Assessing the utilization of functional imaging in multiparametric prostate MRI in routine clinical practice

To evaluate the utilization of functional imaging tests in multiparametric (mp)-MRI of the prostate in routine practice and to assess whether education improves usage.

With research ethics board approval, 254 patients underwent mp-MRI [diffusion-weighted imaging (DWI) and dynamic contrast enhancement (DCE)] over a 1-year period at a single tertiary-care referral centre for prostate disease. All studies were reported by fellowship-trained abdominal radiologists. To determine to what extent parametric tests were used, radiology reports were searched for terms indicating usage of DWI/DCE and studies were reviewed to determine whether post-processing of DCE was performed. Midway through the study, an internal continuing medical education (CME) programme was instituted (consisting of lectures, electronic reading material, intra- and inter-departmental prostate rounds) and a standardized reporting template was introduced. Utilization of functional imaging was compared between radiologists by years of experience and by number of examinations interpreted, by study indication, and before and after CME.

Overall, both DWI and DCE were used in 50.7% of examinations. DWI (67.3%) was more frequently used than DCE (56.3%). DCE contrast curves were generated in 33.5% of studies, and quantitative analysis was performed in only one patient. Use of parametric tests was higher after CME (60.6% versus 40.4%), p = 0.009. There was no correlation between the use of parametric tests and years of experience, (p = 0.94), and there was no association with the number of examinations interpreted (p = 0.19-0.97). There was no association between the use of parametric tests and study indication, (p = 0.16); however, contrast curves were produced more frequently in non-staging studies, (p = 0.027).

Parametric tests were underutilized in routine practice. DWI was used more commonly than DCE. CME was associated with increased utilization of mp-MRI.