Role of Multiparametric Magnetic Resonance in the study of the Prostate

Abstract

Magnetic resonance imaging is the fastest and least invasive diagnostic method for the study of the prostate. The method's multiparametricity allows the acquisition of the images highlighting different characteristics in relation to the different sampling sequences. In particular, the MRI investigation plays a role in: • risk stratification and staging of the tumor, therefore active surveillance • detection of prostate cancer; • localization and characterization of prostate cancer before performing a procedure (pre-biopsy, pre-surgery, or radiation therapy); • procedural guide (targeted biopsy guide). The study protocol includes T2-weighted sequences on an axial and sagittal plane, diffusion-weighted sequences for the functional study (DWI) with high b values, contrast dynamic sequences (DCE-MRI), T1-weighted sequences with a large FOV. The study protocol here presented follows the latest PI-RADS v2.1 guidelines. The axial scan plans are acquired according to the anatomical axis of the gland. In our protocol we add a further neutral T2 weighing, a sequence that will be subsequently used for the coupling of images with fusion techniques, such as target-biopsy. The adoption of PI-RAADS v2.1, the most recent update of the system, improves the assessment of intra-patient injury variability and simplifies the general assessment of the prostate in magnetic resonance imaging. The magnetic resonance examination thus obtained allows the correct overlap of the lesion anatomy with the ultrasound image TRUS acquired with the Fusion technique, used for targeted biopsy sampling.