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Updated: Apr 6, 2026
A Cognitive Fusion-guided Prostate Biopsy Using Multiparametric Magnetic Resonance Imaging and Transrectal Ultrasound
Published on: March 21, 2025
Evolution of multi-parametric MRI quantitative parameters following transrectal ultrasound-guided biopsy of the
A Latifoltojar1, N Dikaios1, A Ridout2
1Centre for Medical Imaging, University College London, London, UK.
Background:
To determine the evolution of prostatic multi-parametric magnetic resonance imaging (mp-MRI) signal following transrectal ultrasound (TRUS)-guided biopsy.
Methods:
Local ethical permission and informed written consent was obtained from all the participants (n=14, aged 43-69, mean 64 years). Patients with a clinical suspicion of prostate cancer (PSA range 2.2-11.7, mean 6.2) and a negative (PIRAD 1-2/5) pre-biopsy mp-MRI (pre-contrast T1, T2, diffusion-weighted and dynamic-contrast-enhanced MRI) who underwent 10-core TRUS-guided biopsy were recruited for additional mp-MRI examinations performed at 1, 2 and 6 months post biopsy. We quantified mp-MRI peripheral zone (PZ) and transition zone (TZ) normalized T2 signal intensity (nT2-SI); T1 relaxation time (T10); diffusion-weighted MRI, apparent diffusion coefficient (ADC); dynamic contrast-enhanced MRI, maximum enhancement (ME); slope of enhancement (SoE) and area-under-the-contrast-enhancement-curve at 120 s (AUC120). Significant changes in mp-MRI parameters were identified by analysis of variance with Dunnett's post testing.
Results:
Diffuse signal changes were observed post-biopsy throughout the PZ. No significant signal change occurred following biopsy within the TZ. Left and right PZ mean nT2-SI (left PZ: 5.73, 5.16, 4.90 and 5.12; right PZ: 5.80, 5.10, 4.84 and 5.05 at pre-biopsy, 1, 2 and 6 months post biopsy, respectively) and mean T10 (left PZ: 1.02, 0.67, 0.78, 0.85; right PZ: 1.29, 0.64, 0.78, 0.87 at pre-biopsy, 1, 2 and 6 months post biopsy, respectively) were reduced significantly (P<0.05) from pre-biopsy values for up to 6 months post biopsy. Significant changes (P<0.05) of PZ-ME and AUC120 were observed at 1 month but resolved by 2 months post biopsy. PZ ADC did not change significantly following biopsy (P=0.23-1.0). There was no significant change of any TZ mp-MRI parameter at any time point following biopsy (P=0.1-1.0).
Conclusions:
Significant PZ (but not TZ) T2 signal changes persist up to 6 months post biopsy, whereas PZ and TZ ADC is not significantly altered as early as 1 month post biopsy. Caution must be exercised when interpreting T1- and T2-weighted imaging early post biopsy, whereas ADC images are more likely to maintain clinical efficacy.
Insights
Prostate multi-parametric MRI (mp-MRI) shows significant peripheral zone (PZ) T2 signal changes for up to six months after transrectal ultrasound (TRUS)-guided biopsy. Apparent diffusion coefficient (ADC) values remain reliable for interpretation post-biopsy.
Area of Science:
- Radiology
- Oncology
- Urology
Background:
- Prostate biopsies can alter MRI signal intensity.
- Understanding these changes is crucial for accurate cancer detection and monitoring.
Purpose of the Study:
- To investigate the temporal evolution of prostatic multi-parametric MRI (mp-MRI) signal changes after transrectal ultrasound (TRUS)-guided biopsy.
Main Methods:
- 14 patients with suspected prostate cancer underwent serial mp-MRI (T1, T2, diffusion-weighted, dynamic-contrast-enhanced) at 1, 2, and 6 months post-biopsy.
- Quantified signal intensity, relaxation time, apparent diffusion coefficient (ADC), and contrast enhancement parameters in peripheral (PZ) and transition zones (TZ).
Main Results:
- Diffuse PZ signal changes and reduced T2 signal intensity persisted up to 6 months post-biopsy (P<0.05).
- Contrast enhancement changes in the PZ resolved by 2 months.
- No significant changes were observed in the TZ or in PZ/TZ ADC values at any time point.
Conclusions:
- Prostate biopsy induces persistent T2 signal alterations in the PZ for up to 6 months.
- Apparent diffusion coefficient (ADC) imaging is less affected and maintains clinical utility post-biopsy.
- Caution is advised when interpreting T1- and T2-weighted MRI early after biopsy.
