Dynamic Contrast-Enhanced Study in the mpMRI of the Prostate-Unnecessary or Underutilised? A Narrative Review

Abstract

The aim of this review is to summarise recent scientific literature regarding the clinical use of DCE-MRI as a component of multiparametric resonance imaging of the prostate. This review presents the principles of DCE-MRI acquisition and analysis, the current role of DCE-MRI in clinical practice with special regard to its role in presently available categorisation systems, and an overview of the advantages and disadvantages of DCE-MRI described in the current literature. DCE-MRI is an important functional sequence that requires intravenous administration of a gadolinium-based contrast agent and gives information regarding the vascularity and capillary permeability of the lesion. Although numerous studies have confirmed that DCE-MRI has great potential in the diagnosis and monitoring of prostate cancer, its role is still inadequate in the PI-RADS categorisation. Moreover, there have been numerous scientific discussions about abandoning the intravenous application of gadolinium-based contrast as a routine part of MRI examination of the prostate. In this review, we summarised the recent literature on the advantages and disadvantages of DCE-MRI, focusing on an overview of currently available data on bpMRI and mpMRI, as well as on studies providing information on the potential better usability of DCE-MRI in improving the sensitivity and specificity of mpMRI examinations of the prostate.

Keywords: DCE-MRI; bpMRI; magnetic resonance imaging; mpMRI; prostate cancer.

Figure 1

A 47-year-old male patient underwent mpMRI due to a slightly elevated serum PSA level. There were no suspicious findings. Figures present original examples of standard anatomical and functional sequences, respectively: (a) T2W and (b) T1W; (c) DWI; (d) ADC map; and (e) DCE.

Figure 2

The mpMRI performed on a 75-year-old male patient shows a right peripheral zone prostate lesion (white arrow) that was confirmed to be cancer on biopsy; Gleason score 4 + 3 = 7. The images present the following: (a) T2W as a hypointense focal lesion; (b) DWI b = 1400 s/mm³; (c) ADC map demonstrates highly restricted diffusion and early contrast enhancement; (d) raw data; (e) semi-quantitative colour-coded parametric map for a wash-in; (f) pharmacokinetic quantitative colour-coded parametric map for Ktrans.

Figure 3

Schematic diagram of the DCE-MRI time-signal intensity (semi-quantitative analysis)/time-concentration (quantitative analysis) enhancement kinetic curves: Type 1 (progressive), type 2 (plateau), and type 3 (wash-in and wash-out).

Figure 4

Schematic diagram of PI-RADS v.2.1. in which DCE-MRI has a role only in peripheral zone lesions categorised on DWI as PI-RADS 3—if those lesions show early arterial accumulation of contrast, DCE-MRI is considered positive, and lesions are upgraded to PI-RADS 4.

Figure 5

Schematic diagram of the PI-RR score in patients after radiation therapy. DWI and DCE have the key role, and the final score is defined by the sequence with a higher score.

Figure 6

Schematic diagram of the PI-RR score in patients after radical prostatectomy, where DCE has a key role in the final score.

Figure 7

mpMRI shows a left transitional zone prostate lesion (white arrow) in a 69-year-old male patient, which was confirmed to be cancer on biopsy; Gleason score 4 + 3 = 7. It can be seen on (a) T2W as a hypointense focal lesion. The lesion is obscured on (b) DWI b = 1400 s/mm³ and (c) ADC maps that are of suboptimal diagnostic quality due to artifacts. DCE-MRI does not demonstrate early contrast enhancement on the (d) pharmacokinetic quantitative colour-coded parametric map for K_trans.

Figure 8

mpMRI shows a right peripheral zone prostate lesion (white arrow) in a 72-year-old male patient, which was confirmed to be cancer on biopsy; Gleason score 3 + 3 = 6. The images present (a) T2W as a lightly hypointense focal lesion, obscured on (b) ADC map due to artifacts, and the most noticeable on (c) DCE-MRI, which demonstrates early contrast enhancement on the pharmacokinetic quantitative colour-coded parametric map for K_trans.