Multiparametric magnetic resonance imaging of the prostate: current concepts

Abstract

Multiparametric MR (mpMR) imaging is rapidly evolving into the mainstay in prostate cancer (PCa) imaging. Generally, the examination consists of T2-weighted sequences, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) evaluation, and less often proton MR spectroscopy imaging (MRSI). Those functional techniques are related to biological properties of the tumor, so that DWI correlates to cellularity and Gleason scores, DCE correlates to angiogenesis, and MRSI correlates to cell membrane turnover. The combined use of those techniques enhances the diagnostic confidence and allows for better characterization of PCa. The present article reviews and illustrates the technical aspects and clinical applications of each component of mpMR imaging, in a practical approach from the urological standpoint.

Diffusion Weighted Imaging in Magnetic Resonance Imaging for Prostate Cancer Diagnosis: Current Efficiency as a Standalone Sequence for an Unenhanced MRI Experience - a Pilot Study

“…We analyzed the data using the EpiInfo v 7.1.4.0 (Centers for Disease Control and Prevention, Atlanta, USA) and the IBM-SPSS V19.0 demo (SPSS Inc, an IBM company) software. After dichotomization of the initial PI-RADS classification as benign (1, 2) and malignant (3,4,5), clinical efficiency indicators (sensitivity, specificity, positive and negative likelihood ratio) were calculated for qualitative DWI, referring to the gold standard. ADC values were analyzed according to the final diagnosis.…”

“…DCE has more of an orientating role, being used mainly when in doubt [2].The use of intravenous gadolinium in DCE can have its setbacks, mainly in the chronic renal failure patients where, for uncertain reasons, there is a risk for a severe disease called Nephrogenic Systemic Fibrosis [3].A potential solution could be the use of sequences as standalone techniques for asuperior native non-contrast -enhanced MpMRI. The main candidate is DWI, with its assessment of water diffusion (and thus cellularity) and also its pre-disposition to artifacts (by movement or eddy currents) requiring special examination techniques like the use of an endorectal coil for 1.5 T scanners [4,5]. However, this can cause discomfort for the patient, increase movement artifacts and influence interpretation.…”

Evaluation of the indications for performing magnetic resonance imaging of the female pelvis at a referral center for cancer, according to the American College of Radiology criteria

“…In oncology, MRI can provide morphological information such as size, contours, number of lesions, edema, necrosis, relationship to adjacent structures, physiological alterations, and cellular metabolism, allowing a more complete evaluation in terms of disease distribution and activity. MRI has been increasingly indicated for the management of cancer patients in Brazil ( 1 - 11 ) .…”

MRI assessment of tissue effects after 180‐W XPS greenlight laser vaporization of the prostate

“…Up to now, only one study assessed the tissue effects of PVP in humans and reported unexpected depth of necrosis using contrast enhanced ultrasonography evaluation (ECUS) . MRI is now considered the standard imaging method to accurately evaluate the tissue effects of local treatments in prostatic diseases, especially with laser sources .…”