Multiparametric Magnetic Resonance Imaging in the Detection of Prostate Cancer

 

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Abstract

Prostate cancer is the most common malignancy in men, but only about 10% of patients die from that cancer. Recent studies suggest that not all patients benefit from a radical therapeutic approach. When prostate cancer is suspected, magnetic resonance imaging (MRI) can make an important contribution to cancer localization within the prostate. Many studies show that T2-weighted morphologic imaging should be supplemented by multiparametric MRI techniques including diffusion-weighted imaging, contrast-enhanced sequences, and MR spectroscopy. This approach detects aggressive prostate cancer with high sensitivity and specificity. The findings of multiparametric MRI additionally contribute information to the assessment of cancer aggressiveness. The use of these multiparametric MRI techniques will gain an increasing role in the clinical management of prostate cancer patients. They can help in establishing a definitive diagnosis with a minimum of invasiveness and may also contribute to optimal individualized treatment. This review article presents the different techniques of multiparametric MRI and discusses their contribution to the detection of prostate cancer. Moreover, this review outlines an objective approach to image interpretation and structured reporting of MRI findings using the PI-RADS criteria. The review concludes with an outline of approaches to prostate biopsy on the basis of MRI (transrectal ultrasound, direct MRI guidance of tissue sampling, and MRI-ultrasound fusion biopsy) and emerging future uses of MRI in the planning of focal treatment options and in the active surveillance of patients diagnosed with prostate cancer.

Zusammenfassung

Das Prostatakarzinom ist der häufigste bösartige Tumor des Mannes; allerdings versterben nur ca. 10% der Patienten am Prostatakarzinom. Studien der letzten Jahre legen nahe, dass nicht jeder Patient von einer radikalen Therapie profitiert. Bei Verdacht auf Prostatakarzinom kann die MRT einen wichtigen Beitrag zur Tumordetektion leisten. Eine Vielzahl von Studien konnte zeigen, dass T2-gewichtete morphologische Bildgebung im Sinne einer multiparametrischen MRT durch diffusionsgewichtete, kontrastmittelgestützte und MR-spektroskopische Bildgebung ergänzt warden sollte. Insbesondere aggressive Karzinome können mit hoher Sensitivität und Spezifität entdeckt werden. Die multiparametriche MRT kann darüber hinaus einen Beitrag zur Aggressivitätsbeurteilung leisten. Die Anwendung dieser Techniken wird in den nächsten Jahren im Management von Patienten mit Prostatakarzinom eine zunehmende Bedeutung erlangen. Sie werden nicht nur dabei helfen, auf möglichst wenig invasive Art die endgültige Diagnose zu sichern, sondern möglicherweise auch dieWahl der für den individuellen Patienten optimal geeigneten Therapieoption beeinflussen. In der vorliegenden Arbeit werden die verschiedenen Techniken der multiparametrischen MRT sowie ihre Bedeutung hinsichtlich der Tumordetektion vorgestellt. Es werden die Objektivierung der Bildinterpretation, die strukturierte Befundung anhand der PI-RADS Kriterien sowie die Verfahren zur bioptischen Befundsicherung auf Basis der MRT (transrektaler Ultraschall, direkte MR-geführte Biopsie und MRT-Ultraschall-Fusionsbiopsie) beleuchtet. Abschließend wird auf mögliche zukünftige Indikationen der MRT hinsichtlich der Planung fokaler Therapien und der aktiven Überwachung von Patienten mit gesichertem Prostatakarzinom eingegangen.

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