Prostate Cancer: Multiparametric MR Imaging for Detection, Localization, and Staging

Abstract

This review presents the current state of the art regarding multiparametric magnetic resonance (MR) imaging of prostate cancer. Technical requirements and clinical indications for the use of multiparametric MR imaging in detection, localization, characterization, staging, biopsy guidance, and active surveillance of prostate cancer are discussed. Although reported accuracies of the separate and combined multiparametric MR imaging techniques vary for diverse clinical prostate cancer indications, multiparametric MR imaging of the prostate has shown promising results and may be of additional value in prostate cancer localization and local staging. Consensus on which technical approaches (field strengths, sequences, use of an endorectal coil) and combination of multiparametric MR imaging techniques should be used for specific clinical indications remains a challenge. Because guidelines are currently lacking, suggestions for a general minimal protocol for multiparametric MR imaging of the prostate based on the literature and the authors' experience are presented. Computer programs that allow evaluation of the various components of a multiparametric MR imaging examination in one view should be developed. In this way, an integrated interpretation of anatomic and functional MR imaging techniques in a multiparametric MR imaging examination is possible. Education and experience of specialist radiologists are essential for correct interpretation of multiparametric prostate MR imaging findings. Supportive techniques, such as computer-aided diagnosis are needed to obtain a fast, cost-effective, easy, and more reproducible prostate cancer diagnosis out of more and more complex multiparametric MR imaging data.

Malakoplakia of the prostate masquerading as locally advanced prostate cancer on mpMRI

“…(0.84 and 0.68, respectively in intermediate risk patients). 2 The mpMRI findings in the current patient by themselves were consistent with locally advanced disease, but these were clearly discrepant from the biopsy findings, which showed minimal cancer on the left side of the prostate, where the tumour was described as abutting the rectum. The patient was keen to avoid radiation, and, with chronic obstructive voiding symptoms due to a very large prostate, was most interested in surgical resection.…”

Practical aspects of prostate MRI: hardware and software considerations, protocols, and patient preparation

“…Additionally, several studies have reported promising findings on the utility of DCE parameters in discriminating prostate cancer based on aggressiveness of the disease [91,92]. While DCE is an invaluable sequence in certain instances where other acquisition sequences will show artifact (i.e., for patients with hip replacements), DCE results might be confounded by the presence of prostatitis in the peripheral zone [1,5,93] or by mixed BPH nodules in the central gland [1,5,94,95].…”

“…Since these characteristics are different for malignant and benign tissues, highresolution mpMRI provides valuable data that helps characterize the extent and biological behavior of prostate cancer. Owing to these capabilities, MR imaging of the prostate is increasingly being used to assist patients and clinicians to make management decisions [4][5][6][7][8].…”

A clinical assessment of external beam focal therapy for localized prostate cancer measured by Gafchromic film

“…This is now possible by incorporating an MRI based imaging technique called multiparametric magnetic resonance imaging (mpMRI). MpMRI consists of complementing T1 and T2 weighted anatomic imaging with functional MR techniques including diffusion weighted imaging (DWI) and dynamic contrast-enhanced (DCE) imaging [4,5]. The imaging potential of mpMRI has undergone scrutinizing validation studies comparing mpMRI image sets directly with radical prostatectomy specimens that have been whole mounted in sections [6].…”