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MRI may be effective in planning nerve-sparing RALP

McClure TD. Radiology. 2012;doi:10.1148/radiol.11103504.

Issue: February 25, 2012

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Review of MRI results caused a surgeon to change the prostate cancer surgical plan in more than 25% of patients, according to recent results.

Researchers aimed to determine whether preoperative MRI of the endorectal coil would yield findings that would affect the decision to preserve nerve bundles and the extent of surgical margins in robotic-assisted laparoscopic prostatectomy (RALP) in 104 men with biopsy-proven prostate cancer.

Eligible participants underwent an MRI at 1.5 T from January 2004 to April 2008. The analysis included 104 men who underwent T2-weighted imaging, 91 men who had MR spectroscopy, 88 men who underwent diffusion-weighted imaging and 51 who underwent dynamic contrast-enhanced imaging.

The planned preoperative extent of resection bilaterally was determined initially on the basis of clinical information by a surgeon and then again by that same surgeon after the MRI results were obtained. The researchers then compared the differences in the surgical plan before and after the review of the MRI with the actual surgical and pathological results. The initial surgical plan was changed after MRI review in 28 of the 104 patients (27%).

“The surgical plan was changed to a nerve-sparing technique in 17 of the 28 patients (61%) and to a non–nerve-sparing technique in 11 (39%),” Daniel J. A. Margolis, MD, assistant professor of radiology at David Geffen School of Medicine at UCLA, and colleagues wrote.
Positive surgical margins were observed in seven of the 104 patients (6.7%). No positive margins on the side of the prostate were observed in patients who had their surgical plan changed to a nerve-sparing technique.

“To our knowledge, this is the first report demonstrating the value of MR imaging in planning RALP,” the researchers wrote. “On the basis of our initial experience, prostate MR imaging may be useful for helping surgeons plan the extent and side of nerve sparing during RALP.”

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