Accelerating prostate MRI: a practical review of modern acquisition strategies

Prostate MRI has become a key tool in the detection, localization, and staging of prostate cancer, as well as in active surveillance. Despite its diagnostic value, conventional PI-RADS v2.1-compliant protocols can exceed 30 min, with T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI) accounting for much of the scan time. Prolonged acquisitions have important clinical consequences, including increased patient motion, reduced image quality, compromised patient comfort, and limited scanner throughput, at a time when demand for prostate MRI has increased markedly. This review provides radiologists with a practical overview of modern acceleration strategies for prostate MRI that may reduce acquisition time while preserving PI-RADS v2.1 diagnostic requirements. We examine innovations in T2WI and DWI acquisition, including deep learning reconstruction, optimized 2D fast spin-echo sequences, near-isotropic 3D T2WI, synthetic high b-value DWI, and deep learning phase correction. In selected, locally validated implementations, accelerated prostate MRI may be performed more efficiently while retaining the PI-RADS-required sequence components. The strength of evidence varies across techniques. Among the approaches discussed, deep learning reconstruction for accelerated 2D T2-weighted imaging has the most mature supporting clinical evidence. Deep learning phase correction for DWI and use of near-isotropic 3D T2WI as a potential alternative to routine multiplanar 2D T2WI are newer approaches that require further validation before they can be broadly relied upon. Widespread implementation requires standardized local validation, ADC reproducibility assessment, and multicenter evaluation across vendors and field strengths. When carefully implemented, accelerated prostate MRI protocols can improve patient experience, reduce motion artifacts, and expand access to high-quality prostate MRI without sacrificing diagnostic reliability.