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. 2017 Jan;71(1):81–92. doi: 10.1016/j.eururo.2016.05.033

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© 2016 Elsevier B.V. on behalf of European Association of Urology. All rights reserved.

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Fig. 2 — Typical comprehensive whole-body magnetic resonance imaging protocol depicting extensive metastatic bone disease. Clinical details: 73-yr-old man with known prostate cancer recurrence, bone and nodal metastases on abiraterone treatment, and rising prostate-specific antigen (49.9 ng/ml). Restaging examination. Typical comprehensive whole-body magnetic resonance imaging examination undertaken using a 3.0T scanner (45min). (A) Panels 1 and 2: zoomed sagittal T1 weighted (W) turbo spin-echo and sagittal short tau inversion recovery (STIR) images of the spine showing multiple metastases with proximal caudal equina impingement at L1. General narrowing of the lumbar spinal canal due to disc degeneration. Panel 3: coronal T1W gradient-recalled echo (GRE) sequence shows the metastasis at L1 (horizontal arrow) but the deposits in the adjacent vertebrae are less conspicuous. Deposits are visible in the sacrum and in both ischia (slanting arrows). Panel 4: coronal b900 diffusion weighted image (multiplanar reconstruction [MPR]) showing multiple hyperintense foci at the bone metastatic sites (except the left ischium). Panels 5 and 6: b900 three dimensional MIP images with coronal and sagittal projections confirm multiple bone metastases (as dark regions). Note that the dark signal of the brain, spleen, spinal cord, and testicles is a normal finding, as are the small lymph nodes in the neck, axillae, and groin. (B) Zoomed T1W images obtained using the Dixon technique with in-phase (IP), opposed-phase (OP), water only (WO), and fat only (FO) reconstructions at the level of the sacrum. Multiple sacral and iliac bone metastases are seen (best depicted on the T1W-IP and FO images; arrows). (C) Zoomed T2W and b900 images in the top row at the same level as B. Increased conspicuity of the metastases on the diffusion weighted b900 image (arrows) due to suppression of the background fat signal. The T1W-fat% (F%) image is calculated using the T1W-wWOand T1W-FO images from B. Small amounts of F are visible with the deposits in the iliac bones on the F% image (arrows on F% image).