Prostate MRI: Who, when, and how? Report from a UK consensus meeting

Kirkham, Alex; Haslam, Philip; Keanie, Julian; McCafferty, Ian; Padhani, Anwar R.; Punwani, Shonit; Richenberg, Jonathan; Rottenberg, Giles; Sohaib, Aslam; Thompson, Pauline; Turnbull, Lindsay W.; Kurban, Lutfi; Sahdev, Anju; Clements, R.; Carey, B.; Allen, Clare

doi:10.1016/j.crad.2013.03.030

Cited by 82 publications

(84 citation statements)

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“…Use of mpMRI exams for the diagnosis and staging of prostate cancer has become prominent at medical centers around the world [164][165][166] and is likely to continue expanding into increasing modalities in the age of precision medicine. However, mpMRI of the prostate did not yet gain the same level of acceptance of other imaging tests; and this is at least in part due to the use of suboptimal protocols, lack of standardization, and inadequate patient preparation.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2015

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The use of multiparametric MRI scans for the evaluation of men with prostate cancer has increased dramatically and is likely to continue expanding as new developments come to practice. However, it has not yet gained the same level of acceptance of other imaging tests. Partly, this is because of the use of suboptimal protocols, lack of standardization, and inadequate patient preparation. In this manuscript, we describe several practical aspects of prostate MRI that may facilitate the implementation of new prostate imaging programs or the expansion of existing ones.

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Section: Resultsmentioning

confidence: 99%

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

et al. 2015

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“…15,31,32 MRI may in the future be performed prior to biopsy as a strategy to triage men with raised PSA and to select the best approach for biopsy. 3,20 This study has shown that initial mpMRI missed at least 1 focus of cancer in 29/148 (19.6%) of patients, corresponding to 46 lesions, 65% of which were considered significant cancers.…”

Section: Discussionmentioning

confidence: 99%

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

Serrao

Barrett

Wadhwa

et al. 2015

CUAJ

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Introduction: We characterized false negative prostate magnetic resonance imaging (MRI) reporting by using histology derived from MRI-transrectal ultrasound (TRUS)-guided transperineal (MTTP) fusion biopsies.Methods: In total, 148 consecutive patients were retrospectively reviewed. Men underwent multiparametric MRI (mpMRI), reported by a consultant/attending radiologist in line with European Society of Urogenital Radiology (ESUR) standards. MTTP biopsy of the lesions was performed according to the Ginsburg recommendations. Cases with an MRI-histology mismatch were identified and underwent a second read by an experienced radiologist. A third review was performed with direct histology comparison to determine a true miss from an MRI-occult cancer. Statistical analysis was performed with McNemar's test. Results: False negative lesions were identified in 29 MRI examinations (19.6%), with a total of 46 lesions. Most false negative lesions (21/46) were located in the anterior sectors of the prostate. The second read led to a significant decrease of false-negative lesions with 7/29 further studies identified as positive on a patientby-patient basis (24.1% of studies, p = 0.016) and 11/46 lesions (23.9%; p = 0.001). Of these, 30 lesions following the first read and 23 lesions after the second read were considered significant cancer according to the University College London criteria. However, on direct comparison with histology, most lesions were MRI occult. Conclusion: We demonstrate that MRI can fail to detect clinically relevant lesions. Improved results were achieved with a second read but despite this, a number of lesions remain MRI-occult. Further advances in imaging are required to reduce false negative results. IntroductionCurrent methods for risk stratification of prostate cancer, including serum prostate-specific antigen (PSA) and transrectal ultrasound (TRUS)-guided biopsies, are limited by sampling error and low sensitivity and specificity.1-3 TRUSbiopsy can lead to inaccurate grading of 32% to 42% of cancers, 4-6 and may fail to detect 30% to 50% of cancers, particularly tumours in the anterior portion of the prostate. 7-12The improvement in multiparametric magnetic resonance imaging (mpMRI) in detecting prostate cancer has led to its recommendation in high-risk patients following a negative TRUS biopsy.13 MRI can then be used to guide subsequent biopsy either cognitively, in-bore (direct MRI-targeting), or by using MRI-TRUS fusion techniques.14-17 The latter combines anatomical MRI localization with the real-time guidance of ultrasound. Repeat biopsy is often undertaken by the transperineal (TP) route as this offers potential advantages over a transrectal route, including better sampling of the anterior and apical regions of the prostate, reduced false negative results, and a sterile approach. 18 mpMRI has the potential to accurately exclude prostate cancer and reduce biopsy burden. 19,20 To achieve this, it must have a high negative predictive value (NPV) on a patient-by-patient basis and maintain ...

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“…[5,8,[28][29][30][31][32]33 & ]. It has been proven that referring physicians prefer structured reports, and that structured reports are evidence of the reader's training and knowledge in the domain [34].…”

Section: Reporting Of Significant Imagesmentioning

confidence: 99%

How are we going to train a generation of radiologists (and urologists) to read prostate MRI?

Puech

Randazzo

Ouzzane

et al. 2015

Current Opinion in Urology

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PURPOSE OF REVIEW Multiparametric MRI has gained tremendous importance in the daily practice for patients at risk or diagnosed with prostate cancer. Interpretation of multiparametric-MRI is a complex task, supposedly restricted to experienced radiologists. The purpose of this review is to analyze fundamentals of multiparametric-MRI interpretation and to describe how multiparametric-MRI training could be organized. RECENT FINDINGS Recently, professional guidelines have been published to provide technical and interpretation frameworks and harmonize multiparametric-MRI practice, but the question of physicians training in prostate multiparametric-MRI reading is still pending. What kind of education, practice, and training makes a radiologist able to reliably interpret a prostate multiparametric-MRI? How can findings be reported to be easily understood? How much experience is needed? How can we train urologists and other physicians to review the examinations they request? Is double-reading necessary? SUMMARY An institutional-based competency certification process for prostate multiparametric-MRI interpretation may encourage nonspecialized radiologists to qualify for prostate imaging in a standardized and reproducible way, exactly as urologists need it. Purpose of review Multiparametric MRI has gained tremendous importance in the daily practice for patients at risk or diagnosed with prostate cancer. Interpretation of multiparametric-MRI is a complex task, supposedly restricted to experienced radiologists. The purpose of this review is to analyze fundamentals of multiparametric-MRI interpretation and to describe how multiparametric-MRI training could be organized. Recent findingsRecently, professional guidelines have been published to provide technical and interpretation frameworks and harmonize multiparametric-MRI practice, but the question of physicians training in prostate multiparametric-MRI reading is still pending. What kind of education, practice, and training makes a radiologist able to reliably interpret a prostate multiparametric-MRI? How can findings be reported to be easily understood? How much experience is needed? How can we train urologists and other physicians to review the examinations they request? Is double-reading necessary? Summary An institutional-based competency certification process for prostate multiparametric-MRI interpretation may encourage nonspecialized radiologists to qualify for prostate imaging in a standardized and reproducible way, exactly as urologists need it.

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Prostate MRI: Who, when, and how? Report from a UK consensus meeting

Cited by 82 publications

References 57 publications

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

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

Investigating the ability of multiparametric MRI to exclude significant prostate cancer prior to transperineal biopsy

How are we going to train a generation of radiologists (and urologists) to read prostate MRI?

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