3rd ESUI Meeting: Insights and prospects on urological imaging

27 November 2014

Leading European experts active in imaging and image-guided treatment in urology gathered in Lisbon, Portugal on November 13 for the 3rd Meeting of the EAU Section of Urological Imaging (ESUI) which was held in conjunction with the 6th European Multidisciplinary Meeting on Urological Cancers (EMUC).

With the aim to provide insights into the latest developments for imaging especially in oncology, the ESUI meeting organised a comprehensive programme. The high attendance was beyond our expectations, proving that combining an imaging and multidisciplinary oncology meeting responds to the needs of physicians active in urological oncology. The programme also complemented the EMUC programme, adding details about the value of imaging in the management of urological malignancies.

Representatives from the European Society of Urogenital Radiology (ESUR) and the European Association of Nuclear Medicine (EANM) also participated. The overarching theme is that key improvements in future cancer management will be driven by better imaging. Providing better detection, staging, and better follow-up and salvage treatments will lead to improved and individualised treatment strategies. During the EMUC it was also apparent that individualised treatment and better disease classification are among the major aims to address in the future. Outstanding presentations examined thematic blocs that prompted a lively interaction. Participants went home with actionable take-home messages, some of which are mentioned below:

Real-time tissue characterisation
One of the main observations regarding imaging in urological surgery was the increasing possibility to improve surgery by adding information gained from imaging and by creating what is called augmented reality. Several drugs and optical processing techniques allow real- time information on tissue function and tissue quality improving the safety and outcome of surgery. Moreover, new navigational computer systems and new imaging techniques such as the DYNA-CT allow real-time 3D navigation during surgery of renal masses or prostate cancer, providing major potential for improvements of surgery in the future especially when done by minimal invasive surgical techniques.

Image-guided therapy of SRMs
This session provided valuable information on how a focal therapy programme could be implemented in a urological department. The European leaders in this field gave tricks and hints to establish such programmes and stressed that these programmes require a multidisciplinary effort between urology and radiology, as well as pathology. This concern reflects the need for multidisciplinary meetings such as the EMUC and ESUI meeting.

Joint ESUI and EANM
One of the meeting’s highlights was the joint meeting between the European Association of Nuclear Medicine (EANM) and the ESUI. The role of PET/CT in the different urological malignancies was critically assessed and clarified the value and limits of PET/CT in managing individual pathology. There was a clear consensus that such information is essential when using this imaging tool in daily practice. Moreover, a point-counterpoint discussion concluded that the selection of the right patient with the right pathology in the right clinical situation plays a crucial role to
improve the value of PET/CT as a diagnostic tool.

Best poster award
ESUI granted the prize for the best poster to Dr. T. Maurer (Munich, DE) for his study entitled “Preoperative lymph node staging of intermediate and high-risk prostate cancer using whole body integrated PET/MR with 68Gallium.lebelled ligand of prostate-specific membrane antigen.” The number of abstracts submitted increased substantially and the quality can be commended. We are confident that future meetings will attract even more talented urologists to submit their research on urological imaging.

Advanced imaging in PCa treatment
Another highlight session was the imaging of prostate cancer (PCa), clearly the hottest topic in urological imaging. The session opened with an excellent point-counterpoint discussion between Hashim Ahmed (UK) and Alberto Briganti (IT) who took pro-con positions regarding focal therapy in PCa. Currently available imaging tools for PCa such as multiparametric MRI, elastography, contrast enhanced ultrasound ANNA/C-TRUS and HistoScanning were also critically assessed during the same session.

There was unanimous agreement that standardisation, training and quality control are mandatory and essential before MRI or its alternatives (based on ultrasound) could reliably be used on a large-scale in daily practice outside specialised research centres. Well-designed trials are also necessary to clarify the real role of these tools and their potential in clinical practice. Future developments such as dispersion analysis for contrast enhanced ultrasound and multiparametric ultrasound were presented.

The ESUI organised a very informative round-table discussion with the industry to improve communication and interaction between clinicians and engineers. Such meetings are important since the needs of urologists and radiologists can be conveyed and joint efforts implemented to improve the quality of care. With the value of round-table discussions, the ESUI will organise them as regular feature in future meetings.

With the success and the very positive feedback from the participants, the 4th ESUI meeting is planned for November 12, 2015 again in conjunction with the 7th EMUC in Barcelona. Save the date and we hope to see you in Barcelona!