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Lymph node involvement signifies an adverse prognosis and modifies the treatment strategies. The number and regions of affected pelvic nodes directly influence the survival rate.
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Superior soft tissue resolution of magnetic resonance (MR) imaging aids in detection of metastatic lesions to visceral organs and detects nonpalpable lesions of the prostate, penis, and testes.
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Disseminated tumors commonly seed pelvic recesses lined by parietal peritoneum, followed by accumulation of increasing amounts
Magnetic Resonance Imaging of Pelvic Metastases in Male Patients
Section snippets
Key points
Lymph node metastasis
In most patients with known pelvic malignancies, presence of nodal disease signifies adverse prognosis and dictates treatment strategies. The number and regions of the pelvic nodes involved affect the nodal (N) and metastasis (M) staging of the tumor and also influence the survival rate. Understanding the lymphatic drainage pathways and MR diagnostic criteria of abnormal nodes can help in the evaluation of pelvic lymph node metastasis.3
Prostate
Primary prostate cancer is one of the most common malignancies likely to metastasize, whereas metastatic malignancy of the prostate is extremely rare. Secondary neoplasms of prostate only account for 0.5% to 5.6% of patients and represent 2.1% of all prostate tumors.33 The most common primary sites for metastases to the prostate are the lung and pancreas.34, 35, 36 MR imaging is the most valuable imaging method for prostate tumors at present. It can provide precise anatomic information and
Peritoneal metastasis
Parietal peritoneum lines the pelvic sidewalls and reflects over the bladder and rectum. The inferior extent of the pelvic peritoneal reflections forms the rectovesicle pouch in men. The dome of the bladder is also covered by peritoneum. The rectovesicle pouch or rectouterine pouch is the first site to accumulate ascitic fluid in the pelvis. Disseminated tumors commonly seed these pelvic recesses, followed by accumulation of increasing amounts of ascites in the bilateral paravesical recesses.54
Metastasis to skeletal muscle
Metastases in skeletal musculature are rare, with prevalences ranging from 0.03% to 5.6% in autopsy and from 1.2% to 1.8% in radiological series.60 According to the diverse features of skeletal muscle metastases (SMMs) on CT, Surov and colleagues61, 62 classified them into 5 different types: type I, focal intramuscular masses with homogeneous contrast enhancement; type II, abscesslike intramuscular lesions (Fig. 10); type III, diffuse metastatic muscle infiltration; type IV, multifocal
Bone metastasis
Metastatic lesions are the most common malignancy observed in the skeleton, including the pelvis. About 80% of skeletal metastases come from prostate, lung, breast, and thyroid carcinomas (Table 3). Most metastases from the pelvis are from prostate, lung, breast, renal, gastrointestinal, and thyroid carcinomas.64 The pelvis is the second most common site of bone metastases after the spine, and the sacrum is the most common site of metastasis in the pelvis.65, 66 Most metastatic lesions in the
Diffusion-weighted Imaging and Diffusion-weighted Whole-body Imaging with Background Body Signal Suppression
Diffusion-weighted imaging (DWI) depicts movements of water molecules within the tissues. Increased cellularity as seen in metastatic lesions exhibit restricted diffusion. DWI is used to evaluate the response of primary tumor and metastases to chemotherapy or radiation therapy, by monitoring changes in tumor size and apparent diffusion coefficient values following treatment. It is an excellent tool in the evaluation of lymphadenopathy in patients with predominantly nodal metastasis and
Summary
Metastasis to the pelvic organs poses a particular challenge to oncologists because of the intricacy and complexity of the pelvic anatomy. Pelvic organs can also be the origin of malignancies that can spread locally to adjacent structures such as lymph nodes, which makes the proper staging and treatment of these malignancies dependent on the accurate identification of local pelvic metastasis. The current clinical practice relies on structural imaging techniques. Functional imaging techniques
References (87)
- et al.
Pelvic nodal imaging
Radiol Clin North Am
(2012) - et al.
Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results
J Urol
(2004) - et al.
Lymph node involvement in patients with bladder cancer treated with radical cystectomy: a patho-anatomical study–a single center experience
J Urol
(2004) - et al.
Detection of lymph nodes in pelvic malignancies with computed tomography and magnetic resonance imaging
Clin Imaging
(2010) - et al.
MR evaluation of normal retroperitoneal and pelvic lymph nodes
Clin Radiol
(2002) - et al.
Small pelvic lymph node metastases: evaluation with MR imaging
Clin Radiol
(1997) - et al.
Late penile metastasis from primary bladder carcinoma
Urology
(2003) Testicular metastasis from carcinoma of the prostate: review of literature and report of a case
J Urol
(1960)- et al.
What is new in bladder cancer imaging
Urol Clin North Am
(1997) - et al.
Rectal metastases from lobular carcinoma of the breast: report of a case and literature review
Ann Oncol
(2001)
Gadolinium-enhanced MR imaging of liver capsule and peritoneum
Magn Reson Imaging Clin N Am
Metastatic bone disease: clinical features, pathophysiology and treatment strategies
Cancer Treat Rev
Diagnostic value of MRI in comparison to scintigraphy, PET, MS-CT and PET/CT for the detection of metastases of bone
Eur J Radiol
Whole-body MRI for the staging and follow-up of patients with metastasis
Eur J Radiol
Whole-body MR imaging of bone marrow
Eur J Radiol
ADC measurements of lymph nodes: inter- and intra-observer reproducibility study and an overview of the literature
Eur J Radiol
Diffusion-weighted MR imaging for whole body metastatic disease and lymphadenopathy
Magn Reson Imaging Clin N Am
MRI with a lymph-node-specific contrast agent as an alternative to CT scan and lymph-node dissection in patients with prostate cancer: a prospective multicohort study
Lancet Oncol
Prostate cancer imaging: what the urologist wants to know
Radiol Clin North Am
How to improve the ability to detect pelvic lymph node metastases of urologic malignancies
Eur Urol
MR imaging of the pelvis
Radiology
MR imaging of the male pelvis
Eur Radiol
Lymph nodal metastases: diagnosis and treatment
Q J Nucl Med Mol Imaging
Pathways of lymphatic spread in male urogenital pelvic malignancies
Radiographics
What next? Managing lymph nodes in men with penile cancer
Can Urol Assoc J
The American Joint Committee on Cancer. AJCC cancer staging manual and the future of TNM. 7th edition
Ann Surg Oncol
AJCC cancer staging atlas. A companion to the seventh editions of the AJCC cancer staging manual and handbook
Metastatic lymph nodes in urogenital cancers: contribution of imaging findings
Abdom Imaging
Patterns of recurrence of bladder carcinoma following radical cystectomy
Canc Imag
Staging urinary bladder cancer after transurethral biopsy: value of fast dynamic contrast-enhanced MR imaging
Radiology
Failure patterns following curative resection of colonic carcinoma
Ann Surg
Prognosis of node-positive colon cancer
Cancer
Relevance of magnetic resonance imaging-detected pelvic sidewall lymph node involvement in rectal cancer
Br J Surg
Pelvic adenopathy in prostatic and urinary bladder carcinoma: MR imaging with a three-dimensional TI-weighted magnetization-prepared-rapid gradient-echo sequence
AJR Am J Roentgenol
Lymph node staging of localized prostatic carcinoma with CT and CT-guided fine-needle aspiration biopsy: prospective study of 285 patients
Radiology
Normal pelvic lymph nodes: evaluation with CT after bipedal lymphangiography
Radiology
Cross-sectional imaging of nodal metastases in the abdomen and pelvis
Abdom Imaging
Local staging of rectal cancer with transrectal ultrasound and endorectal magnetic resonance imaging: comparison with histologic findings
Dis Colon Rectum
Preoperative assessment of prognostic factors in rectal cancer using high-resolution magnetic resonance imaging
Br J Surg
MRI diagnosis of mesorectal lymph node metastasis in patients with rectal carcinoma. What is the optimal criterion?
Anticancer Res
Evaluation of retroperitoneal and pelvic lymph node metastases with MRI and MR lymphangiography
Abdom Imaging
Characterization of lymphadenopathy by magnetic resonance relaxation times: preliminary results
Radiology
Abdominal tuberculosis: CT evaluation
Radiology
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