Magnetic Resonance Imaging (MRI) has revolutionized the detection and diagnosis of prostate cancer. In the hands of an experienced radiologist with access to a powerful 3 Tesla (3T) magnet, prostate MRI provides a high resolution, 3-dimension view of prostate anatomy. It reveals abnormal conditions within the gland or its immediate area. This includes suspicion for significant prostate cancer.

How does prostate MRI create a portrait of the gland?

A portrait of the prostate involves at least two MRI scan sequences (parameters). The two basic sequences are called T2 Weighted Imaging and Diffusion Weighted Imaging.

• T2 Weighted Imaging (T2WI) shows detailed anatomy of the gland. This includes the prostate with its zones, the seminal vesicles, and the surrounding prostate bed.
• Diffusion Weighted Imaging (DWI) reveals characteristic differences in density between normal prostate tissue and cancerous tissue.

By combining the results of these two parameters, the doctor has a portrait of the prostate and any suspicious abnormalities. This is called biparametric MRI (bpMRI), because “bi” means two.

Is there a third parameter that involves a contrast agent?

Yes, there is a third parameter that involves a contrast agent injected into a vein. It is called Dynamic Contrast Enhanced MRI (DCE-MRI). When three parameters are used together it is called multiparametric MRI (mpMRI) because “multi” means more than two.

DCE-MRI adds value to biparametric MRI by revealing characteristic tumor blood flow. Cancer tumors make new blood vessels (angiogenesis) to get the oxygen and nutrients needed to multiply and grow.

How important is DCE-MRI?

DCE-MRI is important because it can make a difference in confirming that cancer is present.

DCE-MRI uses a contrast agent that is highly visible on MRI, highlighting the way it “washes in and out” of tumor blood vessels. It is clearly different than normal prostate blood flow. Thus, this third parameter shows if a suspicious area seen on biparametric MRI is likely cancer.

Think of it like this. There is a famous saying, “If it looks like a duck, swims like a duck and quacks like a duck, then it probably is a duck so treat it like one.” It makes the point that three characteristics greatly increase probability. There are other kinds of water birds that look and swim like ducks (e.g., loons, grebes and coot), but you can’t be sure unless you hear quacking.

Biparametric MRI offers two key characteristics (unusual structure in prostate anatomy, and abnormal tissue density) that point to cancer. Multiparametric MRI increases certainty, thanks to DCE-MRI.

What is the contrast agent made of?

Many types of medical imaging rely on contrast agents to highlight features, and there are different types of contrast. For prostate MRI, doctors use an agent formulated with a metal called gadolinium. Gadolinium-based contrast agents (GBCAs) produce brighter signals due to the metallic component. This improves tumor identification by “seeing” tumor vascularity and timing contrast “wash out.”

Are gadolinium-based contrast agents safe?

Today’s GBCAs are safe for patients with normal kidney function, because the body flushes out the agent through the urinary system.

Early formulations of GBCAs were less stable than today’s improved agents, and there was evidence of very small gadolinium deposits in several organs, including the brain.^[i] Beginning in 2015, the Food & Drug Administration (FDA) began investigating. Research, development and testing since then have produced stable GBCAs.

New, safer formulations use a process called macrocyclic-based chelation. This bonds gadolinium with complex atoms, which prevents gadolinium from leaking into the body.

One such formulation, called gadoterate meglumine (brand names Dotarem and Clariscan), is very safe. A recent (2025) paper gathered data on over 170 million administered doses, with safety results reported in 62 journal articles. The authors wrote,

Clinical evidence from the published data and pharmacovigilance monitoring demonstrated that gadoterate meglumine is a safe magnetic resonance imaging contrast agent for all age groups in a variety of approved indications throughout the whole body, including in patients with renal [kidney] impairment.^[ii]

The Sperling Prostate Center prioritizes patient safety. Based on his own experience with his multiparametric MRI patients, Dr. Dan Sperling states, “I want to emphasize the importance of using GBCAs with macrocyclic-based chelation. It is the only type I use.” For patients with impaired kidney function, Dr. Sperling offers biparametric MRI enhanced by Artificial Intelligence, maintaining diagnostic accuracy while minimizing potential risks.​

Conclusion

Multiparametric MRI of the prostate involves use of a contrast agent for a scan sequence called Dynamic Contrast Enhanced MRI (DCE-MRI). This significantly enhances prostate cancer detection. The Sperling Prostate Center uses only the safest formulation of gadolinium-based contrast agents.

Frequently asked questions

Q: What does Dynamic Contrast Enhanced MRI do?

A: Dynamic Contrast Enhanced MRI (DCE-MRI) boosts identification of suspicious prostate cancer by highlighting the type of blood flow that characterizes prostate cancer tumors. This unusual blood flow is due to the tumor’s ability to build its own blood vessels, called angiogenesis. DCE-MRI shows the effect of angiogenesis, an indication that cancer is present.

Q: Are there some prostate cancer patients who should not have DCE-MRI?

A: DCE-MRI uses a gadolinium-based contrast agent. While there are safe formulations of this contrast agent, generally patients with severe kidney problems, or who have a history of an allergic reaction to such agents, do not have DCE-MRI. However, biparametric MRI has high rates of accurate prostate cancer detection, especially when done by an experienced radiologist on a 3 Tesla magnet.

Content reviewed by Dr. Dan Sperling, M.D., DABR — updated October 2025.

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.

References

[i] Kanda T, Nakai Y, Oba H, Toyoda K, Kitajima K, Furui S. Gadolinium deposition in the brain. Magn Reson Imaging. 2016 Dec;34(10):1346-1350.
[ii] Shahid I, Morvan J, Darmon-Kern E, Hebert F, Lancelot E, Bourrinet P. Safety of Gadoterate Meglumine: A Review of 35 Years of Clinical Use and More Than 170 Million Doses. Invest Radiol. 2025 Nov 1;60(11):711-721.