Multiparametric mri. the role of MRI techniques in the diagnosis, staging and follow up of prostate cancer

The current diagnosis of prostate cancer based on PSA values and systematic biopsy has limitations in its efficacy of detection and staging. Technical advances on imaging over the last decade, mainly MRI, enable improvements in the strategy of prostate cancer management in diagnosis, staging, follow up and therapy monitoring. MRI enables the combination of morphological (T2 sequences) and, at the same time, functional information by means of the application of sequences such as spectroscopy (SMRI), diffusion and dynamic intravenous contrast (CMRI) in the same study, giving the multiparametric MRI (mpMRI). Currently, it is not necessary to apply all sequences to obtain an mpMR study of optimal efficacy, so that a time shorter than 30 minutes is enough to obtain the necessary information depending on the clinical indication. The main clinical indications of prostatic MRI are a) local, regional or distance staging; b) Detection or guide for diagnostic biopsy for clinical risk suspicion or negative result in previous biopsies; c) active surveillance; and d) therapeutic monitoring. Furthermore, one of the most relevant features of prostate cancer, and a challenge for the mpMRI techniques is to be able to differentiate aggressive and non-significant neoplasias. (latent). This update tries to review the current role of mpMRI in the management of prostate cancer using in combination the anatomical (T2) and functional (SMRI, DMRI and CMRI) information. We also describe the European prostate mpMRI guidelines, PI-RADS (Prostate imaging reporting data System)