BERLIN, GERMANY (UroToday.com) - EAU 2007 - Dr. Jurgen Futterer, Nijmegen, The Netherlands discussed "What is possible" in urologic imaging at the plenary session of the EAU on Friday March 23, 2007. The MD-CTU scanner provides up to 64 slices per second. A variety of views are reconstructed to provide significant information. For example, it detects 98% of TCC, compared to 79% for IVP. He provided visual imaging examples and pointed out that the MD-CTU takes less than one hour compared to 3 hours for and IVP. MRI, in a report from Japan, has identified criteria that suggest muscle-invasive disease. The concordance between MRI and surgical pathology, however, was not stated. The prostate is well imaged using MRI. The addition of contrast provides enhancement suggestive of increased vascularity that can correlate with CaP. This is referred to as Dynamic Contrast Enhanced (DCE) MRI. Further imaging advancements include Magnetic Resonance Spectroscopy, which assesses choline and citrate levels. The ability to detect CaP is about 90% he stated, although data supporting this was not presented. Use of endorectal coil can further improve sensitivity. Nodal staging, however, is limited by 30% of positive lymph nodes being less than 5mm in size. Emerging techniques that improve outcomes include Ferumoxtran-10, a nanoparticle that is taken up in normal but not malignant lymph node tissue. The negative predictive value is 97%, thus suggesting when surgical lymphadenectomy can be avoided.

Dr. J. Ramon, Ramat discussed "What is necessary" in urologic imaging. He stated that CT urography gives excellent upper tract data to include information about the renal parenchyma. 3-dimensional reconstruction permits better assessment of particular anatomic components of the urinary tract. Angiography with either CT or MRI delineates the association between critical structures. As an example, he showed images of renal tumors where the use of 3-D images facilitated the determination that a partial nephrectomy was possible. Lymph nodes below 2 cm in size however can not be accurately assessed as malignant by standard CT. Regarding bladder cancer, CT has only 65-80% accuracy for staging. It fails to detect nodal metastases in up to 79% of bladder cancer patients. While upper tract tumors are accurately detected in 97%, staging is only accurate in up to 60%. Dr. Ramon showed images of virtual ureteroscopy, however the quality and ability to detect small lesions was not ready for clinical application. With regard to CaP, TRUS, CT or MRI is of limited value for those on active surveillance. Regarding testis cancer, PET has no apparent advantage over CT following chemotherapy. However, he did not present recently published data suggesting that PET has a role in post-chemo seminomas. He concluded that many new modalities will facilitate the detection of microscopic disease.

EAU 2007 Conference Coverage on UroToday.com

Written by Christopher P. Evans, MD, a Contributing Editor with UroToday.

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