Prostate Cancer: Detection using Multiparametric 1H-MRI
Magnetic resonance imaging (MRI) offers the possibility to accurately detect, localize, and stage prostate cancer, thereby assisting in the selection of an individualized course of treatment. Conventional, anatomical MRI (T2-weighted MRI) lacks the required sensitivity and specificity, in identifying prostate cancer foci, especially in the transition zone, in areas of post-biopsy hemorrhage, and in the setting of post-treatment change. In addition, T2-weighted MRI is suboptimal in determining the presence of extracapsular extension (ECE), which can be the most important factor for selection of an individualized therapy and for predicting the risk of tumor recurrence. Advanced MRI techniques comprising of dynamic contrast enhanced -MRI (DCE-MRI) that provides vascular information, diffusion-weighted MRI (DWI) that provides biophysical information, and magnetic resonance spectroscopic imaging (MRSI) that provides metabolic information can assist in overcoming the limitations of conventional anatomical MRI. In this article, we provide a brief review of these advanced imaging techniques and how they correlate with pathologic findings in prostate cancer. Advanced MRI techniques may increase the specificity of conventional MRI by identifying functional, metabolic, and microstructural changes of the prostate that occur in areas of cancer. MRSI and DWI have added value in detecting tumor within the transitional zone of the prostate, while MRSI and DCE may assist in predicting the presence of ECE, as well as in evaluating for recurrent tumor following hormonal or radiation therapy. Using a combined multi-parametric approach can provide a thorough evaluation for the presence and extent of prostate cancer using MRI.
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