Multiparametric MRI Gives Best Results When Three Parameters are Combined
By: Dan Sperling, MD
Originally published 2/5/2015
The article below was posted in early 2015, making it at least eight years old. It’s time for a refresher!
The question on the line is, can biparametric MRI (bpMRI using only two parameters) detect clinically significant prostate cancer (PCa) as accurately as multiparametric MRI (mpMRI adding contrast enhancement as a third parameter)? This question arises from the search for a shorter, less expensive MRI protocol by eliminating CE-MRI. Would thus increasing the availability of MRI offset compromising accuracy? Here is input from two more recent studies:
A) Belue, et al. (2022) reviewed 41 published studies on bpMRI vs. mpMRI. They found that “a high proportion of the studies investigating whether bpMRI can replace mpMRI did not transparently report information inherent to their study design…” and other problems making comparison difficult. They concluded that the evidence remains murky and it’s not possible to resolve the debate.[i]
B) Iacob, et al. (2023) likewise analyzed 31 published studies on the advantages and disadvantages of bpMRI compared with mpMRI. They note that due to the wide range of vague PCa symptoms, imaging is crucial for early detection and evaluation. They concluded that while bpMRI could “partially replace” mpMRI for early detection, mpMRI is “currently the imaging modality of choice for diagnostic screening and local staging of PCa, but also has a leading role in guiding biopsies and in treatment.”[ii]
While our entire team at Sperling Prostate Center would love to see MRI made more widely available and done in a way that would save upfront healthcare spending, we believe the greatest way to use long-term medical dollars is to invest in mpMRI for the most accurate initial diagnosis, planning the most effective treatment for each patient, and gaining the best cancer control with the least side effects. There is no substitute for mpMRI to achieve such goals.
Magnetic resonance imaging (MRI) of the prostate has been steadily progressing from basic or conventional MRI to an accurate and detailed technology due to the integration of functional parameters. A functional parameter refers to an imaging feature that preferentially distinguishes healthy prostate tissue from cancer by enhancing a specific characteristic (function) of cell behavior. Today, there are five parameters that can be used alone or in various combinations:
- T 1 weighted MRI (T1W MRI)
- T2 weighted MRI (T2W MRI)
- Diffusion Weighted Imaging (DWI-MRI)
- Contrast-enhanced MRI (CE-MRI)
- MRI Spectroscopy (MRI-S)
(Other articles at this site have explained one or more of these parameters in more detail, and interested readers are referred to them in the endnotes.[iii])
Each of these parameters highlights a cellular property that can distinguish healthy tissue from tumor tissue. For instance, tumor cells have greater density, less elasticity, different metabolite composition, and more water molecule restriction than healthy cells. Any one of the parameters by itself may indicate a suspicious abnormality. As an example, much has been written about the accuracy of DWI-MRI which “reads” the hydrogen protons in water molecules and thus can reveal how restricted the water molecules’ motion is.
An article on this site, “Combining MRI Parameters is Better than T2 Weighting Alone,” reported a Memorial Sloan-Kettering study comparing the imaging capability of T2W MRI, DWI-MRI and DCE-MRI alone and in combination to detect PCa recurrence. They found combining T2W and DWI most effective. Click here for more details.
Another study, this time out of a Chinese university medical center, used the same three parameters to detect prostate cancer in the central gland.[iv] (See a diagram of the prostate zones). The goal of the Chinese study was to use the best imaging approach to qualitatively diagnose central gland prostate cancer (CGPCa). The basis for their study was 42 patients with biopsy-proven CGPCa and 42 patients with biopsy-proven benign prostate hyperplasia (BPH). All patients were followed up by imaging using T2W, DWI, and DCE MRI, first separately, and then all combined. The results are shown in this table:
| Parameter | Sensitivity
(Correctly predicts the presence of PCa) |
Specificity
(Correctly predicts the absence of PCa) |
| T1W MRI | 66.7% | 76.2% |
| DWI-MRI | 78.6% | 81.0% |
| DCE-MRI | 83.3% | 61.9% |
| All three combined | 90.5% | 88.1% |
The authors concluded, “DWI is better than T?WI for diagnosing CGPCa. Combining T?WI+DWI+DCE-MRI can obviously improve the diagnostic accuracy of CGPCa. And it has excellent consistency with pathological analysis.”
Today’s multiparametric MRI is unparalleled at detecting lesions suspicious for cancer. While it may seem obvious that the synergistic information obtained when two or more parameters work together would be more valuable than any given parameter alone, the importance of such studies as this lies in the evolution of imaging as a diagnostic tool. In today’s world, a needle biopsy is still the only way to examine prostate tissue for the presence of PCa cells, and to learn more about those cells at the molecular level. As functional parameters advance, and tests are done to combine information, the diagnostic world moves closer to a future in which cancer diagnosis can confidently be made by means of noninvasive imaging.
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] Belue MJ, Yilmaz EC, Daryanani A, Turkbey B. Current Status of Biparametric MRI in Prostate Cancer Diagnosis: Literature Analysis. Life (Basel). 2022 May 28;12(6):804.
[ii] Iacob R, Stoicescu ER, Cerbu S, Manolescu DL et al. Could Biparametric MRI Replace Multiparametric MRI in the Management of Prostate Cancer? Life (Basel). 2023 Feb 7;13(2):465.
[iii] The following articles on various prostate MRI imaging parameters may be of interest:
- Dynamic Contrast Enhanced MRI Correlates With Prostatectomy Findings https://sperlingprostatecenter.com/dynamic-contrast-enhanced-mri-correlates-prostatectomy-findings/
- MRI Imaging of Prostate Cancer: Two Parameters (DWI, DCE) https://sperlingprostatecenter.com/mri-imaging-prostate-cancer-two-parameters/
- Detecting Prostate Cancer Distribution: Two Important MRI Parameters (DWI, MRI-S) https://sperlingprostatecenter.com/detecting-prostate-cancer-distribution-two-important-mri-parameters/
[iv] Li P, Yang W, Chen Z et al. Preliminary study of combining T2-weighted imaging, diffusion weighted imaging and dynamic contrast enhanced-magnetic resonance imaging for diagnosing prostatic central gland cancer. Zhonghua Yi Xue Za Zhi. 2014 Aug 19;94(31):2448-51
