EURURO Vol. 73 No. 1

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interpretation of the MRI in classifying metastatic burden,
but it is only fair to recognise that the BCV used represents
current practice for metastatic confirmation owing to the
difficulty and clinical impracticality of taking multiple
metastatic biopsies. The analytical study factor with the
potential to exaggerate the overall statistical result was
incorporation of only the highest scan accuracy interpreta-
tion when multiple independent readers were used. The
final result also fails to incorporate ‘‘real world’’ interob-
server scan report variability, which may expose less
reliable MRI capabilities. Another major drawback in all
the studies is that in the absence of a truly definitive
reference standard, there has been no reported long-term
follow-up of lesion regression or progression, which might
have bolstered the reader’s confidence in the absolute
veracity of the results.
Is help for the confused clinician at hand to help in
deciding which imaging modality to use? The relative
comparison and replacement of scintigraphy with MRI has
been characterized by a slow and patchy evolution, but uro-
radiologists and uro-oncologists now seem to be rising to
the challenge of modernisation by recognising that the
traditional imaging modalities are probably unfit for
purpose in the modern era. Expert groups have now been
established to develop a rational and usable collaborative
framework for MRI use and reporting . This is a
significant step forward that will help in establishing the
advantages and disadvantages of switching techniques.
However, this alone is not sufficient. It is also incumbent on
clinicians and cancer trial designers to incorporate tightly
drawn imaging protocols within clinical trials and collabo-
rative registration studies so that robust evidence can be
gathered for the future. As a community we have been slow
to develop this unified approach to imaging, but it is hoped
that lost ground can be recovered and perhaps, with the
help of highlight reviews such as this, we can avoid making
the same mistake with positron emission tomography
scanning, for which a headlong rush to publish multiple
articles—often of low quality, frequently uninformative, and
sometimes misleading—based on case series of ever larger
volume is evident . Would it not be good to know in a
short number of years that we are imaging usefully and
cost-effectively and that decisions to switch modalities are
based on a solid foundation of evidence? Perhaps, in our
future decision-making and data-gathering, we should
learn the lesson of history to avoid repeating the mistakes
of the past.
Conflicts of interest: The authors have nothing to disclose.
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