Is contrast enhancement needed for diagnostic prostate MRI?

Area of Science:

• Radiology
• Oncology
• Medical Imaging

Background:

• Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) guides prostate multiparametric MRI (mpMRI).
• mpMRI typically includes T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and dynamic contrast-enhanced MRI (DCE-MRI).
• The added value of DCE-MRI in prostate cancer (PCa) detection and management remains debated.

Purpose of the Study:

• To review the role of DCE-MRI in prostate cancer diagnosis.
• To evaluate the diagnostic contribution of biparametric MRI (bpMRI) comprising T2WI and DWI.
• To assess the significance of lesion volume evaluation in PCa diagnosis.

Main Methods:

• Review of existing literature on PI-RADS v2 and mpMRI protocols.
• Analysis of diagnostic performance comparing bpMRI (T2WI and DWI) with full mpMRI (including DCE-MRI).
• Evaluation of the impact of lesion volume assessment on PCa detection.

Main Results:

• DCE-MRI demonstrated a limited incremental contribution to diagnostic performance when combined with T2WI and DWI.
• Biparametric MRI (bpMRI), utilizing T2WI and DWI, showed significant potential for detecting suspected PCa lesions.
• Lesion volume evaluation may enhance the diagnostic utility of MRI in PCa management.

Conclusions:

• Biparametric MRI (bpMRI) is a potentially effective approach for prostate cancer detection and management.
• DCE-MRI may not be essential for routine prostate cancer assessment, simplifying MRI protocols.
• Further investigation into lesion volume assessment could refine PCa diagnosis using MRI.