What prostate mpMRI includes
mpMRI combines multiple sequences:
- T2 anatomical imaging
- diffusion-weighted imaging (DWI)
- ADC maps
- dynamic contrast-enhanced imaging (DCE)
Combining them increases the accuracy of detecting clinically significant cancer.
PI-RADS and clinical decision-making
The PI-RADS classification guides the risk assessment:
- lower categories: a lower likelihood of significant disease
- intermediate categories: an individualized decision
- higher categories: an increased likelihood, often indicating targeted biopsy
Low-suspicion imaging
Usually a lower likelihood of a clinically significant lesion.
Intermediate-suspicion imaging
Requires correlation with PSA density, age, and clinical risk.
High-suspicion imaging
Often leads to targeted biopsy and further staging.
When it is indicated
Mainly in:
- elevated or persistently borderline PSA
- a suspicious clinical assessment
- re-evaluation after a negative biopsy with ongoing suspicion
- planning for targeted biopsy and risk stratification
Limitations and correct use
mpMRI is not a "perfect filter":
- false negatives or false positives can occur
- scan quality and reader experience affect the result
The decision to biopsy remains multifactorial, not based on imaging alone.
