PMC6011115_01
Image findings at initial diagnosis. Pelvic MRI (DWI) (a) showed extensive high signal of the prostate. FDG-PET/CT revealed multiple spine and pelvic bone (b) and para-aortic and pelvic lymph node metastases (c). MRI, magnetic resonance imaging; DWI, diffusion-weighted imaging; FDG-PET/CT, fluorodeoxyglucose-positron emission tomography/computed tomography.
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Pelvic MRI demonstrated extensive high signal of the prostate in diffusion-weighted imaging (DWI) (Figure 1(a)). Fluorodeoxyglucose-positron emission tomography/CT revealed multiple spine and pelvic bone and para-aortic and pelvic lymph node metastases (Figures 1(b) and 1(c)).
Imaging findings at the time of CRPC diagnosis. CT showed multiple osteoblastic lesions in the spine (a) and pelvic bone (b). Bone scan confirmed multiple accumulations at the same bone sites as CT (c). CRPC, castration-resistant prostate cancer; CT, computed tomography.
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CT. CT showed multiple osteoblastic lesions in the spine and pelvic bone (Figures 2(a) and 2(b)) and shrunken para-aortic lymph nodes. Bone scan similarly showed multiple accumulations at the same bone sites as the CT (Figure 2(c)).
WB-MRI at the time of CRPC diagnosis. Sagittal DWI of the spine (a), coronal DWI + T2 fusion (b), and whole-body DWI (c) showed few high signals. Coronal DWI + T2 fusion of the pelvis (d) revealed diffuse high signal in the prostate. WB-MRI, whole-body magnetic resonance imaging; CRPC, castration-resistant prostate cancer; DWI, diffusion-weighted imaging.
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However, these osteoblastic lesions showed almost no high signal in DWI of WB-MRI, suggesting that the lesions did not have viable tumor cells (Figures 3(a)-3(c)). In contrast, the primary lesion had a diffuse high signal remaining in DWI of WB-MRI (Figure 3(d)).
Histopathological findings at the time of CRPC diagnosis. Prostate needle biopsy detected viable prostate cancer cells from 10 of 12 cores (a). Bone needle biopsy from the second lumbar vertebra demonstrated no malignant cells (b). CRPC, castration-resistant prostate cancer.
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The prostate needle biopsy demonstrated that 10 of 12 cores had viable prostate cancer cells (Figure 4(a)). Histopathological examination of the osteoblastic lesion demonstrated no malignant cells (Figure 4(b)).
Imaging findings of MRI and CT in the second lumbar vertebra where CT-guided needle biopsy was performed. (a) CT revealed an osteoclastic lesion in the second vertebral body (885.4 HU). b = 0 (b) and b = 1200 (c) of DWI displayed no high signal intensity in the second lumbar vertebra. (d) The ADC map exhibited low signal intensity in the second lumbar vertebra (the ADC value was 0.498 x 10-3 mm2/s). MRI, magnetic resonance imaging; CT, computed tomography; HU, Hounsfield unit; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient.
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A CT scan in the second lumbar vertebra revealed an osteoblastic change (885.4 Hounsfield unit), T1- and T2-weighted imaging of MRI revealed low signal intensity, and the ADC value was low (0.498 x 10-3 mm2/s); however, b = 0 and b = 1200 of DWI exhibited no high signal intensity, suggesting a benign osteoblastic change induced by the treatment effect (Figures 5(a)-5(d)).