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Biparametric MRI

3 min.
Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
CME Eligible

Dr. P here looking at the biparametric MRI statement, and some of you out there who don't do prostate MRI routinely are saying, "Well, what's biparametric MRI?"

So let's start out with MRI of the prostate. We got a T2. Let me turn on my little pen here, which is my trusty tool. Got a T2. We got a DWI with its ADC map. We've got DC, dynamic contrast, enhanced MRI. We might use spectroscopy, and maybe some other stuff which we're going to ignore right now. So bi means two, so which two parameters are we using for biparametric MRI? These two. We're not using dynamic contrast-enhanced MRI or spectroscopy. Lots of people use this as a screen in people who are at lower risk or people with a borderline PSA. It's particularly useful in screening without making an injection and potentially averting a biopsy, but it's not for everybody.

So when do we recommend that a patient undergo multiparametric MRI? In other words, more than two. We add DCE MRI into it, dynamic contrast-enhanced MRI. Well, when clinical risk factors indicate that there's a likely presence of significant disease that should not be missed. Strong family history. BRCA positivity. Yes, BRCA patients get prostate cancer. Prior negative biopsy. In other words, you're still suspicious even though they've had a negative biopsy and perhaps you're looking for a small hyperenhancing lesion in the peripheral zone. Active surveillance, you're following an area that's equivocal and you want to see suddenly how it's changed from one year to the next. And the patient has high risk factors based on a risk calculator, that might include factors like genetics, and family history, and other.

Another scenario is the patient had biparametric MRI and had a negative biopsy, but suspicion remains. Why does suspicion remain? The PSA density is now a lot higher than it was before. That would just be one example, where your antennas are up yet the BP MRI is negative. You take the next step and you go to multiparametric, or MP, MRI.

Another scenario where MP MRI is critical is when you've got hip prostheses in place. The technical factors have made DWI, diffusion-weighted imaging, and the ADC map unusable, and now you have to rely on the T2. Well, that's just not good enough. And in that scenario, the DCE MRI may save you. So in this scenario where you can't get a good study with DWI and ADC mapping, perhaps because there's metal in the body, or bilateral or unilateral hip prostheses, I would do T2 and DCE MRI to save the day.

LESSON 2, TOPIC 19

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Content reviewed: December 29, 2021

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