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Whole-body MRI to assess bone involvement in prostate cancer and multiple myeloma: comparison of the diagnostic accuracies of the T1, short tau inversion recovery (STIR), and high b-values diffusion-weighted imaging (DWI) sequences

  • Musculoskeletal
  • Published:
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Abstract

Purpose

To compare the diagnostic accuracy of whole-body T1, short tau inversion recovery (STIR), high b-value diffusion-weighted imaging (DWI), and sequence combinations to detect bone involvement in prostate cancer (PCa) and multiple myeloma (MM) patients.

Materials and methods

We included 50 consecutive patients with PCa at high risk for metastasis and 47 consecutive patients with a histologically confirmed diagnosis of MM who received whole-body MRI at two institutions from January to December 2015. Coronal T1, STIR, and reconstructed coronal high b-values DWI were obtained for all patients. Two musculoskeletal radiologists read individual sequences, pairs of sequences (T1-DWI, T1-STIR, and STIR-DWI), and all combined (T1-STIR-DWI) to detect bone involvement. Receiver operating characteristic curve analysis was used to assess diagnostic performance according to a “best valuable comparator” combining baseline and 6-month imaging and clinical and biological data. Interobserver agreement was calculated.

Results

Interobserver agreement for individual and combined MRI sequences was very good in the PCa group and ranged from good to very good in the MM group (0.76–1.00). In PCa patients, T1-DWI, T1-STIR, and T1-STIR-DWI showed the highest performance (sensitivity = 100% [95% CI = 90.5–100%], specificity = 100% [75.3–100%]). In MM patients, the highest performance was achieved by T1-STIR-DWI (sensitivity = 100% [88.4–100%], specificity = 94.1% [71.3–100%]). T1-STIR-DWI significantly outperformed all sequences (p < 0.05) except T1-DWI (p = 0.49).

Conclusion

In PCa patients, a combination of either T1-DWI or T1-STIR sequences is not inferior to a combination of three sequences to detect bone metastases. In MM, T1-STIR-DWI and T1-DWI had the highest diagnostic performance for detecting bone involvement.

Key Points

• The sequences used in Whole Body MRI studies to detect bone involvement in prostate cancer and myeloma were evaluated.

• In prostate cancer, any pairwise combinations of T1, STIR, and DWI have high diagnostic value.

• In myeloma, the combinations T1-STIR-DWI or T1-DWI sequences should be used.

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Abbreviations

ADC:

Apparent diffusion coefficient

AUC:

Area under the receiver operating characteristic curve

BVC:

Best valuable comparator

CI:

Confidence interval

DWI:

Diffusion-weighted imaging

MM:

Multiple myeloma

PCa:

Prostate cancer

PET:

Positron emission tomography

PSA:

Prostate-specific antigen

ROC:

Receiver operating characteristic

STIR:

Short tau inversion recovery

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Funding

This study has received support by Fondation Contre le Cancer, Fondation Saint Luc, and Fonds de Recherche Clinique des Cliniques universitaires Saint Luc (Belgian non-profit organizations).

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Authors and Affiliations

  1. Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université catholique de Louvain (UCLouvain), Brussels, Belgium

    Ahmed Larbi, Vassiliki Pasoglou, Nicolas Michoux, Perrine Triqueneaux & Frédéric E. Lecouvet

  2. Department of Radiology, CHUV, Lausanne, Switzerland

    Patrick Omoumi

  3. Division of Urology, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium

    Bertrand Tombal

  4. Department of Radiology, Faculté de médecine de Montpellier/Nîmes, Hôpital Lapeyronie, Montpellier, France

    Catherine Cyteval

Authors
  1. Ahmed Larbi
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  2. Patrick Omoumi
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  3. Vassiliki Pasoglou
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  4. Nicolas Michoux
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  5. Perrine Triqueneaux
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  8. Frédéric E. Lecouvet
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Corresponding author

Correspondence to Frédéric E. Lecouvet.

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Guarantor

The scientific guarantor of this publication is Prof Frédéric Lecouvet.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Cross-sectional study

• Multicentre study (two)

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Larbi, A., Omoumi, P., Pasoglou, V. et al. Whole-body MRI to assess bone involvement in prostate cancer and multiple myeloma: comparison of the diagnostic accuracies of the T1, short tau inversion recovery (STIR), and high b-values diffusion-weighted imaging (DWI) sequences. Eur Radiol 29, 4503–4513 (2019). https://doi.org/10.1007/s00330-018-5796-1

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  • DOI: https://doi.org/10.1007/s00330-018-5796-1

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