Whole‐body magnetic resonance imaging for prostate cancer assessment: Current status and future directions

Abstract

Over the past decade, updated definitions for the different stages of prostate cancer and risk for distant disease, along with the advent of new therapies, have remarkably changed the management of patients. The two expectations from imaging are accurate staging and appropriate assessment of disease response to therapies. Modern, next-generation imaging (NGI) modalities, including whole-body magnetic resonance imaging (WB-MRI) and nuclear medicine (most often prostate-specific membrane antigen [PSMA] positron emission tomography [PET]/computed tomography [CT]) bring added value to these imaging tasks. WB-MRI has proven its superiority over bone scintigraphy (BS) and CT for the detection of distant metastasis, also providing reliable evaluations of disease response to treatment. Comparison of the effectiveness of WB-MRI and molecular nuclear imaging techniques with regard to indications and the definition of their respective/complementary roles in clinical practice is ongoing. This paper illustrates the evolution of WB-MRI imaging protocols, defines the current state-of-the art, and highlights the latest developments and future challenges. The paper presents and discusses WB-MRI indications in the care pathway of men with prostate cancer in specific key situations: response assessment of metastatic disease, "all in one" cancer staging, and oligometastatic disease.

Comparison of 68Ga-Prostate Specific Membrane Antigen (PSMA) Positron Emission Tomography Computed Tomography (PET-CT) and Whole-Body Magnetic Resonance Imaging (WB-MRI) with Diffusion Sequences (DWI) in the Staging of Advanced Prostate Cancer

“…“Standard” imaging modalities (CT and BS) were not systematically performed, as both PSMA PET-CT and WB-MRI are available in our center and as the diagnostic superiority of these two techniques has been repeatedly established [ 2 , 3 , 4 , 5 , 6 ]. Patients were treated at the referring physician’s discretion based on international recommendations and were followed up for at least 12 months.…”

“…Current treatment guidelines recognize thoraco-abdominal computed tomography (CT), abdominal magnetic resonance imaging and 99m Tc-bone scintigraphy (BS) as the cornerstone imaging techniques for metastatic assessment in PCa. There is compelling evidence that emerging imaging technologies such as 68 Ga-PSMA-11 positron emission tomography CT (PSMA PET-CT) and whole-body magnetic resonance imaging (WB-MRI) with diffusion weighted imaging (DWI) outperform bone scintigraphy and thoraco-abdomino-pelvic CT for the detection of PCa metastases [ 2 , 3 , 4 , 5 , 6 ].…”

Imaging of treatment response and minimal residual disease in multiple myeloma: state of the art WB-MRI and PET/CT

“…4). This T2 Dixon approach has recently been extended at the scale of the whole body [61]. Beside anatomical images, the Dixon technique allows the calculation of the marrow fat fraction (FF) which is gaining interest along with ADC measurements as a biomarker for response evaluation.…”

Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography

“…The "fluid sensitive-fat saturated" T2-like sequences are now preferably acquired using the Dixon method, that not only provides fatsaturated T2 or STIR equivalent "water only" images, but also "fat only" images providing T1-like information and highly sensitive detection of focal lesions on a background of fatty marrow, questioning the residual need for T1 images (43). This T2 Dixon approach can now be extended to whole body examinations: using T2 Dixon sequences as an alternative to the addition of T1 and STIR drastically decreases the acquisition times of anatomical WB-MRI studies (44). Additionally, the Dixon technique offers the possibility to calculate the marrow fat fraction (FF) and generate fat fraction maps.…”

“…In prostate cancer, AS-MRI and later WB-MRI were introduced after demonstration of their superiority to bone scintigraphy for detection of bone metastases and for a one step staging of bone and lymph node involvement (40,65,66). The current roles of WB-MRI to assess metastatic disease have been recently illustrated and compared to other techniques (44). PSMA-PET/CT is most likely the current most sensitive technique for the detection of low volume metastatic disease and for therapeutic decision (curative versus systemic treatment) in newly diagnosed prostate cancer and at the biochemical recurrence stage.…”