January 2021, VOLUME 216
NUMBER 1

Recommend & Share

January 2021, Volume 216, Number 1

Featured Articles

AJR Expert Panel Narrative Review

PI-RADS Committee Position on MRI Without Contrast Medium in Biopsy-Naive Men With Suspected Prostate Cancer: Narrative Review

+ Affiliations:
1Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands

2Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands

3Department of Radiology, Nuclear Medicine & Anatomy, Radboud University Medical Center, Nijmegen, The Netherlands

4Dasa Company, Rio de Janeiro, Brazil

5Fluminense Federal University, Rio de Janeiro, Brazil

6Joint Department Medical Imaging, Sinai Health System, University Health Network, University of Toronto, Toronto, ON, Canada

7Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD

8Department of Radiology, Weill Cornell Medical College, New York, NY

9Department of Urology, University College London Hospitals NHS Foundation Trust, London, United Kingdom

10Department of Radiology, University of Chicago Medicine, Chicago, IL

11Department of Radiological Sciences, Oncology & Pathology, Sapienza University of Rome, Rome, Italy

12Department of Surgery, Division of Urology, University of Maryland School of Medicine, Baltimore, MD

13Department of Radiology, Brigham and Women's Hospital, Boston, MA

14Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD

15Division of Genitourinary Radiology, Ghent University Hospital, Ghent, Belgium

16Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT

17Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom

Citation: American Journal of Roentgenology. 2021;216: 3-19. 10.2214/AJR.20.24268

ABSTRACT :

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, radiographers, and 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 (bipara-metric 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 for protocol selection, specifically, which biopsy-naive men need MRI with contrast medium (multiparametric MRI). There is a need for prospective studies in which biopsy decisions are made according to MRI without contrast enhancement. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast enhancement. These higher-quality data are needed before the Prostate Imaging Reporting and Data System (PI-RADS) Committee can make evidence-based recommendations about MRI without contrast enhancement as an initial diagnostic approach for prostate cancer workup.

Keywords: biopsy avoidance, biparametric MRI, dynamic contrast-enhanced, gadolinium contrast medium, MRI, multiparametric MRI, PI-RADS, prostate cancer, risk stratification, unenhanced MRI

References
Previous sectionNext section
1. Welch HG, Albertsen PC. Reconsidering prostate cancer mortality: the future of PSA screening. N Engl J Med 2020; 382:1557–1563 [Google Scholar]
2. Padhani AR, Weinreb J, Rosenkrantz AB, Villeirs G, Turkbey B, Barentsz J. Prostate Imaging-Reporting and Data System Steering Committee: PI-RADS v2 status update and future directions. Eur Urol 2019; 75:385–396 [Google Scholar]
3. Rosenkrantz AB, Hemingway J, Hughes DR, Duszak R Jr, Allen B Jr, Weinreb JC. Evolving use of prebiopsy prostate magnetic resonance imaging in the medicare population. J Urol 2018; 200:89–94 [Google Scholar]
4. Oberlin DT, Casalino DD, Miller FH, Meeks JJ. Dramatic increase in the utilization of multiparametric magnetic resonance imaging for detection and management of prostate cancer. Abdom Radiol (NY) 2017; 42:1255–1258 [Google Scholar]
5. Renard-Penna R, Rouvière O, Puech P, et al. Current practice and access to prostate MR imaging in France. Diagn Interv Imaging 2016; 97:1125–1129 [Google Scholar]
6. de Rooij M, Israël B, Tummers M, et al. ESUR/ESUI consensus statements on multi-parametric MRI for the detection of clinically significant prostate cancer: quality requirements for image acquisition, interpretation and radiologists' training. Eur Radiol 2020 May 19 [Epub ahead of print] [Google Scholar]
7. Padhani AR, Schoots I, Villeirs G. Contrast medium or no contrast medium for prostate cancer diagnosis: that is the question. J Magn Reson Imaging 2020 May 3 [Epub ahead of print] [Google Scholar]
8. Turkbey B, Rosenkrantz AB, Haider MA, et al. Prostate imaging reporting and data system version 2.1: 2019 update of prostate imaging reporting and data system version 2. Eur Urol 2019; 76:340–351 [Google Scholar]
9. Fox-Rawlings S, Zuckerman D; National Center for Health Research. NCHR report: the health risks of MRIs with gadolinium-based contrast agents. www.center4research.org/health-risks-of-gbcas/Accessed October 21, 2020 [Google Scholar]
10. Mowatt G, Scotland G, Boachie C, et al. The diagnostic accuracy and cost-effectiveness of magnetic resonance spectroscopy and enhanced magnetic resonance imaging techniques in aiding the localisation of prostate abnormalities for biopsy: a systematic review and economic evaluation. Health Technol Assess 2013; 17:vii–xix, 1–281 [Google Scholar]
11. Kasivisvanathan V, Stabile A, Neves JB, et al. Magnetic resonance imaging-targeted biopsy versus systematic biopsy in the detection of prostate cancer: a systematic review and meta-analysis. Eur Urol 2019; 76:284–303 [Google Scholar]
12. Drost FH, Osses DF, Nieboer D, et al. Prostate MRI, with or without MRI-targeted biopsy, and systematic biopsy for detecting prostate cancer. Cochrane Database Syst Rev 2019; 4:CD012663 [Google Scholar]
13. Schoots IG, Padhani AR. Risk-adapted biopsy decision based on prostate MRI and PSA-density for enhanced biopsy avoidance in first prostate cancer diagnostic work-up. BJU Int 2020 Oct 21 [Epub ahead of print] [Google Scholar]
14. Jambor I, Verho J, Ettala O, et al. Validation of IMPROD biparametric MRI in men with clinically suspected prostate cancer: a prospective multi-institutional trial. PLoS Med 2019; 16:e1002813 [Google Scholar]
15. Boesen L, Nørgaard N, Løgager V, et al. Assessment of the diagnostic accuracy of biparametric magnetic resonance imaging for prostate cancer in biopsy-naive men: the biparametric MRI for detection of prostate cancer (BIDOC) study. JAMA Netw Open 2018; 1:e180219 [Google Scholar]
16. Hansen NL, Barrett T, Kesch C, et al. Multicentre evaluation of magnetic resonance imaging supported transperineal prostate biopsy in biopsy-naïve men with suspicion of prostate cancer. BJU Int 2018; 122:40–49 [Google Scholar]
17. Knaapila J, Jambor I, Ettala O, et al. Negative predictive value of biparametric prostate magnetic resonance imaging in excluding significant prostate cancer: a pooled data analysis based on clinical data from four prospective, registered studies. Eur Urol Focus 2020; 14:30106–30111 [Google Scholar]
18. Kasivisvanathan V, Rannikko AS, Borghi M, et al.; PRECISION Study Group Collaborators. MRI-targeted or standard biopsy for prostate-cancer diagnosis. N Engl J Med 2018; 378:1767–1777 [Google Scholar]
19. Rouvière O, Puech P, Renard-Penna R, et al.; MRI-FIRST Investigators. Use of prostate systematic and targeted biopsy on the basis of multiparametric MRI in biopsy-naive patients (MRI-FIRST): a prospective, multicentre, paired diagnostic study. Lancet Oncol 2019; 20:100–109 [Google Scholar]
20. van der Leest M, Cornel E, Israël B, et al. Head-to-head comparison of transrectal ultrasound-guided prostate biopsy versus multiparametric prostate resonance imaging with subsequent magnetic resonance-guided biopsy in biopsy-naïve men with elevated prostate-specific antigen: a large prospective multicenter clinical study. Eur Urol 2019; 75:570–578 [Google Scholar]
21. Chatterjee A, Tokdemir S, Gallan AJ, et al. Multiparametric MRI features and pathologic outcome of wedge-shaped lesions in the peripheral zone on T2-weighted images of the prostate. AJR 2019; 212:124–129 [Abstract] [Google Scholar]
22. Gatti M, Faletti R, Calleris G, et al. Prostate cancer detection with bipara-metric magnetic resonance imaging (bpMRI) by readers with different experience: performance and comparison with multiparametric (mpMRI). Abdom Radiol (NY) 2019; 44:1883–1893 [Google Scholar]
23. Di Campli E, Delli Pizzi A, Seccia B, et al. Diagnostic accuracy of biparametric vs multiparametric MRI in clinically significant prostate cancer: comparison between readers with different experience. Eur J Radiol 2018; 101:17–23 [Google Scholar]
24. Zawaideh JP, Sala E, Shaida N, et al. Diagnostic accuracy of biparametric versus multiparametric prostate MRI: assessment of contrast benefit in clinical practice. Eur Radiol 2020; 30:4039–4049 [Google Scholar]
25. Roh AT, Fan RE, Sonn GA, Vasanawala SS, Ghanouni P, Loening AM. How often is the dynamic contrast enhanced score needed in PI-RADS version 2? Curr Probl Diagn Radiol 2020; 49:173–176 [Google Scholar]
26. Choi MH, Kim CK, Lee YJ, Jung SE. Prebiopsy biparametric MRI for clinically significant prostate cancer detection with PI-RADS version 2: a multicenter study. AJR 2019; 212:839–846 [Abstract] [Google Scholar]
27. Tamada T, Kido A, Yamamoto A, et al. Comparison of biparametric and multiparametric MRI for clinically significant prostate cancer detection with PI-RADS version 2.1. J Magn Reson Imaging 2020 Jul 2 [Epub ahead of print] [Google Scholar]
28. Maggi M, Panebianco V, Mosca A, et al. Prostate imaging reporting and data system 3 category cases at multiparametric magnetic resonance for prostate cancer: a systematic review and meta-analysis. Eur Urol Focus 2019; 6:463–478 [Google Scholar]
29. Bosaily AE, Frangou E, Ahmed HU, et al.; PROMIS Group. Additional value of dynamic contrast-enhanced sequences in multiparametric prostate magnetic resonance imaging: data from the PROMIS Study. Eur Urol 2020 Apr 17 [Epub ahead of print] [Google Scholar]
30. van der Leest M, Israël B, Cornel EB, et al. High diagnostic performance of short magnetic resonance imaging protocols for prostate cancer detection in biopsy-naïve men: the next step in magnetic resonance imaging accessibility. Eur Urol 2019; 76:574–581 [Google Scholar]
31. Junker D, Steinkohl F, Fritz V, et al. Comparison of multiparametric and bi-parametric MRI of the prostate: are gadolinium-based contrast agents needed for routine examinations? World J Urol 2019; 37:691–699 [Google Scholar]
32. Kuhl CK, Bruhn R, Krämer N, Nebelung S, Heidenreich A, Schrading S. Abbreviated biparametric prostate MR imaging in men with elevated prostate-specific antigen. Radiology 2017; 285:493–505 [Google Scholar]
33. Thestrup KC, Logager V, Baslev I, Møller JM, Hansen RH, Thomsen HS. Bi-parametric versus multiparametric MRI in the diagnosis of prostate cancer. Acta Radiol Open 2016; 5:2058460116663046 [Google Scholar]
34. Franiel T, Hamm B, Hricak H. Dynamic contrast-enhanced magnetic resonance imaging and pharmacokinetic models in prostate cancer. Eur Radiol 2011; 21:616–626 [Google Scholar]
35. Rastinehad AR, Waingankar N, Turkbey B, et al. Comparison of multipara-metric MRI scoring systems and the impact on cancer detection in patients undergoing MR US fusion guided prostate biopsies. PLoS One 2015; 10:e0143404 [Google Scholar]
36. Zhao C, Gao G, Fang D, et al. The efficiency of multiparametric magnetic resonance imaging (mpMRI) using PI-RADS version 2 in the diagnosis of clinically significant prostate cancer. Clin Imaging 2016; 40:885–888 [Google Scholar]
37. Woo S, Suh CH, Kim SY, Cho JY, Kim SH, Moon MH. Head-to-head comparison between biparametric and multiparametric MRI for the diagnosis of prostate cancer: a systematic review and meta-analysis. AJR 2018; 211:[web] W226–W241 [Abstract] [Google Scholar]
38. Alabousi M, Salameh JP, Gusenbauer K, et al. Biparametric vs multiparametric prostate magnetic resonance imaging for the detection of prostate cancer in treatment-naïve patients: a diagnostic test accuracy systematic review and meta-analysis. BJU Int 2019; 124:209–220 [Google Scholar]
39. Liang Z, Hu R, Yang Y, et al. Is dynamic contrast enhancement still necessary in multiparametric magnetic resonance for diagnosis of prostate cancer: a systematic review and meta-analysis. Transl Androl Urol 2020; 9:553–573 [Google Scholar]
40. Niu XK, Chen XH, Chen ZF, Chen L, Li J, Peng T. Diagnostic performance of biparametric MRI for detection of prostate cancer: a systematic review and meta-analysis. AJR 2018; 211:369–378 [Abstract] [Google Scholar]
41. Kang Z, Min X, Weinreb J, Li Q, Feng Z, Wang L. Abbreviated biparametric versus standard multiparametric MRI for diagnosis of prostate cancer: a systematic review and meta-analysis. AJR 2019; 212:357–365 [Abstract] [Google Scholar]
42. Greer MD, Shih JH, Lay N, et al. Validation of the dominant sequence paradigm and role of dynamic contrast-enhanced imaging in PI-RADS version 2. Radiology 2017; 285:859–869 [Google Scholar]
43. Lu YF, Zhang Q, Yao WG, et al. Optimizing prostate cancer accumulating model: combined PI-RADS v2 with prostate specific antigen and its derivative data. Cancer Imaging 2019; 19:26 [Google Scholar]
44. Vos EK, Litjens GJ, Kobus T, et al. Assessment of prostate cancer aggressiveness using dynamic contrast-enhanced magnetic resonance imaging at 3 T. Eur Urol 2013; 64:448–455 [Google Scholar]
45. Giganti F, Allen C, Emberton M, Moore CM, Kasivisvanathan V; PRECISION study group. Prostate Imaging Quality (PI-QUAL): a new quality control scoring system for multiparametric magnetic resonance imaging of the prostate from the PRECISION trial. Eur Urol Oncol 2020 Jul 6 [Epub ahead of print] [Google Scholar]
46. Engels RRM, Israël B, Padhani AR, Barentsz JO. Multiparametric magnetic resonance imaging for the detection of clinically significant prostate cancer: what urologists need to know. Part 1. Acquisition. Eur Urol 2020; 77:457–468 [Google Scholar]
47. Sackett J, Shih JH, Reese SE, et al. Quality of prostate MRI: is the PI-RADS standard sufficient? Acad Radiol 2020 Mar 3 [Epub ahead of print] [Google Scholar]
48. Mottet N, Bellmunt J, Bolla M, et al. EAU-ESTRO-ESUR-SIOG guidelines on prostate cancer. Arnhem, The Netherlands: European Association of Urology, 2020 [Google Scholar]
49. Wirth M, Fossati N, Albers P, et al. The European Prostate Cancer Centres of Excellence: a novel proposal from The European Association of Urology Prostate Cancer Centre consensus meeting. Eur Urol 2019; 76:179–186 [Google Scholar]
50. Eldred-Evans D, Burak P, Connor MJ, et al. Population-based prostate cancer screening using a prospective, blinded, paired screen-positive comparison of PSA and fast MRI: the IP1-PROSTAGRAM study. J Clin Oncol 2020; 38(15_suppl):5513–5513 [Google Scholar]
51. Boesen L, Nørgaard N, Løgager V, et al. Prebiopsy biparametric magnetic resonance imaging combined with prostate-specific antigen density in detecting and ruling out Gleason 7-10 prostate cancer in biopsy-naïve men. Eur Urol Oncol 2019; 2:311–319 [Google Scholar]
52. Knaapila J, Jambor I, Perez IM, et al. Prebiopsy IMPROD biparametric magnetic resonance imaging combined with prostate-specific antigen density in the diagnosis of prostate cancer: an external validation study. Eur Urol Oncol 2019; 2:311–319 [Google Scholar]
53. Padhani AR, Barentsz J, Weinreb J, Schoots IG, Tempany C. Re: Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: Experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel. Eur Urol 2020; 78:633–636 [Google Scholar]
54. Sonn GA, Fan RE, Ghanouni P, et al. Prostate magnetic resonance imaging interpretation varies substantially across radiologists. Eur Urol Focus 2019; 4:592–599 [Google Scholar]
55. Westphalen AC, McCulloch CE, Anaokar JM, et al. Variability of the positive predictive value of PI-RADS for prostate MRI across 26 centers: experience of the Society of Abdominal Radiology Prostate Cancer Disease-focused Panel. Radiology 2020; 296:76–84 [Google Scholar]
56. Rosenkrantz AB, Ginocchio LA, Cornfeld D, et al. Interobserver reproducibility of the PI-RADS version 2 lexicon: a multicenter study of six experienced prostate radiologists. Radiology 2016; 280:793–804 [Google Scholar]
57. Park KJ, Choi SH, Lee JS, Kim JK, Kim MH. Interreader agreement in prostate imaging reporting and data system version 2 for prostate cancer: a systematic review and meta-analysis. J Urol 2020 Jul 18 [Epub ahead of print] [Google Scholar]
58. Elkhoury FF, Felker ER, Kwan L, et al. Comparison of targeted vs systematic prostate biopsy in men who are biopsy naive: the prospective assessment of image registration in the diagnosis of prostate cancer (PAIREDCAP) study. JAMA Surg 2019; 154:811–818 [Google Scholar]
59. Padhani AR, Barentsz J, Villeirs G, et al.; PI-RADS Steering Committee. PI-RADS Steering Committee: the PI-RADS multiparametric MRI and MRI-directed biopsy pathway. Radiology 2019; 292:464–474 [Google Scholar]
60. Grossman DC, Curry SJ, Owens DK, et al.; US Preventive Services Task Force. Screening for prostate cancer: US Preventive Services Task Force recommendation statement. JAMA 2018; 319:1901–1913 [Google Scholar]
61. Morote J, Celma A, Roche S, et al. Who benefits from multiparametric magnetic resonance imaging after suspicion of prostate cancer? Eur Urol Oncol 2019; 2:664–669 [Google Scholar]
Address correspondence to I. G. Schoots ().

The authors declare that they have no disclosures relevant to the subject matter of this article.

Recommended Articles

PI-RADS Committee Position on MRI Without Contrast Medium in Biopsy-Naive Men With Suspected Prostate Cancer: Narrative Review

No Access
American Journal of Roentgenology. 2021;216:32. 10.2214/AJR.20.24854
Citation | Full Text | PDF (422 KB) | PDF Plus (427 KB) 
Full Access, , , ,
American Journal of Roentgenology. 2021;216:38-47. 10.2214/AJR.19.22691
Abstract | Full Text | PDF (868 KB) | PDF Plus (903 KB) 
No Access
American Journal of Roentgenology. 2021;216:33-34. 10.2214/AJR.20.24004
Citation | Full Text | PDF (477 KB) | PDF Plus (484 KB) 
Full Access, ,
American Journal of Roentgenology. 2020;214:1211-1219. 10.2214/AJR.19.22751
Abstract | Full Text | PDF (958 KB) | PDF Plus (939 KB) 
No Access, , , ,
American Journal of Roentgenology. 2021;216:106-110. 10.2214/AJR.20.22998
Abstract | Full Text | PDF (540 KB) | PDF Plus (571 KB) 
No Access,
American Journal of Roentgenology. 2021;216:35-36. 10.2214/AJR.20.23930
Citation | Full Text | PDF (493 KB) | PDF Plus (501 KB)