Crucial need to standardize MRI use and reporting

17 July 2017

Prof. Anwar Padhani, radiologist, of the Paul Strickland Scanner Centre

There is an urgent need to standardize acquisition, interpretation and reporting of whole body Magnetic Resonance Imaging (MRI) to enable doctors to properly evaluate MRI’s impact on the clinical management of advanced prostate cancer (PCa).

There is a clear need for standardizing the acquisition, interpretation and reporting of whole body MRI which can then be evaluated in clinical trials, and to assess its impact on the clinical management of advanced prostate cancer,” said Prof. Anwar Padhani, radiologist, of the Paul Strickland Scanner Centre at the Mount Vernon Cancer Centre in the UK.

“Whole body MRI can detect bone metastases with higher sensitivity than bone scans and with at least comparable performance to choline PET/CT. But it is currently unclear whether the earlier detection of treatment failure by more sensitive methods, and subsequent modifications in life prolonging treatments would have patient benefits,” said Padhani, one of the resource speakers at the 9th European Multidisciplinary congress on Urological Cancers (EMUC17) to be held in Barcelona from 16 to 19 November.

Now on its ninth edition, the multidisciplinary EMUC gathers onco-urological experts to critically examine treatment strategies for urological malignancies. Annually organized by three of Europe’s leading and specialized medical associations- the European Society for Medical Oncology (ESMO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Association of Urology (EAU), EMUC has promoted best practices among onco-urological experts and healthcare professionals.

Advanced prostate cancer is mostly accompanied by metastatic bone disease which makes the management of patients more challenging. This is because bone disease detection and response assessment are both impaired by current methods, and this has direct clinical implications for therapy options.  Nonetheless, Padhani, who will be discussing monitoring patients with metastatic disease during the session on metastatic PCa, said MRI technology offers potentials which can enable doctors to improve their diagnostic and treatment strategies.

“New whole body data processing software has the potential to address the unmet need for robust imaging that allows tumour detection and therapy evaluations in advanced prostate cancer,” explained Padhani. “Next generation imaging can also help deliver the promise of precision medicine to patients with metastatic bone disease.”

In his lecture, Padhani will address key issues in imaging such as the impact of imaging on advanced PCa management via literature review, the limits of current imaging (computed tomography/bone scan), the potential of next-generation imaging to alter diagnostic thinking when assessing response, exploiting the potential of whole body-MRI now that the MET-RADS-P standards have been published.

Challenges in multidisciplinary strategies

Padhani noted that besides improving the doctor’s ability to better define a patient’s metastatic status, modern imaging can also help physicians efficiently adapt their therapies for bone disease. “There is a need to more clearly define therapy strategies based on tumor volume and heterogeneity displayed and to titrate therapies according to response of patients and change therapies in a timely way,” he said.

“Moreover, we need to be able to adapt therapies for bone disease- which we don’t do very well, as we do for soft tissue disease which we do very well at the moment – so promote precision oncology for both soft tissue and bone disease,” added Padhani.

Outside the clinical issues, Padhani observed that multidisciplinary approaches are still facing challenges.

“There are still ‘camps’ in uro-oncology (radiation, urologists, oncologists) and in diagnostics (imaging versus liquid) and within imaging (radiology versus nuclear medicine versus artificial intelligence). These need to be ironed out while keeping patients in the centre and self-interests at the periphery,” said Padhani.

He, however, pointed out events such as the EMUC fulfils several goals, such as informing opinion leaders of the various disciplines regarding the progress being made in imaging, translational research and other fields. “These meetings also enable us to make new connections for collaborations to advance prostate cancer care,” he said.

Prior to the EMUC’s main Scientific Programme, the EMUC Symposium on Genitourinary Pathology and Molecular Diagnostics (ESUP) will take place on November 16, and held concurrently with the 6th Meeting of the EAU Section of Urological Imaging (ESUI17) and a line-up of several European School of Urology (ESU) Courses. ESTRO is also offering a delineation contouring workshop with the topic Target volume contouring in bladder cancer.” A Uropathology Training Workshop will also be held for participants to gain practical insights on uropathology procedures.

More information about registration for EMUC17 can be found here.