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Magnetic Resonance Imaging of the Axial Skeleton for Detecting Bone Metastases in Patients With High-Risk Prostate Cancer: Diagnostic and Cost-Effectiveness and Comparison With Current Detection Strategies

Frédéric E. Lecouvet, Daphné Geukens, Annabelle Stainier, François Jamar, Jacques Jamart, Bertrand Janne d'Othée, Patrick Therasse, Bruno Vande Berg, Bertrand Tombal

From the Departments of Radiology, Urology, and Nuclear Medicine, Cliniques Universitaires Saint Luc, Université Catholique de Louvain; European Organisation for Research and Treatment of Cancer, Brussels; Center of Biostatistics, Mont Godinne University Hospital, Yvoir, Belgium; and the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA

Address reprint requests to Frédéric E. Lecouvet, MD, PhD, Saint-Luc University Hospital, Department of Radiology, Hippocrate Ave 10/2942, B-1200 Brussels, Belgium; e-mail: lecouvet{at}rdgn.ucl.ac.be

Purpose: To evaluate the diagnostic performance, costs, and impact on therapy of one-step magnetic resonance imaging (MRI) of the axial skeleton (MRIas) for detecting bone metastases in patients with high-risk prostate cancer (PCa).

Patients and Methods: Sixty-six consecutive patients with high-risk PCa prospectively underwent MRIas in addition to the standard sequential work-up (SW) of bone metastases (technetium-99m bone scintigraphy [BS] completed with targeted x-rays [TXR] in patients with equivocal BS findings and with MRI obtained on request [MRIor] in patients with inconclusive BS/TXR findings). Panel review of initial and 6-month follow-up MRI findings, BS/TXR, and all available baseline and follow-up clinical and biologic data were used as the best valuable comparator to define metastatic status. Diagnostic effectiveness of MRIas alone was compared with each step of the SW. Impact of MRIas screening on patient management and costs was evaluated.

Results: On the basis of the best valuable comparator, 41 patients (62%) had bone metastases. Sensitivities were 46% for BS alone, 63% for BS/TXR, 83% for BS/TXR/MRIor, and 100% for MRIas; the corresponding specificities were 32%, 64%, 100%, and 88%, respectively. MRIas was significantly more sensitive than any other approach (P < .05, McNemar). MRIas identified metastases in seven (30%) of 23 patients considered negative and eight (47%) of 17 patients considered equivocal by other strategies, which altered the initially planned therapy. Economic impact was variable among countries, depending on reimbursement rates.

Conclusion: MRIas is more sensitive than the current SW of radiographically identified bone metastases in high-risk PCa patients, which impacts the clinical management of a significant proportion of patients.

Supported by an educational grant from the nonprofit organization Fondation Saint-Luc (F.E.L. and B.T.).

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

Related Correspondence

• MRI or Bone Scan or Both for Staging of Prostate Cancer?
  Ramachandran Venkitaraman, Aslam Sohaib, and Gary Cook
  JCO 2007 25: 5837-5838 [Full Text]
• Magnetic Resonance Imaging Versus Bone Scan in High-Risk Prostatic Carcinoma: Some Methodological Considerations
  Filip F.A.Y. Gemmel and Frank W. De Geeter
  JCO 2008 26: 1189-1190 [Full Text]

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				F. E. Lecouvet, B. C. Vande Berg, F. Jamar, B. Tombal, J. Jamart, and B. Janne d'Othee In Reply J. Clin. Oncol., March 1, 2008; 26(7): 1190 - 1191. [Full Text] [PDF]

				F. F.A.Y. Gemmel and F. W. De Geeter Magnetic Resonance Imaging Versus Bone Scan in High-Risk Prostatic Carcinoma: Some Methodological Considerations J. Clin. Oncol., March 1, 2008; 26(7): 1189 - 1190. [Full Text] [PDF]

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