A fair number of studies have been performed to assess the value of DCE-MRI in PCa. Hara et al.62 showed that DCE-MRI was able to detect clinically
important PCa in 93% of the cases, with TRUS-guided biopsy as the gold standard. In patients with at least two negative TRUS-guided biopsy sessions and rising PSA level, MR imaging plays an important role63.
DCE-MRI is of importance in localization and staging of PCa (Fig. 2); several studies have found that DCE MRI is superior to T2-weighted MR imaging for PCa localization. The authors’ group showed in a recent study that the area under the ROC-curve (AUC) for localizing PCa increased significantly from 0.68 with T2-weighted imaging to 0.91 when adding DCE-MRI26. DCE-MRI is
less accurate in the localization of tumor within the TZ, whereas PZ localization is markedly improved. Although the literature is sparse on the
Figure 2
68-year-old man with prostate cancer of the right peripheral zone(A) Axial T2-weighted MR image shows a low signal intensity area in the right peripheral zone. Color parametric maps were calculated (B) and demonstrated increased washout in the right peripheral zone, (C and D) increased Ktrans and k
ep. (E)
ADC map at the same level as in image A shows reduced ADC compared with the normal peripheral zone. (F) Histo- pathology confirmed these findings and showed a tumor with Gleason Score of 4+3=7 (red area).
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Computer-assisted diagnosis seems to perform at least at a comparable level as conventional ADC mapping.
The strength of DWI and DCE-MRI might be in its potential to characterize tumors and possibly predict tumor behavior, making it a valuable tool in selecting patients for different therapies or active surveillance.
Summary
DWI is an advanced MR imaging technique that still needs to be clinically validated in addition to the more commonly used anatomic MR imaging sequences, such as high-resolution T2-weighted imaging. With the increasing availability of 3-T systems, and with the concomitant use of an endorectal coil, the quality of prostate DWI will further improve and this will likely increase its clinical usefulness.
DCE-MRI of the prostate is increasingly recognized as a potential tool for imaging of PCa, helping PCa localization, and improving local staging performance for less experienced readers. This technique should always be used in conjunction with T2-weighted imaging. Differentiation of prostatitis and BPH from PCa is inadequate with current anatomic MR imaging techniques. The combination of T2-weighted imaging, DWI and DCE-MRI (multiparametric MR imaging) may overcome these limitations and may be able accurately to detect, localize, stage, and grade PCa.
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