What are the advantages of multi-parametric magnetic resonance imaging (mpMRI) in the staging of prostate cancer?

Updated: Jan 15, 2019
  • Author: Lanna Cheuck, DO; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

Answer

Guidelines from the NCCN [23] and the European Association of Urology [17] note that evidence supports the use of multi-parametric MRI (mpMRI)—that is, the combination of T2-weighted images with diffusion-weighted imaging, dynamic contrast enhanced imaging, or H1-spectroscopy—in prostate cancer staging. The advantages of mpMRI include the following [23] :

  • Detection of large and poorly differentiated tumors (ie, Gleason score ≥7)
  • T staging: Detection of extracapsular extension, with high negative predictive values in low-risk men
  • N staging: MpMRI is equivalent to CT scan
  • M staging: MpMRI outperforms bone scan and targeted x-rays for M staging, with 98-100% sensitivity and specificity

Although MRI is superior to bone scanning in evaluating bone metastasis, it is impractical for routine total-body surveys. Instead, it is used to determine the etiology of questionable lesions found on bone scans. Bone-scan examples are seen below.

Anterior and posterior bone scans of a patient wit Anterior and posterior bone scans of a patient with prostate cancer, with metastasis to the 12th rib and thoracic spine represented by the increased uptake of isotope.

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