Magnetic Resonance Imaging of the Prostate in the PI-RADS Era [chapter]

Bernd Hamm, Patrick Asbach
2018 IDKD Springer Series  
Over the past years, continuing technical innovation in combination with a broad research activity has resulted in a high diagnostic accuracy of magnetic resonance imaging (MRI) of the prostate. At the same time, the Prostate Imaging Reporting and Data System (PI-RADS) has standardized image acquisition and reporting and facilitated the communication of imaging findings to the urologist and can therefore be considered an obligatory key element in prostate MRI. This has had a tremendous impact
more » ... the diagnostic workup of patients with suspected prostate cancer, with MRI being incorporated in multiple prostate cancer guidelines (e.g., NICE, AUA, German S3-Guideline) by now. As a direct result, imaging-based targeted prostate biopsy has increased almost at the same speed, and urologists not only heavily rely on accurate interpretation of MRI of the prostate but actively claim high-quality MRI scans for their daily practice because prostate MRI has direct impact on their cancer detection rate. Furthermore, a paradigm shift is taking place in the urological community regarding the care of lowgrade prostate cancer patients, where therapy is more and more replaced by active surveillance (AS). Prostate MRI plays an important role in AS not only during the initial assessment whether the patient is a candidate for AS but also during the surveillance of the disease. Therefore, any abdominal and genitourinary radiologist if not already performing prostate MRI will subsequently be involved, and we forecast prostate MRI to be an indispensable diagnostic step for any patient with a clinical suspicion for prostate cancer or during surveillance of low-grade prostate cancer in the near future. PI-RADS The European Society of Uroradiology (ESUR) has introduced PI-RADS (Prostate Imaging Reporting and Data System) in 2012. An updated version (PI-RADS v2) was published in 2015 in collaboration with the American College of Radiology (ACR) and the AdMeTech Foundation. PI-RADS is not based on evidence from clinical research trials rather than on expert knowledge; however, several studies have confirmed that the PI-RADS system improves the diagnostic accuracy of mpMRI. The overall rationale for implementation of PI-RADS was to "improve detection, localization, characterization, and risk stratification in patients with suspected cancer in treatment naïve prostate glands." PI-RADS is currently not applicable to assess treatment response in prostate cancer patients. The following specific definitions and aims regarding MR imaging and reporting are targeted by PI-RADS: Learning Objectives • To understand the current role of prostate MRI for imaging-based targeted prostate biopsy, staging, and active surveillance • To learn how to optimize the multiparametric prostate MR imaging protocol • To illustrate how to use the PI-RADS classification for prostatic lesion assessment • To understand the need of structured reporting in communicating with the urologists • To discuss the most common pitfalls in multiparametric MRI of the prostate
doi:10.1007/978-3-319-75019-4_11 fatcat:k5cbssazorgzjkjghvr7wxrdpm