Document Detail


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.
MedLine Citation:
PMID:  17664475     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Frédéric E Lecouvet; Daphné Geukens; Annabelle Stainier; François Jamar; Jacques Jamart; Bertrand Janne d'Othée; Patrick Therasse; Bruno Vande Berg; Bertrand Tombal
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of clinical oncology : official journal of the American Society of Clinical Oncology     Volume:  25     ISSN:  1527-7755     ISO Abbreviation:  J. Clin. Oncol.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-31     Completed Date:  2007-09-13     Revised Date:  2009-10-09    
Medline Journal Info:
Nlm Unique ID:  8309333     Medline TA:  J Clin Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3281-7     Citation Subset:  IM    
Affiliation:
Department of Radiology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium. lecouvet@rdgn.ucl.ac.be
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Bone Neoplasms / diagnosis*,  radiography,  radionuclide imaging,  secondary*
Cost-Benefit Analysis
Diagnostic Imaging / economics,  methods
Humans
Magnetic Resonance Imaging / economics,  methods*
Male
Middle Aged
Prospective Studies
Prostatic Neoplasms / pathology*
Sensitivity and Specificity
Comments/Corrections
Comment In:
J Clin Oncol. 2007 Dec 20;25(36):5837-8; author reply 5838-9   [PMID:  18089886 ]
Eur Urol. 2009 Sep;56(3):573   [PMID:  19824149 ]
J Clin Oncol. 2008 Mar 1;26(7):1189-90; author reply 1190-1   [PMID:  18309962 ]

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