Multiparametric prostate MRI scans have changed urological practice in the management of suspected prostate cancer.

This examination allows for a more individual analysis of this complex disease, and thereby to choose the best treatment. For this reason, these MRI scans should be done thoroughly and by an experienced team.

The technical aspect is important to obtain high quality images. However, all phases, from preparation to the patient's biopsy, should be respected, and always with a patient-centred approach. The key to success is teamwork.

The multiparametric MRI performed with a 3-Tesla system involves morphological and metabolic sequences of the prostate for detecting small cancers at an early stage. Image acquisition is quick and painless. Associated with clinical analysis, this technique is valuable in the diagnosis of prostate diseases. If a suspicious lesion is discovered, the radiologist marks the target in order to guide the urologist for a biopsy.

Indications for prostate MRI

Tumour detection and characterisation
Guided biopsy

  • MRI ultrasound fusion
  • Perineal biopsies

Mapping intraprostatic lesions to aid the therapeutic decision

  • Radical or focal treatment
  • Active surveillance (inclusion and monitoring)

Pretreatment staging

  • Exploration of relapse
  • Interventional procedure guidance (per-op)

The radiological report is done rigorously according to the recommendations of the ESUR guidelines, including the PI-RADS score for risk stratification. According to the literature, MRI performance for the identification of cancer has an excellent negative predictive value of 97% in peripheral areas for lesions larger than 0.5 cc.

Multidisciplinary meetings and radio-pathological conferences help improve the management of this “chameleon” disease.

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Axial T2: suspicious nodule, anterior right
Merged T2-weighted + DWI B1500 image: shows perfect correlation of the two sequencesDynamic sequence after gadolinium injection: suspicious lesion on early-phase contrast-enhanced images, anterior rightExample of a radio-pathological correlation. Prostate segmentation used worldwideMartina Martins Favre MD, tel. +4122 818 58 65, www.imadev.ch