Are you a photography buff? Do you read online reviews and consult with salespersons to find the perfect digital single-lens reflex camera (DSLR), for which you also want the perfect bag to tote your camera around with you? Of course, your sense of art and esthetics are essential for great photos using composition, light, color, balance, etc. But without the right equipment, and knowing how to use it, you won’t get the best image quality.

Then along came smartphones. Today’s smartphones have put good digital photography in the hands of the masses. According to a blog at photographyacademy.com, “As a general rule, mobile phones are not able to capture higher-quality images than a DSLR. But many photographers believe their images taken on a mobile phone look better because the phone automatically adds contrast, saturation, skin softening, and background blur.” Ah, the miracles of modern technology aided by Artificial Intelligence (AI). If it pleases the eye, apparently it’s okay to sacrifice an unnoticeably small amount of image quality.

Prostate MRI quality

When it comes to prostate imaging, however, it is never okay to compromise on image quality. One of our favorite research groups, the multidisciplinary team at University College London, published a paper titled “Picture Perfect: The Status of Image Quality in Prostate MRI.”^[i] They declare, “Image quality is a fundamental prerequisite for the ability to detect clinically significant disease.”

In their paper, they explore the minimum technical requirements for high quality multiparametric MRI, areas for further research, and how to evaluate image quality using a scoring system. According to a news story about the article, the authors address questions such as

• Does pre-MRI enema use facilitate improved diagnosis of clinically significant PCa (csPCa)?
• Does the PI-QUAL scoring system bolster sensitivity for extraprostatic extension (EPE)?^[ii]

The authors identify six steps to help radiologists achieve excellence in prostate imaging quality:

1. Scanner choice – A more powerful magnet (3 Tesla or 3T) is preferred over 1.5 T magnets, but “adequate diagnostic quality is still possible for a well optimized 1.5 T scan.”
2. Use of an endorectal coil (ERC) – Studies show that using an ERC helps to optimize image quality if the magnet strength is 1.5T, but ERC does not significantly improve 3T magnet scan quality.
3. Patient preparation – In the interest of reducing imaging artifacts (misleading flaws), administrating an enema prior to the scan is the most studied technique. That said, “Patient preparation tends to be very anecdotal and thus centers should investigate the feasibility and success of different methods.”
4. Additional imaging sequences – Standard multiparametric MRI includes three imaging sequences, or parameters (T2 weighted, diffusion weighted, and contrast enhanced MRI). Currently, other sequences in development may improve imaging quality but more research is needed. “Optimization of time without sacrificing image quality is a future goal due to the increasing number of prostate MRI scans performed globally.”
5. Artificial Intelligence (AI) – The use of AI is rapidly expanding in radiologic imaging. For prostate cancer, products are either in development or already available to assist radiologists with image based detection, lesion identification/contouring, prostate segmentation, and improvement of image quality. There is potential for AI to enhance efficiency, but, “Further investigation into evaluation of image quality using AI algorithms should be conducted.”
6. Evaluating and assessing image quality – Currently there are two systems for assessing image quality. The PI-QUAL “is now an established scoring system for assessing image quality that has been validated in multiple contexts.” The PSHS, a subjective rating method, “is a simple yet effective system of assessing image quality and initial results are promising.” In addition, some AI programs are being introduced that can be trained to automate image evaluation “with encouraging results.”

Reason for optimism

The authors sum it all up on an optimistic note:

In conclusion, the field of image quality in prostate MRI is rapidly evolving, with opportunities for improvement across a variety of processes including patient preparation, scanner setup, additional sequences, teaching courses and AI. The recent standardized assessment of prostate MRI is expected to facilitate these developments, which will inevitably result in the refinement of future recommendations.

The Sperling Prostate Center performs all MRI scans on our powerful, state-of-the-art 3T magnet. Our imaging studies integrate AI to ensure accurate interpretation of our high-resolution 3D scans, and we do not use an endorectal coil thanks to our advanced technology. In pursuit of the perfect prostate MRI, our Center has continually adhered to the highest standards of imaging quality, and we follow research developments and quality assessment as they emerge.

NOTE: This content is solely for purposes of information and does not substitute for diagnostic or medical advice. Talk to your doctor if you are experiencing pelvic pain, or have any other health concerns or questions of a personal medical nature.

[i] Woernle A, Englman C, Dickinson L, Kirkham A et al. Picture Perfect: The Status of Image Quality in Prostate MRI. J Magn Reson Imaging. 2023 Oct. 7. https://onlinelibrary.wiley.com/doi/full/10.1002/jmri.29025
[ii] Hall, J. “Seven Takeaways from Recent Review on Prostate MRI Imaging Quality.” Diagnostic Imaging, 10/10/23. https://www.diagnosticimaging.com/view/seven-takeaways-from-recent-review-prostate-mri-imaging-quality