Skip to main content
SpringerLink
Log in

Multiparametrische MRT der Prostata

Wichtige radiologische Befunde für den Urologen

Multiparametric MRI of the prostate

Important radiological findings for urologists

  • Leitthema
  • Published:
Der Radiologe Aims and scope Submit manuscript

Zusammenfassung

Klinisches/methodisches Problem

Hohe Prävalenz des Prostatakarzinoms mit Multifokalität und biologischer Heterogenität. Unzureichende konventionelle urologische Diagnostik. Unterscheidung klinisch signifikanter von klinisch nicht signifikanten Karzinomen erforderlich.

Diagnostische Standardverfahren

Digitale rektale Untersuchung, Serum-PSA (prostataspezifisches Antigen), transrektale Sonographie (TRUS), systematische transrektale TRUS-Biopsie.

Methodische Innovationen

Multiparametrische Magnetresonanztomographie (mpMRT) mit T2w- und diffusionsgewichteten sowie dynamischen kontrastmittelverstärkten T1w-Sequenzen, dem Standard nach dem Prostate Imaging Reporting and Data System (PIRADS) entsprechend. MR-unterstützte Biopsie, meist MR-/TRUS-Fusionsbiopsie.

Befunde und Leistungsfähigkeit

Prostatakarzinome sind typischerweise T2-hypointens mit eingeschränkter Diffusion und zeigen eine rasche Kontrastmittelanflutung. Nach der Literatur betragen Sensitivität und Spezifität der mpMRT ca. 80 bzw. 90 %.

Empfehlung für die Praxis

Für die Abklärung bei Verdacht auf ein Prostatakarzinom sollten eine mpMRT nach PIRADS-Standard und bei suspekten Befunden eine MR-unterstützte Biopsie erfolgen, vorzugsweise als MR-/TRUS-Fusionsbiopsie.

Abstract

Clinical/methodical issue

High prevalence of prostate cancer with multifocality and biological heterogeneity. Insufficient conventional urological diagnostics. Discrimination between significant and insignificant cancer needed.

Standard diagnostic methods

Digital rectal examination, prostate-specific antigen (PSA) serum level, systematic transrectal ultrasound (TRUS)-guided prostate biopsy.

Methodical innovations

Multiparametric magnetic resonance imaging (mpMRI) including T2-weighted (T2w), diffusion-weighted and dynamic contrast-enhanced MRI according to the prostate imaging reporting and data system (PIRADS), MR-targeted biopsy, most frequently MR/TRUS image fusion biopsy.

Findings and performance

Prostate cancer is characterized by low signal intensity on T2w MRI, restricted water diffusion and pronounced and early uptake of contrast enhancement. Sensitivity and specificity according to the current literature are ca. 80% and 90%, respectively.

Practical recommendations

In cases of suspected prostate cancer, most accurate are mpMRI according to PIRADS and in cases of positive findings, MRI-targeted biopsy, most frequently as MRI/TRUS image fusion biopsy

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Radtke JP, Teber D, Hohenfellner M et al (2015) The current and future role of magnetic resonance imaging in prostate cancer detection and management. Transl Androl Urol 4(3):326–341

    PubMed  PubMed Central  Google Scholar 

  2. de Rooij M, Hamoen EH, Fütterer JJ et al (2014) Accuracy of multiparametric MRI for prostate cancer detection: a meta-analysis. AJR Am J Roentgenol 202(2):343–351

    Article  PubMed  Google Scholar 

  3. Turkbey B, Brown AM, Sankineni S et al (2016) Multiparametric prostate magnetic resonance imaging in the evaluation of prostate cancer. CA Cancer J Clin 66(4):326–336

    Article  PubMed  Google Scholar 

  4. Loeb S, Bjurlin MA, Nicholson J et al (2014) Overdiagnosis and overtreatment of prostate cancer. Eur Urol 65(6):1046–1055

    Article  PubMed  PubMed Central  Google Scholar 

  5. Rider JR, Sandin F, Andrén O et al (2013) Long-term outcomes among noncuratively treated men according to prostate cancer risk category in a nationwide, population-based study. Eur Urol 63(1):88–96

    Article  PubMed  Google Scholar 

  6. Global Burden of Disease Cancer Collaboration (2016) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol. doi:10.1001/jamaoncol.2016.5688

    Google Scholar 

  7. Popiolek M, Rider JR, Andrén O et al (2013) Natural history of early, localized prostate cancer: a final report from three decades of follow-up. Eur Urol 63(3):428–435

    Article  PubMed  Google Scholar 

  8. Schröder FH (2009) Review of diagnostic markers for prostate cancer. Recent Results Cancer Res 181:173–182

    Article  PubMed  Google Scholar 

  9. Tosoian JJ, Loeb S, Epstein JI et al (2016) Active surveillance of prostate cancer: use, outcomes, imaging, and diagnostic tools. Am Soc Clin Oncol Educ Book 35:e235–e245

    Article  PubMed  PubMed Central  Google Scholar 

  10. Radtke JP, Kuru TH, Bonekamp D et al (2016) Further reduction of disqualification rates by additional MRI-targeted biopsy with transperineal saturation biopsy compared with standard 12-core systematic biopsies for the selection of prostate cancer patients for active surveillance. Prostate Cancer Prostatic Dis 19(3):283–291

    Article  CAS  PubMed  Google Scholar 

  11. Scarpato KR, Barocas DA (2016) Use of mpMRI in active surveillance for localized prostate cancer. Urol Oncol 34(7):320–325

    Article  PubMed  Google Scholar 

  12. Franiel T, Quentin M, Mueller-Lisse U et al (2017) MRT der Prostata: Empfehlungen zur Vorbereitung und Durchführung. RöFo 189:21–28

    PubMed  Google Scholar 

  13. Kitzing YX, Prando A, Varol C et al (2016) Benign conditions that mimic prostate carcinoma: MR imaging features with Histopathologic correlation. Radiographics 36(1):162–175

    Article  PubMed  Google Scholar 

  14. Tan CH, Wei W, Johnson V et al (2012) Diffusion-weighted MRI in the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol 199(4):822–829

    Article  PubMed  PubMed Central  Google Scholar 

  15. Jie C, Rongbo L, Ping T (2014) The value of diffusion-weighted imaging in the detection of prostate cancer: a meta-analysis. Eur Radiol 24(8):1929–1941

    Article  PubMed  PubMed Central  Google Scholar 

  16. Glazer DI, Hassanzadeh E, Fedorov A et al (2017) Diffusion -weighted endorectal MR imaging at 3T for prostate cancer: correlation with tumor cell density and percentage Gleason pattern on whole mount pathology. Abdom Radiol 42(1):278–289

    Article  Google Scholar 

  17. Panagiotaki E, Chan RW, Dikaios N et al (2015) Microstructural characterization of normal and malignant human prostate tissue with vascular, extracellular, and restricted diffusion for cytometry in tumours magnetic resonance imaging. Invest Radiol 50(4):218–227

    Article  CAS  PubMed  Google Scholar 

  18. Tan CH, Hobbs BP, Wei W et al (2015) Dynamic contrast-enhanced MRI for the detection of prostate cancer: meta-analysis. AJR Am J Roentgenol 204(4):W439–W448

    Article  PubMed  PubMed Central  Google Scholar 

  19. Bonekamp D, Jacobs MA, El-Khouli R et al (2011) Advancements in MR imaging of the prostate: from diagnosis to interventions. Radiographics 31(3):677–703

    Article  PubMed  PubMed Central  Google Scholar 

  20. Scheenen TW, Rosenkrantz AB, Haider MA et al (2015) Multiparametric magnetic resonance imaging in prostate cancer management: current status and future perspectives. Invest Radiol 50(9):594–600

    Article  CAS  PubMed  Google Scholar 

  21. Li Y, Mongan J, Behr SC, Sud S et al (2016) Beyond prostate adenocarcinoma: expanding the differential diagnosis in prostate pathologic conditions. Radiographics 36(4):1055–1075

    Article  PubMed  Google Scholar 

  22. Katafigiotis I, Sfoungaristos S, Duvdevani M et al (2016) Primary adenocarcinoma of the seminal vesicles. A review of the literature. Arch Ital Urol Androl 88(1):47–51

    Article  PubMed  Google Scholar 

  23. Ahmed HU, El-Shater Bosaily A, Brown LC et al (2017) Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. Lancet 389(10071):815–822

    Article  PubMed  Google Scholar 

  24. de Rooij M, Hamoen EH, Witjes JA et al (2016) Accuracy of magnetic resonance imaging for local staging of prostate cancer: a diagnostic meta-analysis. Eur Urol 70(2):233–245

    Article  PubMed  Google Scholar 

  25. Kilcoyne A, Price MC, McDermott S et al (2017) Imaging on nodal staging of prostate cancer. Future Oncol 13(6):551–565

    Article  CAS  PubMed  Google Scholar 

  26. European Society of Urogenital Radiology (2015) Prostate MRI. http://www.esur.org/esur-guidelines/prostate-mri/. Zugegriffen: 9. Febr 2017

    Google Scholar 

  27. Vargas HA, Hötker AM, Goldman DA et al (2016) Updated prostate imaging reporting and data system (PIRADS v2) recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference. Eur Radiol 26(6):1606–1612

    Article  CAS  PubMed  Google Scholar 

  28. Hassanzadeh E, Glazer DI, Dunne RM et al (2017) Prostate imaging reporting and data system version 2 (PI-RADS v2): a pictorial review. Abdom Radiol 42(1):278–289

    Article  Google Scholar 

  29. Schlemmer HP (2017) Multiparametrische MR-Bildgebung beim Prostatakarzinom. Radiol Up2date 17:1–18

    Google Scholar 

  30. Leitlinienprogramm Onkologie (2016) S3-Leitlinie Prostatakarzinom 4.0. http://leitlinienprogramm-onkologie.de/Prostatakarzinom.58.0.html. Zugegriffen: 9. Febr 2017

    Google Scholar 

  31. Franiel T, Röthke M (2017) Prostatadiagnostik nach PI-RADS 2.0. Radiologe. doi:10.1007/s00117-017-0269-0

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Deutsches Krebsforschungszentrum (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Deutschland

    Heinz-Peter Schlemmer

Authors
  1. Heinz-Peter Schlemmer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Heinz-Peter Schlemmer.

Ethics declarations

Interessenkonflikt

H.-P. Schlemmer gibt an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schlemmer, HP. Multiparametrische MRT der Prostata. Radiologe 57, 621–630 (2017). https://doi.org/10.1007/s00117-017-0277-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00117-017-0277-0

Schlüsselwörter

Keywords

Search

Navigation