Multiparametric magnetic resonance imaging of the prostate: current concepts

Multiparametric MR (mpMR) imaging is rapidly evolving into the mainstay in prostate cancer (PCa) imaging. Generally, the examination consists of T2-weighted sequences, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) evaluation, and less often proton MR spectroscopy imaging (MRSI). Those functional techniques are related to biological properties of the tumor, so that DWI correlates to cellularity and Gleason scores, DCE correlates to angiogenesis, and MRSI correlates to cell membrane turnover. The combined use of those techniques enhances the diagnostic confidence and allows for better characterization of PCa. The present article reviews and illustrates the technical aspects and clinical applications of each component of mpMR imaging, in a practical approach from the urological standpoint.

多参数磁共振成像（Multiparametric MR，mpMR）正快速成为前列腺癌（prostate cancer，PCa）影像学诊断的主流技术。一般来说，该检查方案涵盖T2加权序列（T2-weighted sequences）、弥散加权成像（diffusion-weighted imaging，DWI）、动态对比增强（dynamic contrast-enhanced，DCE）评估，而质子磁共振波谱成像（proton MR spectroscopy imaging，MRSI）的应用相对较少。上述功能成像技术均与肿瘤的生物学特性紧密关联：其中弥散加权成像与肿瘤细胞密度及格里森评分相关，动态对比增强与血管生成相关，质子磁共振波谱成像则与细胞膜更新相关。联合应用此类技术可提升诊断置信度，实现对前列腺癌更精准的特征刻画。本文从泌尿外科的实用视角出发，对多参数磁共振成像各组成部分的技术要点与临床应用展开综述与阐释。