[Detection of bone metastasis of prostate cancer - comparison of whole-body MRI and bone scintigraphy].
OBJECTIVE
Prostate cancer continues to be the third leading cancer-related mortality of western men. Early diagnosis of bone metastasis is important for the therapy regime and for assessing the prognosis. The standard method is bone scintigraphy. Whole-body MRI proved to be more sensitive for early detection of skeletal metastasis. However, studies of homogenous tumor entities are not available. The aim of the study was to compare bone scintigraphy and whole-body MRI regarding the detection of bone metastasis of prostate cancer.


METHODS
14 patients with histologically confirmed prostate cancer and a bone scintigraphy as well as whole-body MRI within one month were included. The mean age was 68 years. Scintigraphy was performed using the planar whole-body technique (ventral and dorsal projections). Suspect areas were enlarged. Whole-body MRI was conducted using native T 1w and STIR sequences in the coronary plane of the whole body, sagittal imaging of spine and breath-hold STIR and T 1w-Flash-2D sequences of ribs and chest. Bone scintigraphy and whole-body MRI were evaluated retrospectively by experienced radiologists in a consensus reading on a lesion-based level.


RESULTS
Whole-body MRI detected significantly more bone metastasis (p = 0.024). 96.4 % of the demonstrated skeletal metastases in bone scintigraphy were founded in whole-body MRI while only 58.6 % of the depicted metastases in MRI were able to be located in scintigraphy. There was no significant difference regarding bone metastasis greater than one centimeter (p = 0.082) in contrast to metastasis less than one centimeter (p = 0.035). Small osteoblastic metastases showed a considerably higher contrast in T 1w sequences than in STIR imaging. Further advantages of whole-body MRI were additional information about extra-osseous tumor infiltration and their complications, for example stenosis of spinal canal or vertebral body fractures, found in 42.9 % of patients.


CONCLUSIONS
Whole-body MRI using native STIR and T 1w sequences is superior to bone scintigraphy for the detection of small bone metastasis of prostate cancer. Simultaneous clarification of associated complications demonstrates further advantages.
Abteilung für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen. dominik.ketelsen@med.uni-tuebingen.de
D
D
Ketelsen
M
M
Röthke
P
P
Aschoff
A S
AS
Merseburger
M P
MP
Lichy
M
M
Reimold
C D
CD
Claussen
H-P
HP
Schlemmer
D000368:Aged; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary*; D001842:Bone and Bones / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D004164:Diphosphonates; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015609:Organotechnetium Compounds; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D011877:Radionuclide Imaging / Q000379:methods*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013125:Spinal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D013131:Spine / Q000473:pathology; D051598:Whole Body Imaging / Q000379:methods*
D003287:Contrast Media; D004164:Diphosphonates; D015609:Organotechnetium Compounds; C033905:technetium Tc 99m 1,1-diphosphonopropane-2,3-dicarboxylic acid