Dynamic contrast enhancement in prostate cancer
Protocol and equipment
Typically 3D T1-weighted fast spoiled gradient-echo MRI sequences are used to repeatedly image a volume of interest after the administration of a bolus of intravenous gadolinium contrast medium. An endorectal coil may be used.
Image sets are obtained sequentially every few seconds for up to 5-10 minutes. Ideally, acquisitions should be obtained approximately every 5 seconds to allow the detection of early enhancement 1.
- spatial resolution is often lower than conventional T2-weighted sequences
- there may be a variation in sensitivity according to zonal anatomy 3
- enhancement kinetics are quite variable and heterogeneous 4
- a type III wash-out curve (time intensity curve) with early enhancement followed by decreasing enhancement over time, has been thought to be a concerning feature
The role of dynamic contrast enhancement in routine evaluation for prostate cancer is uncertain. At the present time its value in addition to T2W and diffusion sequence is considered modest 4. In PI-RADS version 2.1, "suspicious" enhancement (focal early enhancement) is considered a minor feature in evaluation.
Contrast enhancement is much more useful in the setting of a post-prostatectomy patient, in whom a small focus/foci of enhancement in the operative bed is suspicious for recurrent disease.
- 1. Verma S, Turkbey B, Muradyan N et-al. Overview of dynamic contrast-enhanced MRI in prostate cancer diagnosis and management. AJR Am J Roentgenol. 2012;198 (6): 1277-88. doi:10.2214/AJR.12.8510 - Pubmed citation
- 2. Fütterer JJ, Heijmink SW, Scheenen TW et-al. Prostate cancer localization with dynamic contrast-enhanced MR imaging and proton MR spectroscopic imaging. Radiology. 2006;241 (2): 449-58. doi:10.1148/radiol.2412051866 - Pubmed citation
- 3. Jackson AS, Reinsberg SA, Sohaib SA et-al. Dynamic contrast-enhanced MRI for prostate cancer localization. Br J Radiol. 2009;82 (974): 148-56. doi:10.1259/bjr/89518905 - Pubmed citation
- 4. Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S. PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2. (2016) European urology. 69 (1): 16-40. doi:10.1016/j.eururo.2015.08.052 - Pubmed
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