Abdominal Imaging

, Volume 39, Issue 5, pp 1036–1051

Interpretation and reporting multiparametric prostate MRI: a primer for residents and novices

  • Sandeep S. Hedgire
  • Steven C. Eberhardt
  • Rachel Borczuk
  • Shaunagh McDermott
  • Mukesh G. Harisinghani
Review Paper


Multiparametric MRI has developed as a tool for prostate cancer lesion detection, characterization, staging, surveillance, and imaging of local recurrence. Given the disease frequency and the growing importance of imaging, as reliance on PSA declines, radiologists involved in prostate MRI imaging must become proficient with the fundamentals of multiparametric prostate MRI (T2WI, DWI, DCE-MRI, and MR spectroscopy). Interpretation and reporting must yield accuracy, consistency, and add value to clinical care. This review provides a primer to novices and trainees learning about multiparametric prostate MRI. MRI technique is presented along with the use of particular MRI sequences. Relevant prostate anatomy is outlined and imaging features of prostate cancer with staging are discussed. Finally structured reporting is introduced, and some limitations of prostate MRI are discussed.


Prostate cancer Multiparametric MRI Interpretation and reporting of prostate MRI Diffusion-weighted MRI Dynamic contrast-enhanced MRI (DCE-MRI) 


  1. 1.
  2. 2.
    Prostate Cancer Information from Drugs.com. http://www.drugs.com/cancer-prostate.html.
  3. 3.
  4. 4.
    Eberhardt SC, Carter S, Casalino DD, et al. (2013) ACR appropriateness criteria prostate cancer: pretreatment detection, staging, and surveillance. J Am Coll Radiol 10(2):83–92PubMedCrossRefGoogle Scholar
  5. 5.
    Cirillo S, Petracchini M, Della Monica P, et al. (2008) Value of endorectal MRI and MRS in patients with elevated prostate-specific antigen levels and previous negative biopsies to localize peripheral zone tumours. Clin Radiol 63(8):871–879PubMedCrossRefGoogle Scholar
  6. 6.
    Franiel T, Stephan C, Erbersdobler A, et al. (2011) Areas suspicious for prostate cancer: MR-guided biopsy in patients with at least one transrectal US-guided biopsy with a negative finding-multiparametric MR imaging for detection and biopsy planning. Radiology 259(1):162–172PubMedCrossRefGoogle Scholar
  7. 7.
    Hambrock T, Somford DM, Hoeks C, et al. (2010) Magnetic resonance imaging guided prostate biopsy in men with repeat negative biopsies and increased prostate specific antigen. J Urol 183(2):520–527PubMedCrossRefGoogle Scholar
  8. 8.
    Roethke M, Anastasiadis AG, Lichy M, et al. (2012) MRI-guided prostate biopsy detects clinically significant cancer: analysis of a cohort of 100 patients after previous negative TRUS biopsy. World J Urol 30(2):213–218PubMedCrossRefGoogle Scholar
  9. 9.
    Barentsz JO, Richenberg J, Clements R, et al. (2012) ESUR prostate MR guidelines 2012. Eur Radiol 22(4):746–757PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Cooperberg MR, Carroll PR, Klotz L (2011) Active surveillance for prostate cancer: progress and promise. J Clin Oncol 29(27):3669–3676PubMedCrossRefGoogle Scholar
  11. 11.
    Berglund RK, Masterson TA, Vora KC, et al. (2008) Pathological upgrading and up staging with immediate repeat biopsy in patients eligible for active surveillance. J Urol 180(5):1964–1967 (discussion 1967–1968)PubMedCrossRefPubMedCentralGoogle Scholar
  12. 12.
    Margel D, Yap SA, Lawrentschuk N, et al. (2012) Impact of multiparametric endorectal coil prostate magnetic resonance imaging on disease reclassification among active surveillance candidates: a prospective cohort study. J Urol 187(4):1247–1252PubMedCrossRefGoogle Scholar
  13. 13.
    Bouchelouche K, Turkbey B, Choyke P, Capala J (2010) Imaging prostate cancer: an update on positron emission tomography and magnetic resonance imaging. Curr Urol Rep 11(3):180–190PubMedCrossRefPubMedCentralGoogle Scholar
  14. 14.
    Rosenkrantz AB, Mussi TC, Hindman N, et al. (2012) Impact of delay after biopsy and post-biopsy haemorrhage on prostate cancer tumour detection using multi-parametric MRI: a multi-reader study. Clin Radiol 67(12):e83–e90PubMedCrossRefGoogle Scholar
  15. 15.
    Murphy G, Haider M, Ghai S, Sreeharsha B (2013) The expanding role of MRI in prostate cancer. Am J Roentgenol 201(6):1229–1238CrossRefGoogle Scholar
  16. 16.
    Rosen Y, Bloch BN, Lenkinski RE, et al. (2007) 3 T MR of the prostate: reducing susceptibility gradients by inflating the endorectal coil with a barium sulfate suspension. Magn Reson Med 57(5):898–904PubMedCrossRefGoogle Scholar
  17. 17.
    Engelbrecht MR, Jager GJ, Laheij RJ, et al. (2002) Local staging of prostate cancer using magnetic resonance imaging: a meta-analysis. Eur Radiol 12(9):2294–2302PubMedCrossRefGoogle Scholar
  18. 18.
    Wagner M, Rief M, Busch J, et al. (2010) Effect of butylscopolamine on image quality in MRI of the prostate. Clin Radiol 65(6):460–464PubMedCrossRefGoogle Scholar
  19. 19.
    Qayyum A, Coakley FV, Lu Y, et al. (2004) Organ-confined prostate cancer: effect of prior transrectal biopsy on endorectal MRI and MR spectroscopic imaging. AJR Am J Roentgenol 183(4):1079–1083PubMedCrossRefGoogle Scholar
  20. 20.
    Girouin N, Mège-Lechevallier F, ToninaSenes A, et al. (2007) Prostate dynamic contrast-enhanced MRI with simple visual diagnostic criteria: is it reasonable? Eur Radiol 17(6):1498–1509PubMedCrossRefGoogle Scholar
  21. 21.
    Verma S, Turkbey B, Muradyan N, et al. (2012) Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol 198(6):1277–1288PubMedCrossRefGoogle Scholar
  22. 22.
    Scheenen TWJ, Fütterer J, Weiland E, et al. (2011) Discriminating cancer from noncancer tissue in the prostate by 3-dimensional proton magnetic resonance spectroscopic imaging: a prospective multicenter validation study. Investig Radiol 46(1):25–33CrossRefGoogle Scholar
  23. 23.
    Kobus T, Vos PC, Hambrock T, et al. (2012) Prostate cancer aggressiveness: in vivo assessment of MR spectroscopy and diffusion-weighted imaging at 3 T. Radiology 265(2):457–467PubMedCrossRefGoogle Scholar
  24. 24.
    Valentini AL, Gui B, D’Agostino GR, et al. (2012) Locally advanced prostate cancer: three-dimensional magnetic resonance spectroscopy to monitor prostate response to therapy. Int J Radiat Oncol Biol Phys 84(3):719–724PubMedCrossRefGoogle Scholar
  25. 25.
    Roy C, Foudi F, Charton J, et al. (2013) Comparative sensitivities of functional MRI sequences in detection of local recurrence of prostate carcinoma after radical prostatectomy or external-beam radiotherapy. AJR Am J Roentgenol 200(4):W361–W368PubMedCrossRefGoogle Scholar
  26. 26.
    NICE (n.d.) CG58 Prostate cancer: NICE guidance. NICE.Google Scholar
  27. 27.
    McNeal JE (1988) Normal histology of the prostate. Am J Surg Pathol 12(8):619–633PubMedCrossRefGoogle Scholar
  28. 28.
    McNeal JE, Redwine EA, Freiha FS, Stamey TA (1988) Zonal distribution of prostatic adenocarcinoma. Correlation with histologic pattern and direction of spread. Am J Surg Pathol 12(12):897–906PubMedCrossRefGoogle Scholar
  29. 29.
    Ravizzini G, Turkbey B, Kurdziel K, Choyke PL (2009) New horizons in prostate cancer imaging. Eur J Radiol 70(2):212–226PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Verma S, Rajesh A (2011) A clinically relevant approach to imaging prostate cancer: review. AJR Am J Roentgenol 196(3 Suppl):S1–S10PubMedCrossRefGoogle Scholar
  31. 31.
    Puech P, Huglo D, Petyt G, Lemaitre L, Villers A (2009) Imaging of organ-confined prostate cancer: functional ultrasound, MRI and PET/computed tomography. Curr Opin Urol 19(2):168–176PubMedCrossRefGoogle Scholar
  32. 32.
    Sooriakumaran P, Tan GY, Grover S, Takenaka A, Tewari AK (2013) Anatomical aspects of the neurovascular bundle in prostate surgery. In: John H, Wiklund P (eds) Robotic urology. Berlin: Springer, pp 199–207CrossRefGoogle Scholar
  33. 33.
    Kim B, Kawashima A, Ryu J-A, et al. (2009) Imaging of the seminal vesicle and vas deferens. Radiographics 29(4):1105–1121PubMedCrossRefGoogle Scholar
  34. 34.
    Wang L, Mazaheri Y, Zhang J, et al. (2008) Assessment of biologic aggressiveness of prostate cancer: correlation of MR signal intensity with Gleason grade after radical prostatectomy. Radiology 246(1):168–176PubMedCrossRefGoogle Scholar
  35. 35.
    Aydin H, Kizilgöz V, Tatar IG, et al. (2012) Detection of prostate cancer with magnetic resonance imaging: optimization of T1-weighted, T2-weighted, dynamic-enhanced T1-weighted, diffusion-weighted imaging apparent diffusion coefficient mapping sequences and MR spectroscopy, correlated with biopsy and histopathological findings. J Comput Assist Tomogr 36(1):30–45PubMedCrossRefGoogle Scholar
  36. 36.
    Chen M, Dang H-D, Wang J-Y, et al. (2008) Prostate cancer detection: comparison of T2-weighted imaging, diffusion-weighted imaging, proton magnetic resonance spectroscopic imaging, and the three techniques combined. Acta Radiol 49(5):602–610PubMedCrossRefGoogle Scholar
  37. 37.
    Tan CH, Wei W, Johnson V, Kundra V (2012) Diffusion-weighted MRI in the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol 199(4):822–829PubMedCrossRefPubMedCentralGoogle Scholar
  38. 38.
    Koo JH, Kim CK, Choi D, et al. (2013) Diffusion-weighted magnetic resonance imaging for the evaluation of prostate cancer: optimal B value at 3 T. Korean J Radiol 14(1):61–69PubMedCrossRefPubMedCentralGoogle Scholar
  39. 39.
    Kitajima K, Kaji Y, Kuroda K, Sugimura K (2008) High b-value diffusion-weighted imaging in normal and malignant peripheral zone tissue of the prostate: effect of signal-to-noise ratio. Magn Reson Med 7(2):93–99CrossRefGoogle Scholar
  40. 40.
    Akgun V, Karaman B, Battal B, Sari S (2013) Re: diffusion-weighted imaging of prostate cancer: how can we use it accurately? Korean J Radiol 14(5):865PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Bae H, Yoshida S, Matsuoka Y, et al. (2013) Apparent diffusion coefficient value as a biomarker reflecting morphological and biological features of prostate cancer. Int Urol Nephrol. doi:10.1007/s11255-013-0557-1.
  42. 42.
    Nagarajan R, Margolis D, Raman S, et al. (2012) Correlation of Gleason scores with diffusion-weighted imaging findings of prostate cancer. Adv Urol 2012:374805PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Peng Y, Jiang Y, Yang C, et al. (2013) Quantitative analysis of multiparametric prostate MR images: differentiation between prostate cancer and normal tissue and correlation with Gleason score: a computer-aided diagnosis development study. Radiology 267(3):787–796PubMedCrossRefGoogle Scholar
  44. 44.
    Park SY, Kim CK, Park BK, Lee HM, Lee KS (2011) Prediction of biochemical recurrence following radical prostatectomy in men with prostate cancer by diffusion-weighted magnetic resonance imaging: initial results. Eur Radiol 21(5):1111–1118PubMedCrossRefGoogle Scholar
  45. 45.
    Van As NJ, de Souza NM, Riches SF, et al. (2009) A study of diffusion-weighted magnetic resonance imaging in men with untreated localised prostate cancer on active surveillance. Eur Urol 56(6):981–987PubMedCrossRefGoogle Scholar
  46. 46.
    Ocak I, Bernardo M, Metzger G, et al. (2007) Dynamic contrast-enhanced MRI of prostate cancer at 3 T: a study of pharmacokinetic parameters. AJR Am J Roentgenol 189(4):849PubMedGoogle Scholar
  47. 47.
    Yoshizako T, Wada A, Hayashi T, et al. (2008) Usefulness of diffusion-weighted imaging and dynamic contrast-enhanced magnetic resonance imaging in the diagnosis of prostate transition-zone cancer. Acta Radiol 49(10):1207–1213PubMedCrossRefGoogle Scholar
  48. 48.
    Kelloff GJ, Choyke P, Coffey DS, Prostate Cancer Imaging Working Group (2009) Challenges in clinical prostate cancer: role of imaging. AJR Am J Roentgenol 192(6):1455–1470PubMedCrossRefPubMedCentralGoogle Scholar
  49. 49.
    Kurhanewicz J, Vigneron DB, Hricak H, et al. (1996) Three-dimensional H-1 MR spectroscopic imaging of the in situ human prostate with high (0.24–0.7-cm3) spatial resolution. Radiology 198(3):795–805PubMedCrossRefGoogle Scholar
  50. 50.
    Verma S, Rajesh A, Fütterer JJ, et al. (2010) Prostate MRI and 3D MR spectroscopy: how we do it. AJR Am J Roentgenol 194(6):1414–1426PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Jung JA, Coakley FV, Vigneron DB, et al. (2004) Prostate depiction at endorectal MR spectroscopic imaging: investigation of a standardized evaluation system. Radiology 233(3):701–708PubMedCrossRefGoogle Scholar
  52. 52.
    Zakian KL, Eberhardt S, Hricak H, et al. (2003) Transition zone prostate cancer: metabolic characteristics at 1H MR spectroscopic imaging: initial results. Radiology 229(1):241–247PubMedCrossRefGoogle Scholar
  53. 53.
    Scheidler J, Hricak H, Vigneron DB, et al. (1999) Prostate cancer: localization with three-dimensional proton MR spectroscopic imaging: clinicopathologic study. Radiology 213(2):473–480PubMedCrossRefGoogle Scholar
  54. 54.
    Greene F (2002) AJCC cancer staging handbook, 6th edn. London: SpringerCrossRefGoogle Scholar
  55. 55.
    Bloch BN, Furman-Haran E, Helbich TH, et al. (2007) Prostate cancer: accurate determination of extracapsular extension with high-spatial-resolution dynamic contrast-enhanced and T2-weighted MR imaging: initial results. Radiology 245(1):176–185PubMedCrossRefGoogle Scholar
  56. 56.
    Cornud F, Flam T, Chauveinc L, et al. (2002) Extraprostatic spread of clinically localized prostate cancer: factors predictive of pT3 tumor and of positive endorectal MR imaging examination results. Radiology 224(1):203–210PubMedCrossRefGoogle Scholar
  57. 57.
    Yu KK, Hricak H, Alagappan R, et al. (1997) Detection of extracapsular extension of prostate carcinoma with endorectal and phased-array coil MR imaging: multivariate feature analysis. Radiology 202(3):697–702PubMedCrossRefGoogle Scholar
  58. 58.
    Outwater EK, Petersen RO, Siegelman ES, et al. (1994) Prostate carcinoma: assessment of diagnostic criteria for capsular penetration on endorectal coil MR images. Radiology 193(2):333–339PubMedCrossRefGoogle Scholar
  59. 59.
    Sala E, Akin O, Moskowitz CS, et al. (2006) Endorectal MR imaging in the evaluation of seminal vesicle invasion: diagnostic accuracy and multivariate feature analysis. Radiology 238(3):929–937PubMedCrossRefGoogle Scholar
  60. 60.
    Soylu FN, Peng Y, Jiang Y, et al. (2013) Seminal vesicle invasion in prostate cancer: evaluation by using multiparametric endorectal MR imaging. Radiology 267(3):797–806PubMedCrossRefGoogle Scholar
  61. 61.
    Claus FG, Hricak H, Hattery RR (2004) Pretreatment evaluation of prostate cancer: role of MR imaging and 1H MR spectroscopy. Radiographics 24(Suppl 1):S167–S180PubMedCrossRefGoogle Scholar
  62. 62.
    Wang L, Mullerad M, Chen H-N, et al. (2004) Prostate cancer: incremental value of endorectal MR imaging findings for prediction of extracapsular extension. Radiology 232(1):133–139PubMedCrossRefGoogle Scholar
  63. 63.
    Fütterer JJ, Barentsz JO, Heijmink SWTPJ (2008) Value of 3-T magnetic resonance imaging in local staging of prostate cancer. Top Magn Reson Imaging 19(6):285–289PubMedCrossRefGoogle Scholar
  64. 64.
    Ramchandani P, Schnall MD, LiVolsi VA, Tomaszewski JE, Pollack HM (1993) Senile amyloidosis of the seminal vesicles mimicking metastatic spread of prostatic carcinoma on MR images. AJR Am J Roentgenol 161(1):99–100PubMedCrossRefGoogle Scholar
  65. 65.
    Daneshmand S, Quek ML, Stein JP, et al. (2004) Prognosis of patients with lymph node positive prostate cancer following radical prostatectomy: long-term results. J Urol 172(6 Pt 1):2252–2255PubMedCrossRefGoogle Scholar
  66. 66.
    Fukuda H, Nakagawa T, Shibuya H (1999) Metastases to pelvic lymph nodes from carcinoma in the pelvic cavity: diagnosis using thin-section CT. Clin Radiol 54(4):237–242PubMedCrossRefGoogle Scholar
  67. 67.
    Brown G, Richards CJ, Bourne MW, et al. (2003) Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 227(2):371–377PubMedCrossRefGoogle Scholar
  68. 68.
    Yang WT, Lam WW, Yu MY, Cheung TH, Metreweli C (2000) Comparison of dynamic helical CT and dynamic MR imaging in the evaluation of pelvic lymph nodes in cervical carcinoma. AJR Am J Roentgenol 175(3):759–766PubMedCrossRefGoogle Scholar
  69. 69.
    Cooperberg MR, Broering JM, Carroll PR (2010) Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28(7):1117–1123PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Ben Cheikh A, Girouin N, Ryon-Taponnier P, et al. (2008) MR detection of local prostate cancer recurrence after transrectal high-intensity focused US treatment: preliminary results. J Radiol 89(5 Pt 1):571–577PubMedCrossRefGoogle Scholar
  71. 71.
    Vellet AD, Saliken J, Donnelly B, et al. (1997) Prostatic cryosurgery: use of MR imaging in evaluation of success and technical modifications. Radiology 203(3):653–659PubMedCrossRefGoogle Scholar
  72. 72.
    Akin O, Gultekin DH, Vargas HA, et al. (2011) Incremental value of diffusion weighted and dynamic contrast enhanced MRI in the detection of locally recurrent prostate cancer after radiation treatment: preliminary results. Eur Radiol 21(9):1970–1978PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Donati OF, Jung SI, Vargas HA, et al. (2013) Multiparametric prostate MR imaging with T2-weighted, diffusion-weighted, and dynamic contrast-enhanced sequences: are all pulse sequences necessary to detect locally recurrent prostate cancer after radiation therapy? Radiology 268(2):440–450PubMedCrossRefGoogle Scholar
  74. 74.
    De Visschere PJ, De Meerleer GO, Fütterer JJ, Villeirs GM (2010) Role of MRI in follow-up after focal therapy for prostate carcinoma. AJR Am J Roentgenol 194(6):1427–1433PubMedCrossRefGoogle Scholar
  75. 75.
    Pucar D, Shukla-Dave A, Hricak H, et al. (2005) Prostate cancer: correlation of MR imaging and MR spectroscopy with pathologic findings after radiation therapy: initial experience. Radiology 236(2):545–553PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Cirillo S, Petracchini M, Scotti L, et al. (2009) Endorectal magnetic resonance imaging at 1.5 Tesla to assess local recurrence following radical prostatectomy using T2-weighted and contrast-enhanced imaging. Eur Radiol 19(3):761–769PubMedCrossRefGoogle Scholar
  77. 77.
    Sella T, Schwartz LH, Swindle PW, et al. (2004) Suspected local recurrence after radical prostatectomy: endorectal coil MR imaging. Radiology 231(2):379–385PubMedCrossRefGoogle Scholar
  78. 78.
    Casciani E, Polettini E, Carmenini E, et al. (2008) Endorectal and dynamic contrast-enhanced MRI for detection of local recurrence after radical prostatectomy. AJR Am J Roentgenol 190(5):1187–1192PubMedCrossRefGoogle Scholar
  79. 79.
    Langer DL, van der Kwast TH, Evans AJ, et al. (2008) Intermixed normal tissue within prostate cancer: effect on MR imaging measurements of apparent diffusion coefficient and T2: sparse versus dense cancers. Radiology 249(3):900–908PubMedCrossRefGoogle Scholar
  80. 80.
    Choi YJ, Kim JK, Kim N, et al. (2007) Functional MR imaging of prostate cancer. Radiographics. 27(1):63–75 (discussion 75–77)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sandeep S. Hedgire
    • 1
  • Steven C. Eberhardt
    • 2
  • Rachel Borczuk
    • 1
  • Shaunagh McDermott
    • 1
  • Mukesh G. Harisinghani
    • 1
  1. 1.Department of Abdominal Imaging and InterventionMassachusetts General HospitalBostonUSA
  2. 2.Department of RadiologyUniversity of New MexicoAlbuquerqueUSA

Personalised recommendations