MRI Functional and Multiparametric: Traditional T1- and T2-weighted MRI sequences can be supplemented with functional techniques: dynamic contrast-enhanced MRI (DCE-MRI) imaging, DWI-MRI including apparent diffusion coefficient map and high b value DWI-MRI (preferentially b >1400 sec/mm2). When these 2 are added to anatomic T2 and T2-weighted MRI, the term MP-MRI is often applied. These will be briefly discussed, but a detailed explanation of these techniques is beyond the scope of this document. In summary, all 3 have shown some evidence of incremental value when added to anatomic imaging (T2-weighted), and there is evidence that use of more than 1 functional technique can also be additive and complementary. Among the 3, DCE-MRI has the strongest evidence and has consistently shown the greatest use in the setting of BCR evaluation. DCE-MRI: DCE-MRI has been shown to be the most important sequence for evaluation of BCR post-RP [38]. Wu et al [39] in a meta-analysis to assess the effectiveness of MRI in detecting local recurrent prostate cancer after RP found that DCE-MRI, compared to T2-weighted imaging, showed a higher pooled sensitivity (85%) and specificity (95%). Roy et al [38] evaluated the performance of the 3 types of functional MRI techniques in the detection of local prostate cancer recurrence after RP and concluded DCE-MRI to be the most efficient tool to detect prostate cancer recurrence post-RP. Similarly, Casciani et al [30] and Cirillo et al [6] showed that DCE- MRI had a significantly higher sensitivity and accuracy than T2-weighted imaging alone in detecting local recurrences after RP. DWI-MRI: DWI-MRI can be helpful for local recurrence depiction, but DWI is typically lower in resolution and more often adversely affected by postoperative changes and surgical clip artifacts than DCE, making it less reliable for local recurrence. A combination of these functional sequences can be more accurate to evaluate for recurrence in the postprostatectomy bed [33].
Post Treatment Follow up of Prostate Cancer. MRI Functional and Multiparametric: Traditional T1- and T2-weighted MRI sequences can be supplemented with functional techniques: dynamic contrast-enhanced MRI (DCE-MRI) imaging, DWI-MRI including apparent diffusion coefficient map and high b value DWI-MRI (preferentially b >1400 sec/mm2). When these 2 are added to anatomic T2 and T2-weighted MRI, the term MP-MRI is often applied. These will be briefly discussed, but a detailed explanation of these techniques is beyond the scope of this document. In summary, all 3 have shown some evidence of incremental value when added to anatomic imaging (T2-weighted), and there is evidence that use of more than 1 functional technique can also be additive and complementary. Among the 3, DCE-MRI has the strongest evidence and has consistently shown the greatest use in the setting of BCR evaluation. DCE-MRI: DCE-MRI has been shown to be the most important sequence for evaluation of BCR post-RP [38]. Wu et al [39] in a meta-analysis to assess the effectiveness of MRI in detecting local recurrent prostate cancer after RP found that DCE-MRI, compared to T2-weighted imaging, showed a higher pooled sensitivity (85%) and specificity (95%). Roy et al [38] evaluated the performance of the 3 types of functional MRI techniques in the detection of local prostate cancer recurrence after RP and concluded DCE-MRI to be the most efficient tool to detect prostate cancer recurrence post-RP. Similarly, Casciani et al [30] and Cirillo et al [6] showed that DCE- MRI had a significantly higher sensitivity and accuracy than T2-weighted imaging alone in detecting local recurrences after RP. DWI-MRI: DWI-MRI can be helpful for local recurrence depiction, but DWI is typically lower in resolution and more often adversely affected by postoperative changes and surgical clip artifacts than DCE, making it less reliable for local recurrence. A combination of these functional sequences can be more accurate to evaluate for recurrence in the postprostatectomy bed [33].