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Klinischer Stellenwert kontrastmittelfreier Kurzprotokolle in der Magnetresonanztomographie

Clinical impact of abbreviated unenhanced prostate protocols in magnetic resonance imaging

Zusammenfassung

Hintergrund

Dem Prostate Imaging Reporting and Data System (PI-RADS) v2.1 zufolge stellt der Einsatz der multiparametrischen Magnetresonanztomographie (mpMRT) mit Gadolinium(Gd)-haltigen Kontrastmitteln (KM) den Standard in der Diagnostik des Prostatakarzinoms (PCa) dar. Aktuelle Untersuchungen weisen darauf hin, dass kontrastmittelfreie Kurzprotokolle, sog. biparametrische MRT(bpMRT)-Protokolle bei spezifischen Indikationen der mpMRT gleichwertig sind.

Ziel der Arbeit

Beurteilung von Indikation und Stellenwert kontrastmittelfreier Kurzprotokolle in der Diagnostik des PCa.

Material und Methoden

Es erfolgte eine Evaluation klinischer Studien, aktueller Leitlinien und Expertenempfehlungen.

Ergebnisse

Der Einsatz von dynamischen kontrastverstärkten MRT-Sequenzen (DCE) geht mit potenziellen KM-assoziierten Nebenwirkungen einher und wirkt sich erheblich auf den Ablauf der MRT-Untersuchung und die Kosten der Untersuchung aus. Vor- und Nachteile der Kontrastmittelanwendung sollen abgewogen und die indikationsbezogene Äquivalenz von bpMRT und mpMRT diskutiert werden.

Schlussfolgerung

Die Indikation zur bpMRT kann aktuell nur bei sehr guter Bildqualität und umfangreicher Erfahrung in der Befundung der Prostata-MRT gestellt werden. Es besteht Bedarf an prospektiven Studien, um die bpMRT als primäres diagnostisches Verfahren in der Primärdiagnostik des PCa zu qualifizieren.

Abstract

Background

According to the Prostate Imaging Reporting and Data System (PI-RADS) v2.1 multiparametric magnetic resonance imaging (mpMRI) with gadolinium-(Gd)-based contrast agents is the diagnostic standard of care in the detection of prostate cancer (PCa). Recent data suggest equivalent performance of biparametric MRI (bpMRI) and mpMRI in defined indications.

Objectives

Evaluation of the current role of abbreviated or unenhanced protocols in MRI of the prostate in various clinical settings.

Materials and methods

Evaluation of clinical trials, guidelines and expert opinions.

Results

The use of dynamic contrast-enhanced (DCE) MRI sequences is associated with contrast agent-associated risks and has significant impact on the imaging procedure and costs. Arguments for and against the use of contrast agent in prostate protocols as well as equivalence from bpMRI and mpMRI are discussed.

Conclusions

Currently, bpMRI can only be performed if very good image quality is available and in the hands of a radiologist with extensive experience in reading prostate MRI. There is a need for prospective studies to qualify bpMRI as the diagnostic method for the primary diagnosis of PCa.

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Abbreviations

ADC:

Apparent diffusion coefficient

BpMRT:

Biparametrische Magnetresonanztomographie

CsPCa:

Klinisch signifikantes Prostatakarzinom

DCE:

Dynamische kontrastmittelverstärkte MRT

DWI:

Diffusionsgewichtete MRT

Gd:

Gadolinium

GFR:

Glomeruläre Filtrationsrate

KM:

Kontrastmittel

MpMRT:

Multiparametrische Magnetresonanztomographie

PCa:

Prostatakarzinom

PI-RADS:

Prostate Imaging Reporting and Data System

PSA:

Prostataspezifisches Antigen

PZ:

Periphere Zone

TZ:

Transitionszone

T2w:

T2-gewichtete MRT

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Correspondence to Olga Solyanik.

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Interessenkonflikt

O. Solyanik und M. Heimer geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Solyanik, O., Heimer, M. Klinischer Stellenwert kontrastmittelfreier Kurzprotokolle in der Magnetresonanztomographie. Radiologe 61, 810–817 (2021). https://doi.org/10.1007/s00117-021-00890-8

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Schlüsselwörter

  • Prostatakarzinom
  • Biparametrische Magnetresonanztomographie
  • Multiparametrische Magnetresonanztomographie
  • Prostate Imaging Reporting and Data System
  • Gadolinium

Keywords

  • Prostate cancer
  • Biparametric magnetic resonance imaging
  • Multiparametric magnetic resonance imaging
  • Prostate Imaging Reporting and Data System
  • Gadolinium