How you can help your radiologist get better MRIs results to prostate cancer diagnosis.

Join the free webinar tonight with Drs. Klotz and Carroll on AS safety

(Editor’s note: Personally, I have to white-knuckle my way through an MRI. I get claustrophobic. Still, I feel that an MRI is good because it can help you avoid an unnecessary biopsy. I was surprised to learn from our columnist that we patients can help to enhance MRI quality, which helps us and the radiologists alike. Go for it.— Howard Wolinsky.)

Achieving Clarity: The Importance of High-Quality MRI Imaging in Prostate Cancer Diagnosis

As a dedicated radiologist committed to the well-being of my patients, I emphasize the pivotal role that high-quality MRI imaging plays in the accurate diagnosis of prostate cancer. Obtaining precise imaging results hinges on a combination of patient cooperation and technical factors, both of which are essential for achieving optimal outcomes.

Patients can actively contribute to the quality of their MRI by ensuring minimal movement during the scan. Even slight movements like pelvic muscle contractions can compromise image clarity.

Technologists play a vital role in guiding patients on when to remain still and when muscle contraction and relaxation are permissible. Moreover, reducing gas and stool in the rectum prior to the scan can significantly enhance image quality.

This is often accomplished through a self-administered enema before arriving at the imaging facility. In some cases, medications like glucagon may be used to slow bowel movement during the procedure, improving the clarity of the MRI images.

It's noteworthy, however, that a medication called Buscopan (hyoscine butylbromide), also used to slow bowel peristalsis, is not approved for human use in the United States. While some studies have found these drugs beneficial, the research on their effectiveness in improving the quality of prostate MRI is not conclusive.

Regardless, it's imperative for patients to communicate any discomfort or the need for a pause during the procedure, as this cooperation is vital to ensuring the best possible results.

In addition to patient actions, technical considerations such as scan protocols and equipment characteristics profoundly influence MRI outcomes. Tailoring protocols to individual patient needs, including adjustments for body size, is paramount for obtaining clear images.

Common factors like metallic implants can introduce artifacts, which may necessitate special imaging protocols or adjustments in scanning techniques. Furthermore, the choice of MRI scanner and the quality of coils utilized can greatly impact image signal and noise levels. While larger institutions typically have robust systems in place for prostate MRI, patients should inquire about the available equipment and expertise before scheduling their exam, particularly when considering smaller imaging centers.

Many institutions adhere to the ACR PI-RADS guidelines, which aid in image interpretation and offer recommendations for optimizing imaging techniques and protocols for prostate MRI. Additionally, some institutions provide brief descriptions of scan quality and potential limitations in their reports, empowering patients to better comprehend their results and the reliability of their diagnoses.

Recently, the introduction of PI-QUAL aims to standardize the evaluation of prostate MRI image quality across different imaging centers and protocols, serving as a valuable tool for quality assurance. While PI-QUAL is not as widely adopted as PI-RADS, several institutions include it in their reports.

The American College of Radiology's Prostate Cancer MRI Center Designation program further underscores the commitment to excellence in prostate MRI. By recognizing imaging centers that excel in prostate MRI, this program assures patients and providers of high-quality services, ultimately enhancing the accuracy of prostate cancer detection and care.

Through collaborative efforts between patients and healthcare providers, prioritizing high-quality MRI imaging in the diagnosis and management of prostate cancer is paramount, ultimately leading to improved patient outcomes and quality of life. Remember, your active participation, including asking questions and ensuring optimal conditions, plays a vital role in helping us acquire the best possible images for accurate diagnosis and treatment planning.

Dr. Antonio Westphalen is the Section Chief of abdominal imaging at the University of Washington and UW professor of radiology. Dr. Westphalen’s research interests are centered on the use of advanced imaging technologies to diagnose and treat patients with prostate cancer,

(Send your questions about AS and urology, radiology, pathology, sexual health, genomics, and lifestyle via email to mailto:pros8canswers@gmail.com, or just cut and paste pro8canswers@gmail.com

Still time to join the webinar on AS safety featuring Drs. Klotz and Carroll

By Howard Wolinsky

Active surveillance (AS) pioneers Peter Carroll, MD, MPH, of University of California San Francisco, and Laurence Klotz, MD, of the University of Toronto, will be sharing the latest data on the safety of AS at a special webinar at 8 pm Eastern Monday, April 29. Register here: https://tinyurl.com/aspcasafe

The AnCan Foundation and ASPI are cosponsoring this event, which include a Q&A with the speakers followed by a brief peer-support meeting.

The free meeting was organized as a response to the sudden diagnosis of a Gleason 9 of famed researcher Francis Collins, MD, PhD, which made headlines and led some AS patients to question whether they could safely continue on AS. Collins went from being an Active Surveillance patient to planning a radical prostatectomy seemingly overnight.

Register here: https://tinyurl.com/aspcasaf.