Learning objectives
To describe multi-parametric prostate MRI technique.
To describe MRI imaging of significant prostate cancer according to thePIRADS lexicon.
To educate radiologists on multi-parametric prostate MRI reporting,
enhancedrepoducibility and reduced variability in imaging interpretation.
To assess concordance off multi-parametric MRI with histopathology.
Background
Prostate cancer is the most common cancer in males in the UK (13% of new cancer diagnosis).
The 10 year survival is approximately 84%(1).
Clinical behaviour varies from indolent disease to aggressive tumors,
potentially leading to over diagnosis and overtreatment of the indolent tumors (2,
3).
Conversely,
tumor in some sites of the prostate especially the anterior aspect may be potentially underestimated with systematic ultrasound-guided biopsies(2). Patients are either managed expectantly or actively and followed up with PSA,
digital rectal examination and multi-parametric MRI.
Patients...
Findings and procedure details
Multiparametric (mp) MRI of the prostate entails functional imaging sequences in addition to the standard anatomical T1WI and T2WI imaging.
The functional sequences of choice are dynamic contrast-enhanced (DCE) MRI and diffusion-weighted imaging (DWI) and calculation of apparent diffusion co-efficient (ADC) maps.
MR spectroscopy is no longer considered essential for multi-parametric MRI and is not recommended in PIRADS v2(5).
Typical imaging consists of T2WI imaging small field of view in three planes,
unenhanced T1-weighted axial imaging,
axial DCE- over ideally 3 - 4 minutes,
and...
Conclusion
Multi-parametric MRI is useful in lesion detection,
characterization and staging of prostate cancer.
It is also useful in targeting prostate biopsies.
Direct comparison of histopathological specimen to the multi-parametric MRI sequences has provided useful insight to the imaging appearances of clinically significant tumor.
Personal information
1.
Edward C Nganga oncology imaging fellow,
Royal Marsden NHS trust London UK.
2.
Dalia Kazzaz oncology imaging fellow,
Royal Marsden NHS trust London UK.
3.
Derfel apDafydd consultant radiologist,
Royal Marsden NHS trust London UK.
References
1.
UK CR.
Prostate cancer statistics.
2014.
2.
Barrett T.
What is Multiparametric-MRI of the Prostate and Why Do We Need It? 2015.
3.
Steiger P,
Thoeny HC.
Prostate MRI based on PI-RADS version 2: how we review and report.
Cancer Imaging.
2016;16(1):9.
4.
Graham J,
Kirkbride P,
Cann K,
Hasler E,
Prettyjohns M.
Prostate cancer: summary of updated NICE guidance.
BMJ: British Medical Journal (Online).
2014;348.
5.
Radiology ACo.
PIRADS v2.
Reston,
VA: American College of Radiology.
2014.
6.
Vargas HA,
Hötker AM,
Goldman...
