Pulse sequences necessary for recurrence detection after Radiotherapy

Donati OF, Jung SI, Vargas HA, Gultekin DH, Zheng J, Moskowitz CS, Hricak H, Zelefsky MJ, Akin O. Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology. 2013 Aug;268(2):440-50

Short summary 

Investigation whether all pulse sequences of mpMRI (T2w, DWI, ADC) are necessary to detect recurrent prostate cancer in patients after radiotherapy.

Conclusion

T2+DWI seems to be the optimal combination for detection of local recurrence after radiotherapy. 

Patient cohort

35 patients with biochemical recurrence after radiotherapy (EBRT and brachytherapy) undergoing mpMRI of the prostate.

The Good

• Comparison of multiple combinations of mpMRI (T2 vs T2+DWI vs T2+DCE vs T2+DWI+DCE).

The Bad

• Standard of reference:  12 to 16 core TRUS-Biopsy

Possible consequences for clinical practice

• DCE may be added optionally to T2+DWI only if quality of DWI is hampered by artifacts (e.g. susceptibility artifacts in patients after brachytherapy). Therefore, standard protocol may be shortened for detection of local recurrence after radiotherapy. 

Future study ideas derived from this paper

• Determine optimal protocol for detection of local recurrence after prostatectomy and compare it to nuclear medicine examinations (e.g. PSMA-PET/MRI).