Diffusion MRI?

Hi Caz,

It is super important that the place that produces the images are experienced with prostate imaging. Prostates are very difficult to get good images of unless the MRI is used properly. Current best MRI is the 3T machine, which is better at MRI images of the prostate without using internal 'coils'(common one was the T2 MRI endorectal coil, placed in the anus while imaging) 3T machines do not need this internal coil, but often use an external cage coil.

When you get a 3TmpMRI, the images come in several varieties, the most common are T1 and T2 weighted images. Often a cage coil is placed on your hips during the entire MRI to help with the image focus. There are usually a few other usual enhancements:

DCE, being Dynamic Contrast Enhancement, A contrast material is injected to see the prostates take up of fluids, the contrast(dye) helps make the prostate image much clearer. The contrast is usually Gadolinium, which most people do not have an allergy for, and is injected for the last 30 minutes or so of the MRI..

DWI, being Diffusion Weighted imaging, which is another way of measuring the image through ADC, Apparent Diffusion Coefficient. A very technical term saying the images are compared with different ratios applied.  

My 3TmpMRI included all four of these images calculations. I specifically chose a radiologist who specialises in images for the specialist and research centres. Good images require a highly trained technician to produce the images, and an experienced radiologist to read the images.

Talk to your urologist and or other MRI centres about their prostate MRI images and what images they will provide. Unless the images are top notch, they may not be useful.

Hope this helps.

?Geoff

 I copied only the first few paragraphs of that article’s INTRODUCTION, below:

[Sub-title] Prostate Imaging and Reporting and Data System: Version 2

INTRODUCTION

Magnetic Resonance Imaging (MRI) has been used for noninvasive assessment of the prostate gland and surrounding structures since the 1980s.  Initially, prostate MRI was based solely on  morphologic assessment using T1-weighted (T1W) and T2-weighted (T2W) pulse sequences, and its role was primarily for locoregional staging in patients with biopsy proven cancer.  However, it provided limited capability to distinguish benign pathological tissue and clinically insignificant prostate cancer from significant cancer.

Advances in technology (both in software and hardware) have led to the development of multiparametric MRI (mpMRI), which combines anatomic T2W with functional and physiologic assessment, including diffusion-weighted imaging (DWI) and its derivative apparent-diffusion coefficient (ADC) maps, dynamic contrast-enhanced (DCE) MRI, and sometimes other techniques such as in-vivo MR proton spectroscopy.  These technologic advances, combined with a growing interpreter experience with mpMRI, have substantially improved diagnostic capabilities for addressing the central challenges in prostate cancer care: 1) Improving detection of clinically significant cancer, which is critical for reducing mortality; and 2) Increasing confidence in benign diseases and dormant malignancies, which are not likely to cause problems in a man’s lifetime, in order to reduce unnecessary biopsies and treatment. 

Consequently, clinical applications of prostate MRI have expanded to include, not only locoregional staging, but also tumor detection, localization (registration against an anatomical reference), characterization, risk stratification, surveillance, assessment of suspected recurrence, and image guidance for biopsy, surgery, focal therapy and radiation therapy. 

In 2007, recognizing an important evolving role for MRI in assessment of prostate cancer, the AdMeTech Foundation organized the International Prostate MRI Working Group, which brought together key leaders of academic research and industry.  Based on deliberations by this group, a research strategy was developed and a number of critical impediments to the widespread acceptance and use of MRI were identified.  Amongst these was excessive variation in the performance, interpretation, and reporting of prostate MRI exams.  A greater level of standardization and consistency was recommended in order to facilitate multi-center clinical evaluation and implementation.  

Harvey in Southern California.

I had an mpMRI in Jan, 2015, in Thousand Oaks, California, after a scary leap of PSA from 8.5 to 14.  The reading came back as PI-RADS 2 (out of 5), which is: Low (clinically significant cancer is unlikely to be present), so I had no biopsy taken.   A month later my PSA zoomed back down to 8.5, where it has remained since, approximately.

I have emailed the clinic and they have confirmed that they carry out diffusion-weighted imaging as standard protocol in prostate 3T MRI, so we feel a lot happier now. Fingers crossed we will get the best images possible and see where we go from here. The downside is that he has not to urinate for 2 hours before the scan and last time he had to do this for a bladder scan it enlarged his prostate so much he had to get a catheter in! Don't know of any way around this, we are probably best to hang around the hospital for a while afterwards to make sure he can go ok. His burning and frequency came back with a vengeance last night, the worst since all this began 5 months ago. We just need answers now.