Magnetic Resonance Imaging of Pelvic Metastases in Male Patients

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Key points

  • 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.

  • 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.

  • Disseminated tumors commonly seed pelvic recesses lined by parietal peritoneum, followed by accumulation of increasing amounts

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

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