RadteraMRI Prostate Multiparametric (mpMRI, PI-RADS v2.1)
MR+ ContrastAbdomen & Pelvis
Indications
- Detection of clinically significant prostate cancer
- Elevated PSA with prior negative biopsy
- Active surveillance
- Local staging
- Biopsy targeting (fusion)
Patient prep
- Consider bowel prep/enema and antiperistaltic agent per site to reduce rectal gas/motion
- Ideally image ≥6 weeks after biopsy (post-biopsy hemorrhage)
- MRI safety screening; IV access for DCE
- External pelvic phased-array coil (3T preferred; endorectal coil optional, mostly at 1.5T)
Contrast
Agentgadolinium-based
RouteIV
Dose0.1 mmol/kg
TimingDynamic contrast-enhanced (DCE): rapid 3D T1 fat-sat, temporal resolution ≤7-15 s, ~2-3 min
Technique
- mpMRI = high-res T2 + DWI (with ADC + high b-value) + DCE per PI-RADS v2.1
- T2 small-FOV axial + at least one orthogonal plane (sagittal and/or coronal), slice ≤3 mm, no gap
- DWI: slice ≤4 mm, multiple b-values; high b-value ≥1400 s/mm2 (acquired or calculated) plus ADC map
- DCE: 3D T1 fat-sat, temporal resolution ≤15 s (≤7 s preferred)
Series / Sequences
| # | Series / Sequence | Plane | Weighting / Recon | Thickness | Notes |
|---|---|---|---|---|---|
| 1 | Ax high-res T2 FSE | axial | T2 | 3 mm (no gap) | Zonal anatomy, PI-RADS T2 scoring of TZ |
| 2 | Sag T2 FSE | sagittal | T2 | 3 mm | Orthogonal plane |
| 3 | Cor T2 FSE | coronal | T2 | 3 mm | Orthogonal / apex-base |
| 4 | Ax DWI | axial | DWI | ≤4 mm | ≥2 b-values; TR≥3000, TE≤90 |
| 5 | Ax high b-value | axial | DWI b≥1400 | ≤4 mm | Acquired or calculated; PI-RADS PZ scoring |
| 6 | Ax ADC map | axial | ADC | ≤4 mm | Quantitative diffusion |
| 7 | Ax DCE 3D T1 fat-sat | axial | T1 FS +C dynamic | 3 mm | Temporal res ≤15 s; PI-RADS DCE +/- |
| 8 | Ax T1 (large FOV) | axial | T1 | 4-5 mm | Nodes, bones, post-biopsy hemorrhage |
Key points
- DWI/ADC is the dominant (primary) sequence for the peripheral zone; T2 is dominant for the transition zone per PI-RADS v2.1.
- High b-value (≥1400 s/mm2) image required—acquire or calculate.
- DCE is used to upgrade equivocal (PI-RADS 3) PZ lesions to 4 (positive early focal enhancement).
- Wait ~6 weeks after biopsy to avoid hemorrhage mimics; use T1 to map post-biopsy blood.
- 3T with surface coil is standard; bowel prep/antispasmodic improve quality.
Source: Researched — verify against your institution
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.