Research conducted at the State University of New York Upstate Medical University has found that multiparametric MRI and subsequent fusion of MR images with ultrasound enables a targeted biopsy of high-suspicion foci with increased diagnostic accuracy of prostate cancer over established methods.

For patients on active surveillance for low-risk cancer, multiparametric MRI can better characterize the prostate gland and find occult foci of higher grade disease.

"The need to differentiate a clinically significant cancer from indolent cancers is a major challenge in current practice," said Sajeev Ezhapilli, MD. "Detection of occult lesions has a direct effect on management and may affect oncologic outcome."

The study was featured in an electronic exhibit at the ARRS 2015 Annual Meeting in Toronto.

Abstract

Urinary Imaging

E5317. Multiparametric MRI of the Prostate With Ultrasound Fusion Biopsy: A Problem-Solving Tool for Detection of Clinically and Sonographically Occult Prostate Cancer

EZHAPILLI S, Vourganti S, Wojtowycz A. State University of New York Upstate Medical University, SYRACUSE, United States

Background Information: Persistently rising prostate-specific antigen levels in a patient with a negative transrectal ultrasound-guided biopsy pose a common diagnostic challenge encountered in clinical practice. The need for differentiating a clinically significant cancer from indolent cancers is a major challenge in current practice. Detection of occult lesions has direct impact on management and may affect oncologic outcome.

Educational Goals/Teaching Points : Multiparametric MRI with subsequent fusion of MR images with ultrasound allows a targeted biopsy of high suspicion foci with increased diagnostic accuracy of cancer over standard techniques. In patients on active surveillance for low-risk cancer, multiparametric MRI can better characterize the prostate gland and find occult foci of higher grade disease.

Key Anatomic/Physiologic Issues and Imaging Findsings/Techniques : The primary objective of this exhibit is to educate participants about prostate multiparametric MRI as well as ultrasound/MRI fusion biopsy. This exhibit includes illustration of our institutional experience in patients with clinical suspicion of prostate cancer who presented with at least one negative transrectal ultrasound-guided biopsy result. The multiparametric MRI approach includes a combination of information from various sequences including T2-weighted, dynamic contrast-enhanced (DCE), and diffusion-weighted imaging (DWI) to determine high suspicion foci for transrectal ultrasound-guided biopsy. Multiparametric MRI of the prostate offers the benefit of cancer detection with high negative predictive value. Notable advantages of ultrasound/MRI fusion biopsy include the ability to conduct the procedure in an outpatient setting with equivalent safety to standard systematic biopsy techniques.

Conclusion: A multiparametric approach improves detection and characterization of prostate cancer and ultrasound fusion biopsy increases diagnostic yield. Thus, MRI of the prostate offers a greater diagnostic certainty of prostate cancer diagnosis compared with established methods of standard of care in such patients.