Value of Multiparametric MRI in the Work-up of Prostate Cancer

Abstract

The role of magnetic resonance imaging (MRI) in prostate cancer evaluation is controversial and likely underestimated. Technological advances over the past 5 years have demonstrated that multiparametric MRI, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI, can evaluate the actual tumor burden of a newly diagnosed prostate cancer more accurately than sextant biopsy protocols. Tumor risk, defined by the D'Amico criteria, hence can be re-evaluated by multiparametric MRI. As a result, there is increasing evidence that MRI before repeat or even initial biopsy can accurately select patients who require immediate biopsies and those in whom biopsy could be deferred. Also, a relationship between apparent diffusion coefficient (ADC), calculated from DWI, and Gleason score was found. Thus, MRI before biopsy helps to detect high-grade tumors to target biopsies within areas of low ADC values. To achieve good targeting accuracy, transrectal ultrasound (TRUS)-MRI image registration is necessary. Three-dimensional deformable registration is sufficiently accurate to match TRUS and MRI volumes with a topographic precision of 1 mm. Real-time MRI-guided biopsy is another technique under evaluation. Both approaches will allow for increasing acceptance of focal therapies, should these techniques be validated in the future.

Low Temperature Plasma: A Novel Focal Therapy for Localized Prostate Cancer?

“…The prostate zones are clearly visualized using MRI [87]. However, standard MRI is not accurate enough to determine precise location and diagnosis, where multiparametric MRI is required [88]. This includes diffusion-weighted imaging (DWI-MRI) that measures water diffusivity, dynamic contrast enhanced (DCE-MRI), making use of a contrast agent, and proton magnetic resonance spectroscopic imaging (H MRSI) that measures metabolites (citrate, choline, creatine, and polyamines), the ratios of which change between normal and cancerous prostate [89].…”

A Randomized Controlled Trial To Assess and Compare the Outcomes of Two-core Prostate Biopsy Guided by Fused Magnetic Resonance and Transrectal Ultrasound Images and Traditional 12-core Systematic Biopsy

“…The median time lag between MRI and biopsy was 7 d (interquartile range 2-10 d). An Accuvix-V10 ultrasound machine with an end-firing threedimensional transrectal transducer (Medison, Seoul, Korea) and a computer-assisted elastic image fusion system with real-time 3D tracking technology (UroStation; Koelis, Grenoble, France) were used for all patients[5,[7][8][9][10].…”

Role of Multiparametric MR Imaging in Malignancies of the Urogenital Tract

“…Initially limited to disease staging in patients with a known diagnosis of prostate cancer, MR imaging is now accepted as the most accurate imaging technique for detection and localization of cancer in the prostate. 104,105 Preoperative imaging for disease localization may help determine whether nerve-sparing surgery or focal therapies can be pursued. 106–108 The development of MR imaging–transrectal ultrasound (TRUS) image fusion software has further expanded the utility of MR imaging in evaluating patients with rising prostate-specific antigen (PSA) levels and prior negative systematic TRUS biopsies.…”