Wie viele MRT-Sequenzen der Prostata werden benötigt?

Zusammenfassung

Die multiparametrische Magnetresonanztomografie (mpMRT) ist die etablierte Bildgebungsmodalität der Prostata. Multiparametrisch bedeutet in diesem Zusammenhang, dass neben den anatomischen (T1- und T2-gewichtet) noch funktionelle (diffusionsgewichtet) und kontrastmittelverstärkte Sequenzen enthalten sind. Die anatomischen Sequenzen ermöglichen eine hohe Ortsauflösung. Die diffusionsgewichteten Sequenzen (Diffusion-Weighted Imaging, DWI) misst die Bewegung von Wassermolekülen im Gewebe (Brown’sche Molekularbewegung) und trifft somit Aussagen über die Gewebezusammensetzung. Die Kontrastmittelsequenz (Dynamic Contrast-Enhanced, DCE) nutzt hingegen die Gewebeperfusion zur Beurteilung einer möglichen Tumorangiogenese. Durch diese Kombination werden mit verschiedenen Sequenzen unterschiedliche Aspekte des Prostatagewebes analysiert. Diese Kombination an Sequenzen hat sich gegenüber den initialen MRT-Untersuchungen in den 1980er als zunächst reine T1-/T2-Untersuchung der Prostata durchgesetzt. Aufgrund des großen Bedarfs an Prostata-MRT stellt sich zunehmend die Frage, ob aus ökonomischen und versorgungstechnischen Gründen auf eine Sequenz im Rahmen der Untersuchung verzichten werden kann und, falls ja, auf welche.

Abstract

Multiparametric magnetic resonance imaging (mpMRI) is an established imaging modality for prostate cancer. In this context, “multiparametric” refers to the combination of anatomical sequences (T1- and T2-weighted) with functional (diffusion-weighted) and contrast-enhanced sequences. Anatomical sequences offer high spatial resolution, while diffusion-weighted imaging (DWI) assesses the movement of water molecules within tissues, providing information on tissue composition. The contrast-enhanced sequence (Dynamic Contrast-Enhanced, DCE) evaluates tissue perfusion to identify potential tumour angiogenesis. This combination of sequences allows a comprehensive assessment of various aspects of prostate tissue. However, growing evidence suggests that not all sequences are always required. For early detection of prostate cancer, MRI without DCE (=biparametric MRI, bpMRI) should be the standard, because it exhibits similar detection rates for clinically significant prostate cancer. In special cases, such as after previous prostate treatments (e.g., after focal therapy), radiological challenges (e.g., hip replacement), or in cases of negative bpMRI findings with persistent suspicion of prostate cancer, adding DCE may be helpful. MRI screening without DCE is safer, less expensive, and reduces gadolinium emissions. The final results from the prospective, multicentre PRIME study (bpMRI vs. mpMRI before biopsy) are still pending and will further clarify the role of DCE in early detection.

Schlüsselwörter

Prostatakarzinom - Prostatabiopsie - MRT - Fusionsbiopsie

Keywords

prostate cancer - prostate biopsy - MRI - targeted biopsy

Publication History

Received: 07 November 2024

Accepted after revision: 21 January 2025

Article published online:
05 May 2025

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