title: Value of multiparametric MRI in the work-up of prostate cancer.
abstract: The role of magnetic resonance imaging (MRI) in prostate cancer evaluation is controversial and likely underestimated. Technological advances over the past 5 years have demonstrated that multiparametric MRI, including diffusion-weighted imaging (DWI) and dynamic contrast-enhanced MRI, can evaluate the actual tumor burden of a newly diagnosed prostate cancer more accurately than sextant biopsy protocols. Tumor risk, defined by the D'Amico criteria, hence can be re-evaluated by multiparametric MRI. As a result, there is increasing evidence that MRI before repeat or even initial biopsy can accurately select patients who require immediate biopsies and those in whom biopsy could be deferred. Also, a relationship between apparent diffusion coefficient (ADC), calculated from DWI, and Gleason score was found. Thus, MRI before biopsy helps to detect high-grade tumors to target biopsies within areas of low ADC values. To achieve good targeting accuracy, transrectal ultrasound (TRUS)-MRI image registration is necessary. Three-dimensional deformable registration is sufficiently accurate to match TRUS and MRI volumes with a topographic precision of 1 mm. Real-time MRI-guided biopsy is another technique under evaluation. Both approaches will allow for increasing acceptance of focal therapies, should these techniques be validated in the future.
authors.affiliation: Service de Radiologie, Hôpital Cochin, Paris, France. francois.cornud@imagerie-tourville.com
authors.forename: F
authors.initials: F
authors.lastname: Cornud
authors.forename: N B
authors.initials: NB
authors.lastname: Delongchamps
authors.forename: P
authors.initials: P
authors.lastname: Mozer
authors.forename: F
authors.initials: F
authors.lastname: Beuvon
authors.forename: A
authors.initials: A
authors.lastname: Schull
authors.forename: N
authors.initials: N
authors.lastname: Muradyan
authors.forename: M
authors.initials: M
authors.lastname: Peyromaure
mesh_terms: D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D060787:Neoplasm Grading / Q000379:methods; D011471:Prostatic Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity