The steadily increasing demand for diagnostic prostate MRI has led to concerns regarding the lack of access to, and the availability of qualified MRI scanners, and sufficiently experienced radiologists and radiographers/technologists to meet the demand. Solutions must enhance operational benefits without compromising diagnostic performance, quality and delivery of service. Solutions should also mitigate risks, such as decreased reader confidence and referrer engagement. One approach may be the implementation of MRI without the use gadolinium-based contrast medium (also referred to as "biparametric MRI"), but only if certain prerequisites such as high-quality imaging, expert interpretation quality, and availability of patient recall or on-table monitoring are mandated. Alternatively, or in combination, a clinical risk-based approach could be used to decide on protocol selection, specifically which biopsy naïve man needs MRI with contrast (multiparametric MRI). There is a need for prospective studies where biopsy decisions are based upon MRI without contrast. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast. These higher quality data are needed before the PI-RADS Committee can make evidence-based recommendations about MRI without contrast as an initial diagnostic approach for prostate cancer work-up.
AJR. American journal of roentgenology. 2020 Aug 19 [Epub ahead of print]
Ivo G Schoots, Jelle O Barentsz, Leonardo K Bittencourt, Masoom A Haider, Katarzyna J Macura, Daniel J A Margolis, Caroline M Moore, Aytekin Oto, Valeria Panebianco, Mohummad M Siddiqui, Clare Tempany, Baris Turkbey, Geert M Villeirs, Jeffrey C Weinreb, Anwar R Padhani
Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, and Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands., Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands., Dasa Company and Fluminense Federal University, Rio de Janeiro, Brazil., Joint Department Medical Imaging, Sinai Health System, University Health Network, University of Toronto, Toronto, Ontario, Canada., Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA., Department of Radiology, Weill Cornell Medical College, New York, NY., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Radiology, University of Chicago Medicine, Chicago, IL, USA., Department of Radiological Sciences, Oncology & Pathology, Sapienza, University of Rome, Italy., Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD USA., Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA., Molecular Imaging Program, NCI, NIH, Bethesda, MD., Division of Genitourinary Radiology, Ghent University Hospital, Ghent, Belgium., Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT USA., Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom.