Multimodal Imaging Aids in the Diagnosis of Perineural Spread of Prostate Cancer

Jonathan J. Stone, Daniel A. Adamo, Danyal Z. Khan, Ann T. Packard, Stephen Broski, Mark A. Nathan, B. Matthew Howe, Robert J. Spinner

Research output: Contribution to journalArticle

Abstract

Background: The perineural spread of prostate cancer into pelvic peripheral nerves is a rare, but increasingly recognized, entity. This form of metastasis invades the lumbosacral plexus via the splanchnic nerves innervating the prostate. The prevalence of perineural spread is likely underappreciated, and further imaging-based studies are needed to elucidate its true frequency. Methods: A retrospective review was performed using an institutional radiology database. Medical reports from patients with prostate cancer who had undergone positron emission tomography (PET) imaging were queried for terms suggestive of perineural spread. PET and magnetic resonance imaging (MRI) from the identified patients were blindly reviewed for peripheral nerve involvement by 2 nuclear medicine and 2 musculoskeletal radiologists. Results: A total of 22 patients were identified. After review by the radiologists, 16 patients had positive findings of perineural spread found on PET and 15 had abnormalities found on MRI involving lumbosacral plexus neural elements. All patients with biopsy-proven neoplastic perineural spread (including 1 patient with malignant peripheral nerve sheath tumor) had positive findings on both PET and MRI. All patients with biopsy-proven inflammatory lesions had negative PET and variable MRI findings. Conclusions: The perineural spread of prostate cancer might be more common than previously thought. The use of multimodal imaging for patients suspected of having perineural spread should be a part of the treatment algorithm. Targeted fascicular biopsy might be indicated for patients with progressive neurological deficit and an unclear diagnosis.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018

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Multimodal Imaging
Prostatic Neoplasms
Positron-Emission Tomography
Magnetic Resonance Imaging
Lumbosacral Plexus
Peripheral Nerves
Biopsy
Splanchnic Nerves
Nuclear Medicine
Neurilemmoma
Radiology
Prostate
Databases
Neoplasm Metastasis

Keywords

  • Lumbosacral plexus
  • Magnetic resonance imaging
  • MRI
  • Perineural spread
  • PET
  • Positron emission tomography
  • Prostate cancer
  • Sciatic nerve

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Stone, J. J., Adamo, D. A., Khan, D. Z., Packard, A. T., Broski, S., Nathan, M. A., ... Spinner, R. J. (Accepted/In press). Multimodal Imaging Aids in the Diagnosis of Perineural Spread of Prostate Cancer. World Neurosurgery. https://doi.org/10.1016/j.wneu.2018.09.221

Multimodal Imaging Aids in the Diagnosis of Perineural Spread of Prostate Cancer. / Stone, Jonathan J.; Adamo, Daniel A.; Khan, Danyal Z.; Packard, Ann T.; Broski, Stephen; Nathan, Mark A.; Howe, B. Matthew; Spinner, Robert J.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Stone, Jonathan J. ; Adamo, Daniel A. ; Khan, Danyal Z. ; Packard, Ann T. ; Broski, Stephen ; Nathan, Mark A. ; Howe, B. Matthew ; Spinner, Robert J. / Multimodal Imaging Aids in the Diagnosis of Perineural Spread of Prostate Cancer. In: World Neurosurgery. 2018.
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