Multiparametric magnetic resonance imaging of the prostate: Lights and shadows

Abstract

Prostate cancer is the second most commonly diagnosed cancer in man. Since the first MRI was performed, enormous progress has been made in diagnosis, treatment, and follow up of PCa, mainly due to multiparametric prostatic MRI (mpMRI). Although mpMRI has become the best imaging tool for identifying PCa, some limitations still exist. Prostate imaging with mpMRI is, to date, the best way to locate suspicious lesions to trigger prostate biopsy, plan active surveillance, or definitive treatment. In case of relapse, mpMRI can help detect local disease and provide specific management. It is well known that there is a subset of patients in whom mpMRI fails to depict csPCa. These missed significant cancers demand great attention. Prostate mpMRI quality depends on several factors related to equipment (including equipment vendor, magnet field and gradient strength, coil set used, software and hardware levels, sequence parameter choices), patient (medications, body habitus, motion, metal implants, rectal gas), and most importantly the radiologic interpretation of images (learning curve effects, subjectivity of observations, interobserver variations, and reporting styles). Inter-reader variability represents a huge current limitation of this method. Therefore, mpMRI remains the best imaging tool available to detect PCa, guiding diagnosis, treatment, and follow up while inter-reader variability represents the best limitation. Radiomics can help identifying imaging biomarkers to help radiologist in detecting significant PCa, reducing examination times, and costs.

Biparametric MRI-based radiomics for noninvastive discrimination of benign and malignant prostate nodules: A bio-centric retrospective cohort study

“…However, PI-RADS-3 corresponds to CsPCa in less than 15% of patients [10]. Therefore, using mpMRI only to determine which patients should undergo biopsy is suboptimal [11]. Previous studies have shown that biparametric MRI, with its lower cost, no need of contrast agent, and shorter scanning time, is not inferior to, and even superior to, mpMRI in detecting PCa [12,13].…”

Novel Multiparametric Magnetic Resonance Imaging-Based Deep Learning and Clinical Parameter Integration for the Prediction of Long-Term Biochemical Recurrence-Free Survival in Prostate Cancer after Radical Prostatectomy

“…Generally, multiparametric magnetic resonance imaging (mpMRI) integrates conventional anatomic sequences (T1- and T2-weighted imaging) with functional sequences, such as diffusion-weighted MRI (DWI), including the calculation of apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) maps, and optionally, MR spectroscopy [ 8 , 9 , 10 , 11 , 12 ]. Owing to its superior spatial resolution, mpMRI is regarded as the most sensitive and specific imaging method for clinical staging, preoperative risk stratification, surgical planning, predicting the presence of clinically significant PCa, and monitoring recurrence following RP [ 1 , 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ].…”

“…Generally, multiparametric magnetic resonance imaging (mpMRI) integrates conventional anatomic sequences (T1- and T2-weighted imaging) with functional sequences, such as diffusion-weighted MRI (DWI), including the calculation of apparent diffusion coefficient (ADC) and dynamic contrast-enhanced (DCE) maps, and optionally, MR spectroscopy [ 8 , 9 , 10 , 11 , 12 ]. Owing to its superior spatial resolution, mpMRI is regarded as the most sensitive and specific imaging method for clinical staging, preoperative risk stratification, surgical planning, predicting the presence of clinically significant PCa, and monitoring recurrence following RP [ 1 , 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Noninvasive radiological assessment of anatomical, functional, and physiologic information about the entire prostate through preoperative mpMRI can overcome the known molecular heterogeneity and multifocality of PCa that can be neglected by conventional tools incorporating only clinicopathological factors [ 7 , 8 , 9 , 10 , 11 , 12 ].…”

“…Owing to its superior spatial resolution, mpMRI is regarded as the most sensitive and specific imaging method for clinical staging, preoperative risk stratification, surgical planning, predicting the presence of clinically significant PCa, and monitoring recurrence following RP [ 1 , 3 , 4 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Noninvasive radiological assessment of anatomical, functional, and physiologic information about the entire prostate through preoperative mpMRI can overcome the known molecular heterogeneity and multifocality of PCa that can be neglected by conventional tools incorporating only clinicopathological factors [ 7 , 8 , 9 , 10 , 11 , 12 ].…”