomy for prostate cancer and rising levels of PSA, who were referred for an ¹⁸F-Choline PET/MRI study. A dual-phase study was acquired after intravenous administration of 185±10% MBq of ¹⁸F-Choline: 1) early imaging (immediately after tracer administration) of prostate area (emission PET/Multiparametric MRI). 2) whole-body imaging 1 h after tracer injection (emission PET/MRI: T1, T2, STIR, diffusion). The therapy approach for patients was decided upon the Oncology Committee consensus based on ¹⁸F-Choline PET/MRI findings.

RESULTS

Twenty out of 36 patients (55.6%) were positive for the ¹⁸F-Choline PET/MRI study: 8 (22.2%) within the prostatectomy bed, 7 (19.4%) with infradiaphragmatic lymph nodes, 4 (11.1%) with local recurrence and infradiaphragmatic lymph nodes, and 1 (2.8%) with bone metastasis. Sixteen out of the 36 patients (44.4%) were negative for the ¹⁸F-Choline PET/MRI study. ¹⁸F-Choline PET/MRI findings had an impact on the therapy approach to follow: 15 patients (41.6%) showed oligometastatic disease which was treated by imaging-guided radiotherapy, 5 (13.9%) with multiple metastatic disease were treated by androgen deprivation therapy, 16 (44.4%) negative were under active surveillance.

CONCLUSION

Hybrid ¹⁸F-Choline PET/MRI procedure showed a high detection rate for recurrence in prostate cancer patients treated with prostatectomy and rising PSA levels <1 ng/ml, and ¹⁸F-Choline PET/MRI findings resulted in a better tailored therapy approach delivered to our patients.