Korean J Radiol.  2017 ;18(4):597-606. 10.3348/kjr.2017.18.4.597.

Multiparametric MRI in the Detection of Clinically Significant Prostate Cancer

• Fütterer

• KMID: 2427228
• DOI: http://doi.org/10.3348/kjr.2017.18.4.597

Abstract

Prostate cancer is the most common cancer among men aged 50 years and older in developed countries and the third leading cause of cancer-related death in men. Multiparametric prostate MR imaging is currently the most accurate imaging modality to detect, localize, and stage prostate cancer. The role of multi-parametric MR imaging in the detection of clinically significant prostate cancer are discussed. In addition, insights are provided in imaging techniques, protocol, and interpretation.

Keyword

MRI prostate cancer; Magnetic resonance imaging; Multiparametric MRI; Prostate; PI-RADS

MeSH Terms

Humans
Image-Guided Biopsy
*Magnetic Resonance Imaging
Male
Prostate-Specific Antigen/blood
Prostatic Neoplasms/*diagnostic imaging/pathology
Prostate-Specific Antigen

Figure

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  Fig. 1 61-year-old male with fluctuating PSA and current PSA level of 7.5 ng/mL.Prior biopsy session revealed no prostate cancer. A. T2-weighted MR imaging demonstrates asymmetric right peripheral zone with volume loss. Low signal intensity can be observed in right peripheral zone. B, C. ADC map (B) demonstrates intermediate signal intensity in right peripheral zone (arrows) and high b-value image (C) demonstrate intermediate to high signal intensity (arrow). D. T1-weighted post-contrast image demonstrates early uptake of contrast material in right peripheral zone (arrows). MR image guided biopsy revealed prostatitis and fibrosis. ADC = apparent diffusion coefficient, PSA = prostatespecific antigen

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  Fig. 2 75-year-old male with PSA level of 21 ng/mL.T2-weighted MR imaging reveals multiple BPH nodules (organized chaos) in transition zone. BPH = benign prostatic hyperplasia, PSA = prostate-specific antigen

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  Fig. 3 62-year-old male with PSA level of 5.6 ng/mL.A. T2-weighted MR imaging reveals low signal intensity lesion (arrow) in right apex. B, C. ADC map (B) demonstrates distinct low signal intensity in right peripheral zone (arrow) and high b-value image (C) demonstrates high signal intensity (arrow). D. T1-weighted post-contrast image demonstrates early uptake of contrast material at corresponding location (arrow) (A-C). MR image targeted biopsy revealed Gleason 4 + 3 prostate cancer. ADC = apparent diffusion coefficient, PSA = prostate-specific antigen

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  Fig. 4 78-year-old male with PSA level of 10.2 ng/mL and two negative prior transrectal ultrasound-guided biopsy sessions.A. T2-weighted MR imaging reveals low signal intensity lesion (arrows) in right peripheral zone. B. ADC map is not diagnostic as result of bilateral hip implants. C. T1-weighted post-contrast image demonstrates early uptake of contrast material at corresponding location (arrow) (A). MR image targeted biopsy revealed Gleason 3 + 4 prostate cancer. ADC = apparent diffusion coefficient, PSA = prostate-specific antigen

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  Fig. 5 68-year-old male with PSA level of 2.5 ng/mL.A. T2-weighted MR imaging reveals low signal intensity lesion (arrows) in left peripheral zone. B, C. ADC map (B) demonstrates distinct low signal intensity (arrows) and high b-value image (C) demonstrates high signal intensity at corresponding location (arrow) (A). D. T1-weighted post-contrast image demonstrates early uptake of contrast material (arrows) at corresponding location (A-C). MR image targeted biopsy revealed chronic prostatitis. ADC = apparent diffusion coefficient, PSA = prostate-specific antigen

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  Fig. 6 64-year-old male with PSA level of 4.9 ng/mL.A. T2-weighted MR imaging reveals mild low signal intensity area (arrows) in left peripheral zone at base of prostate. B, C. ADC map (B) demonstrates mild low signal intensity (arrows) and high b-value image (C) demonstrates no high signal intensity at corresponding location (arrows) (A). D. T1-weighted post-contrast image demonstrates early uptake of contrast material (arrows) at corresponding location (A-C). Final PI-RADS assessment was 2. Clinical suspicion persisted and patient underwent MR image targeted biopsy which revealed Gleason 4 + 3 prostate cancer. ADC = apparent diffusion coefficient, PI-RADS = Prostate Imaging Reporting And Data System, PSA = prostate-specific antigen

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