Cancro da próstata: sinais de recidiva local na ressonância magnética

Autores e Afiliações:

João Lopes Dias, MD (1), Rita Lucas, MD (2), João Magalhães Pina, MD (3), Raquel João, MD (3), Nuno Vasco Costa, MD (1), Cecília Leal, MD (4), Tiago Bilhim, MD, PhD (1), Luís Campos Pinheiro, MD, PhD (1), Rui Mateus Marques, MD, PhD (1)

(1) Department of Radiology, Hospital de S. José, Lisboa, Portugal

(2) Department of Radiology, Hospital de Santo António dos Capuchos, Lisboa, Portugal

(3) Department of Urology, Hospital de S. José, Lisboa, Portugal

(4) Department of Radiology, Hospital de Santa Marta, Lisboa, Portugal

Abstract:

The use of multiparametric magnetic resonance imaging (mp-MRI) for prostate cancer (PCa) has increased over recent years, mainly for detection, staging and active surveillance. However, suspicion of recurrence in the set of biochemical failure is becoming a significant reason for clinicians to request mp-MRI.

Radiologists should be able to recognize the normal post-treatment MRI findings. Fibrosis and atrophic remnant seminal vesicles after prostatectomy are often found and must be differentiated from local relapse. Moreover, brachytherapy, external beam radiotherapy, cryosurgery and hormonal therapy tend to diffusely decrease the signal intensity of the peripheral zone on T2-weighted images (T2WI) due to the loss of water content, consequently mimicking tumor and hemorrhage.

The combination of T2WI and functional studies like diffusion-weighted imaging  (DWI) and dynamic contrast-enhanced (DCE) improves the identification of local relapse. Tumor recurrence tends to restrict on diffusion images and avidly enhances after contrast administration either within or outside the gland.

The authors provide a pictorial review of the normal findings and the signs of local tumor relapse after radical prostatectomy, external beam radiotherapy, brachytherapy, cryosurgery, and hormonal therapy.

Revista: Abdominal Imaging

Link: http://link.springer.com/article/10.1007%2Fs00261-015-0473-1