Implementation of Multi-parametric Prostate MRI in Clinical Practice

Abstract

While initial implementations of prostate MRI suffered from suboptimal performance in tumor detection, technological advances over the past decade have allowed modern multi-parametric prostate MRI (mpMRI) to achieve high diagnostic accuracy for detection, localization, and staging and thereby impact patient management. A particular emerging application of mpMRI is in the pre-biopsy setting to allow for MRI-targeted biopsy, for instance, through real-time MRI/ultrasound fusion, which may help reduce the over-detection of low-risk disease and selectively detect clinically significant cancers, in comparison with use of standard systematic biopsy alone. mpMRI and MRI-targeted biopsy are spreading beyond the large academic centers to increasingly be adopted within small and community practices. Aims of this review article are to summarize the hardware and sequences used for performing mpMRI, explore patient specific technical considerations, delineate approaches for study interpretation and reporting [including the recent American College of Radiology Prostate Imaging Reporting and Data System (PI-RADS) version 2], and describe challenges and implications relating to the widespread clinical implementation of mpMRI.

Multiparametric Ultrasound Approach Using a Tree-Based Decision Classifier for Inconclusive Focal Liver Lesions Evaluated by Contrast Enhanced Ultrasound

“…The concept was mainly used for prostate cancer evaluation and staging due to the lack of specificity of conventional methods (prostate-specific antigens, digital rectal examination, and transrectal ultrasound biopsy). Prostate MRI provides an excellent assessment of the standard anatomical sequence, and the additional information from the contrast medium offers high accuracy for tumor detection localization and staging, thus influencing related management [18].…”

Quantitative analysis of diffusion-weighted magnetic resonance images: differentiation between prostate cancer and normal tissue based on a computer-aided diagnosis system

“…Previous studies have shown that the PI-RADS v2 also requires that many image features of DWI be used for image interpretation, such as dimension, boundary, shape, signal intensity, and homogeneity (Weinreb et al, 2016). However, each image feature of DWI for PCa diagnosis was weighted differently (Westphalen and Rosenkrantz, 2014) and interpretation was subjective, which resulted in diagnosis performance that was highly reader-dependent (Kierans et al, 2015;Muller et al, 2015;Schimmöller et al, 2013). Therefore, it is reasonable that the features of DWI be extracted and weighted in the CAD system.…”

“…MpMRI is based on complicated imaging principles and various signal characteristics. Despite its potential, the interpretation of results by radiologists, especially for less experienced ones, is difficult (Kierans et al, 2015). Although the PI-RADS has recommendations for image reading and reporting, the inter-reader agreement of mpMRI interpretations remains barely satisfactory (Muller et al, 2015;Schimmöller et al, 2013).…”

Routine systematic prostate biopsies not replaced by magnetic resonance imaging-targeted biopsy

“…The advances in imaging technology have led to improvements in early detection, whereby the detection of CSPCa has become more frequent for urologists 4,5 . Prostate magnetic resonance imaging (MRI) has been in use for nearly two decades.…”

“…Prostate magnetic resonance imaging (MRI) has been in use for nearly two decades. Initially, its utility was mainly for disease localization and staging after histopathologic diagnosis was reached 4 . At present, it is used not only for detecting suspicious foci but also for targeting the prostate biopsies 5 .…”