Multiparametric magnetic resonance imaging (mpMRI) of the prostate has become the standard of care in prostate cancer imaging during the last decade. mpMRI plays an important role in biopsy planning, local staging, as well as active surveillance. The currently recommended protocol of the European Society of Urology consists of the following sequences: T2-weighted turbo spin echo (TSE) imaging in three planes with a slice thickness of 3 mm without gaps and with high morphological resolution. Furthermore, diffusion-weighted imaging (DWI) including apparent diffusion coefficient maps (ADC) as well as dynamic contrast-enhanced imaging should be acquired, to provide further parameters for analysis. Additionally, a precontrast T1-weighted sequence of the pelvis with a larger field of view should be acquired, for lymph node staging as well as for assessment of pelvic bones. A disadvantage of...

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We retrospectively analyzed 140 patients who underwent 1.5T mp-MRI of the prostate followed by 12-core transrectal ultrasound (TRUS) guided biopsy between January 2018 and July 2021.

Images were acquired under fasting conditions with a 1.5 T scanner (Optima MR450w, GE Healthcare, Milwaukee, Illinois, USA) using a 32-channel phased-array coil combined with air-inflated endorectal coil (Medrad, Indianola, Pa). Imaging protocol included three orthogonal T2w sequences, axial Diffusion Weighted Imaging (DWI) and Dynamic Contrast Enhanced (DCE) which was triggered to start simultaneously with the power injection of 0.1 mmol/kg gadobutrol (Gadovist, Bayer Schering, Berlin, Germany) through a peripheral line at 0.7 mL/s, followed by infusion of 20 cc normal saline at the same rate. Axial DWI was acquired at b-values of 0, 1000 and 2000 s/mm2. The average time to complete the whole MRI...

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At pathological analysis we found csPCa in 100 patients (only index lesions were included), all 40 patients without diagnosis of PCa had a negative 12-core TRUS-guided prostate biopsy.

Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of monoparametric MRI for PCa were respectively 87%, 80%, 85%, 91,5% (Table 1) and 71%, while for mpMRI 98%, 87,5%, 95%, 93%, 94,5% (Table 2).

Interprotocol agreement between the two protocols was good (k= 0,79). 13 csPCas were not identified by monoparametric MRI (all with predominant Gleason Pattern of 3); two Gleason 3+3 PCas were misdiagnosed also by mpMRI (Figure 1 and 2).

Although the detection of csPCa with fast-MRI was comparatively lower than that with mpMRI, the diagnostic performance was still high in fast-MRI. The interprotocol agreement was good.

Our study has several limitation. First it is a retrospective study with a small number of patients. In addition MRI were analyzed by a single reader, who however had over 8 years of experience in interpreting prostate MRI and inter-reader agreement was not evaluated.

Though there are distinct indications and benefits in some cases to using the standard mpMRI, fast-MRI can allow for increased access and MRI throughput while mitigating scan expense, allowing prostate MRI to become an effective csPCa screening tool.