Download • History: - Society of Abdominal Radiology

• History:
– 71 yo male post radical prostatectomy 4 years ago for
Gleason 4+5 prostate cancer
– Pre-op staging CT and MDP bone scan were negative
for metastatic disease
– Pathology:
• Gleason 4+5, with bilateral SV involvement and 1/3 R pelvic
nodes positive.
– Patient was started on early hormone therapy and
PSA remained < 0.4 during post operative follow up
period.
– LHRH agonist therapy discontinued due to side effects
– Now with serially rising PSA, up to 4.4
– Pelvic/Prostate MRI, CT C/A/P and MDP bone scan
were ordered to assess for recurrence/metastases
Case courtesy of: Amirkasra Mojtahed, MD and Steven C. Eberhardt, MD
Department of Radiology, University of New Mexico Hospital, Albuquerque, NM
A
B
Initial MDP bone scan (A) demonstrates marked radiopharmaceutical
uptake within the right acetabulum anteriorly, which correlates with
sclerotic lesion on CT (B) performed 2 weeks later.
Case courtesy of: Amirkasra Mojthed, MD, Steven C. Eberhardt MD, UNM Radiology
A
B
A
B
C
MRI Pelvis/Prostate (3T, no ER coil) performed 2 days after CT:
Axial (A) and coronal (B) T2WI of the prostatectomy bed show no local recurrence.
Large FOV axial T1WI (C) demonstrates a hypointense lesion within the anterior right
acetabulum/pubic root, correlating with lesion on preceding CT and bone scan.
Case courtesy of: Amirkasra Mojthed, MD, Steven C. Eberhardt MD, UNM Radiology
Teaching point
• In cases of biochemical failure following RRP,
bone scan, CT and MRI can be useful in finding a
cause for the rising PSA.
• Large field of view sequences on MRI can be
helpful in assessing for regional osseous
metastases or adenopathy, in addition to small
field of view sequences for recurrence in the
operative bed.
• CT and MDP bone scan can be used to provide a
more broad survey
Case courtesy of: Amirkasra Mojthed, MD, Steven C. Eberhardt MD, UNM Radiology
Useful references
•
•
•
May EJ, Viers LD et al. Prostate cancer post-treatment follow-up and recurrence
evaluation. Abdominal Radiology, May 2016, Volume 41, Issue 5, pp 862-876
Sella, Tamar, et al. "Suspected Local Recurrence after Radical Prostatectomy:
Endorectal Coil MR Imaging 1."Radiology 231.2 (2004): 379-385.
Casciani, Emanuele, et al. "Endorectal and dynamic contrast-enhanced MRI for
detection of local recurrence after radical prostatectomy." American Journal of
Roentgenology 190.5 (2008): 1187-1192.