PT - JOURNAL ARTICLE AU - Ali Civelek AU - Jeffrey Lin AU - Piyush Agarwal AU - Ashkan Malayeri AU - Andrea Apolo TI - <strong>FDG PET-MRI in the management of patients with </strong><strong>muscle invasive bladder cancer</strong> DP - 2017 May 01 TA - Journal of Nuclear Medicine PG - 753--753 VI - 58 IP - supplement 1 4099 - http://jnm.snmjournals.org/content/58/supplement_1/753.short 4100 - http://jnm.snmjournals.org/content/58/supplement_1/753.full SO - J Nucl Med2017 May 01; 58 AB - 753Objectives: Metastatic bladder cancer is an aggressive disease that can be difficult to locally diagnose and stage with cross-sectional imaging. The most commonly used imaging modalities for the diagnosis, staging, and follow-up of bladder cancers are CT, MRI, and positron emission PET/CT, with Multi-planar high-resolution CT and multi-parametric MRI (mpMRI) imaging being the main stream modalities. The primary objective of this study is to determine the clinical value of 18F-FDG PET-MRI in local and distant metastases in the surveillance and re-staging of the bladder cancer patients (pts).Methods: In this retrospective study, previously treated advance stage bladder cancer pts, many with a urinary diversion undergoing clinical an 18F-FDG PET-MRI for local or metastatic staging, were selected. All pts also underwent other standard imaging including: CT chest/abdomen/pelvis, or 18F-NaF PET/CT bone scans. Morphological data was obtained using the high resolution T1 and T2 weighted images of the pelvis. For patients who undergo local staging for bladder cancer, inherent fat signal in the pelvis is used to provide contrast between the cancer and normal para-vesical tissue, to distinguish bladder confined lesions from muscular invasion. Functional data to obtain information regarding angiogenesis and cellularity of the mass is mainly derived from kinetic contrast enhancement and diffusion weighted imaging. Whole body evaluation for extent of metastatic bladder cancer is performed using STIR and Dixon sequences and pre and post T1 weighted images. Dynamic post contrast images were performed through the pelvis with delayed post contrast images though the chest and abdomen.Results: Total of 34 18F-FDG PET-MRI scans were performed on 14 pts (4 for surveillance and 10 for restaging). Additional conventional scans included 28 enhanced chest/abdomen/pelvis CTs and 3 18F-NaF PET/CT bone scans performed around the time of PET MRI ((median 5.5 days (range 0-105) Of the 14 patients (11 male) the median age was 61.5 years (range 37-73) ; histology included urothelial carcinoma (13 pts) bladder small cell carcinoma (1 pt) with stages, 4 (12 pts), 3 (1 pt), and 2 (1 pt). Primary disease site included bladder (13 pts) and bladder and ureter (1 pts). Prior surgical treatments include: radical cystoprostatectomy (11 pts), partial nephrectomy (1 pt) and no prior surgery (3 pts); intravesical, BCG (5 pts), mitomycin (1 pt), valrubicin (1 pt); and chemotherapy (Gemcitabine/Cisplatin (7 pts), Methotrexate/Vinblastin/Adriamycin/Cisplatin (2 pts), Cisplatin/Etoposide (2 pts), Cisplatin/Paclitaxel (1pt) ,18F FDG PET-MRI detected metastases included: lymph nodes (13 pts), liver (4 pts), lung (8 pts), soft tissue (8 pts), adrenal (1 pt), and bone (1 pt). PET MR detected more lesions than conventional CT scan, Of the lesions detected on PET-MRI there was a59% concordance and 38% discordance with conventional imaging. There was overall good correlation between FDG PET-MRI and enhanced CT studies and 18F-NaF PET/CT bone scans in detection of metastatic lesion of bladder cancer, and with better tissue characterization.Conclusion: MRI imaging can provide morphologic and functional information for staging of bladder cancer. 18F-FDG PET-MRI has the potential to enhance the diagnostic power of the PET by adding exceptional anatomic resolution and soft-tissue contrast in the management of metastatic bladder cancer pts. In this small patient cohort, 18F-FDG PET-MRI enhanced our ability to detect malignant lesions more accurately and confidently, thus improved treatment planning and improved disease monitoring. Studies with larger patient cohorts are underway. Research Support: none