M. Recio

Fetal magnetic resonance imaging and neurosonography in congenital neurological anomalies: supplementary diagnostic and postnatal prognostic value

Abstract Objective: To compare the diagnostic conclusions between fetal neurosonography and MRI in the cases of congenital neurological abnormalities, and with postnatal clinical and imaging evaluation, when available. Methods: A retrospective study of 28 patients who underwent a fetal MRI study for suspected congenital neurological anomalies. The diagnoses obtained by neurosonography and MRI were collected and compared. Both of them were compared with the final diagnosis when available by necropsy or postnatal evaluation. Postnatal imaging tests were performed only when clinically indicated. Results: The indications for the fetal MRI examination were: fetal ventriculomegaly, posterior fossa anomalies, suspected midline defects, small-for-gestational-age cephalic biometry and confirmed congenital CMV infection. There was a good degree of agreement beyond chance between both techniques (kappa test = 0.76). Conclusions: Both imaging modalities give a high-diagnostic performance with a good degree of agreement between them, when made by specialized staff. Fetal MRI is a valuable complementary tool to detailed neurosonography which allows an evaluation of the normal brain maturation from the second trimester. It also offers a higher diagnostic performance for some congenital abnormalities such as cortical development or acquired lesions.

Magnetic resonance imaging for prostate cancer before radical and salvage radiotherapy: What radiation oncologists need to know

External beam radiotherapy (EBRT) is one of the principal curative treatments for patients with prostate cancer (PCa). Risk group classification is based on prostate-specific antigen (PSA) level, Gleason score, and T-stage. After risk group determination, the treatment volume and dose are defined and androgen deprivation therapy is prescribed, if appropriate. Traditionally, imaging has played only a minor role in T-staging due to the low diagnostic accuracy of conventional imaging strategies such as transrectal ultrasound, computed tomography, and morphologic magnetic resonance imaging (MRI). As a result, a notable percentage of tumours are understaged, leading to inappropriate and imprecise EBRT. The development of multiparametric MRI (mpMRI), an imaging technique that combines morphologic studies with functional diffusion-weighted sequences and dynamic contrast-enhanced imaging, has revolutionized the diagnosis and management of PCa. As a result, mpMRI is now used in staging PCa prior to EBRT, with possible implications for both risk group classification and treatment decision-making for EBRT. mpMRI is also being used in salvage radiotherapy (SRT), the treatment of choice for patients who develop biochemical recurrence after radical prostatectomy. In the clinical context of biochemical relapse, it is essential to accurately determine the site of recurrence - pelvic (local, nodal, or bone) or distant - in order to select the optimal therapeutic management approach. Studies have demonstrated the value of mpMRI in detecting local recurrences - even in patients with low PSA levels (0.3-0.5 ng/mL) - and in diagnosing bone and nodal metastasis. The main objective of this review is to update the role of mpMRI prior to radical EBRT or SRT. We also consider future directions for the use and development of MRI in the field of radiation oncology.

Resonancia magnética fetal en patología cervical. torácica y abdominal

— Cuello. La nasofaringe, la hipofaringe, la tráquea y el esófago muestran hiperseñal en T2 al estar rellenas de líquido amniótico. El tiroides presenta hiperintensidad en T1. — Tórax. La aorta, los vasos pulmonares y el corazón aparecen hipointensos en secuencias SSFSE T2 y T1 y son hiperintensos en la secuencia FIESTA. El timo tiene una señal intermedia en SSFSE T2. — Abdomen. El estómago es fácilmente reconocible como una estructura sacular hiperintensa en T2, al igual que la vesícula biliar. El intestino delgado proximal aparece hiperintenso en T2 y el intestino delgado distal, colon y recto hiperintenso en T1 al contener meconio. El hígado es claramente visualizado como una estructura hiperintensa en T1 e hipointensa en T2. Los riñones, los sistemas pielocaliciales y sobre todo la vejiga se visualizan con claridad en secuencias T22.

Endorectal magnetic resonance imaging for risk classification of localized prostate cancer: Radiographic findings and influence on treatment decisions.

To the Editor: We appreciated the article of Liauw et al. [1] about the endorectal magnetic resonance imaging (MRI) and its influence in radiotherapeutic management. The influence of the 3 T endorectal MRI staging on the final radiotherapy (RT) treatment decision was analyzed in a total of 122 patients with prostate cancer. Briefly, in that study, the initially planned treatment was modified in 18% of patients. Surprisingly, the authors stated the following within the discussion: “There are no reports to our knowledge, which address the role of MRI on clinical decision-making from the radiation oncologists perspective.” However, our group has already published 2 studies analyzing the influence on final decisions in RT treatment of 3 T multiparametric MRI (mpMRI) without endorectal coil [2,3]. In our series, with a total of 274 patients [3], the global change in the risk groups when considering all factors, such as prostate-specific antigen levels, Gleason score, and tumor category, occurred in 32.8% of patients. Our results are comparable to an article published by Panje et al. [4] (28.7%). According to these data, we might say that at least 18% to 32% of patients with prostate cancer staged with mpMRI with or without endorectal coil could face an alteration of the final RT treatment decision. We obtained a global alteration of RT treatment in 43.8% or 52.5% of patients (depending on hormone therapy [HT] criteria for intermediate-risk patients). Other studies have shown a change in RT treatment of between 8% and 34% [5–8]. Such variability can be due to several causes previously described [3], such as factors related to MRI (magnet and coil, the use of functional sequences, expertise of the radiologist, the use of previous HT, etc.); factors related to the initial clinical staging (expertise of the clinician for the digital rectal examination/transrectal ultrasound, the use of computerized tomography scan to evaluate pelvic lymph nodes, etc.); clinical features of the cohorts of patients included in the studies; factors related to the RT treatment given in each center (doses, fractionation, target volume, HT indication, brachytherapy use, etc.); and

PO-0736: Tumour staging using MRI in prostate cancer: improvement of treatment decisions for radiotherapy

Hospital Quiron, Radiology, Madrid, Spain Universidad Europea, Clinical DepartmentFaculty of Biomedicine, Madrid, Spain Universidad Europea, Department of Research, Madrid, Spain Universidad Europea, School of Medicine, Madrid, Spain Hospital Quiron, Medical Physics, Madrid, Spain Hospital Quiron, Pathology, Madrid, Spain Hospital Quiron, Urology, Madrid, Spain Hospital Quiron, Clinical Oncology, Madrid, Spain Hospital Quiron, Assistant manager, Madrid, Spain

Resonancia magnética fetal cerebral

La RM fetal presenta varias ventajas sobre ecografía perinatal como mejorar la resolución espacial, no presentar limitaciones en el caso de oligoamnios, posición fetal inadecuada o presencia de sombras acústicas por la osificación de la calota y valorar con más detalle el desarrollo cortical cerebral. Las principales limitaciones de la RM fetal son la presencia de artefactos por movimiento fetal (que se reducen con el uso de nuevas secuencias ultrarrápidas y con el ayuno materno de al menos 4 h), baja resolución espacial en el primer trimestre y claustrofobia o incomodidad de la paciente durante el estudio (sobre todo en edades gestacionales avanzadas).