Prostate MRI what it is for

Indications for MRI examination of the prostate preparation, contraindications and cost

Today, MRI of the prostate is the most informative method for examining prostate tissue. Magnetic resonance imaging helps to accurately determine the presence of pathology in the organ, determine its specificity, chemical composition, development dynamics. The procedure is safe and painless for the patient. This method of diagnosis contributes to obtaining clear images, but based on reading which, the doctor will be able to prescribe the correct treatment.

What is prostate MRI

The study of the prostate by magnetic resonance imaging is based on the reaction to the interaction of tissue structures of the human body with a magnetic field. In this way, you can check the condition of the prostate gland and adjacent organs (lymph nodes, bladder, rectum). The results reflected in the images help to objectively assess organic changes in tissues, establish the type of pathologies, their prevalence. If a person is healthy, the device will reflect the absence of signs of illness.

MRI of the prostate with contrast

The method of conducting an MRI examination of the prostate with contrast involves the introduction of a special substance into the patient's blood, which is well distinguished by the device. This type of diagnosis is prescribed by a doctor in most cases with suspected prostate cancer. A contrast agent is injected through the patient's vein just before the start of the procedure. Before choosing an MRI with contrast, the doctor sends the person for an analysis, which should establish his sensitivity to the substance.

MRI without contrast

Magnetic resonance imaging of the prostate without contrast can be performed in 2 ways:

• Classic - this method does not provide for additional procedures, except for preparation and direct research. A person is placed on a movable table, which is immersed in a capsule with magnets installed in it.
• With an endorectal coil - in this case, a special flexible wire is inserted into the patient's rectum. Such a device creates an additional magnetic field located in close proximity to the prostate. The examination mechanism with the endorectal coil contributes to a more accurate diagnosis.

What is an MRI of the prostate done for

Prostate MRI is used to confirm or deny the presence of certain diseases:

• oncological diseases of the genital organs;
• prostatitis;
• venereal diseases;
• viral and fungal infections;
• prostate adenomas;
• diphallia, cryptorchidism - congenital pathologies of the prostate gland;
• complications after surgical operations.

For prostatitis

In men, such a disease develops due to the action of pathogenic microflora or microcirculation disorders in the prostate gland with venous insufficiency. Congestion and prolonged inflammation provoke a decrease in local immunity. If prostatitis is not detected in time, it can cause the development of an abscess. Treatment of this complication is reduced to surgical intervention. To accurately determine the disease and its stage, doctors recommend that the patient, if prostatitis is suspected, undergo an MRI using a contrast agent.

For prostate cancer

Malignant tumors of the prostate are often found in older men. The first alarming signs are manifested in problems with urination, incomplete emptying of the bladder. As the formation increases, there are signs of intoxication, increased fatigue, depression, irritability and general weakness. When a patient has these symptoms, indicating the possible development of a tumor in the prostate gland, the urologist prescribes an MRI to examine in detail the presence, size and type of tumor in the prostate.

For prostate adenoma

With an increase in the intensity of the synthesis of prostate cells, adenoma or prostate hyperplasia may occur. The growth of tissues provokes difficulty in urination, sexual dysfunction, urinary incontinence and the formation of constipation. In the early stages, adenoma is often asymptomatic, detected by ultrasound. Doctors prescribe an MRI of the prostate to confirm or refute the presence of a diagnosis, to determine the degree of tissue growth. Based on the study, a treatment plan is formed.

Preparing for MRI of the prostate

In order for the procedure to show the most accurate result, important conditions must be met. Specialists distinguish the following stages of preparation for MRI of the prostate:

• The patient is shown a diet that should eliminate the possibility of formation of gases in the digestive tract.To do this, before the MRI procedure, it is strictly forbidden to eat cabbage, fresh pastries, beans, cereals, carrots, sour-milk and carbonated drinks. This diet should last 3 days.
• You can get unreliable results if there is excess fluid in the body, so the last drink should be made no later than 6 hours before the start of the study.
• If the MRI is done with a coil inserted, the patient can be given pain medication by injection within half an hour if necessary.
• When gas and bloating are detected in a patient, the patient is given an active sorbent that eliminates symptoms.
• Before starting the MRI procedure, you need to remove all metal objects from yourself, as they provoke image distortion.
• The bladder should be moderately full, so urination should be done 2 hours before the MRI.

MRI examination of the prostate

Today, MRI is the most accurate method for diagnosing prostate pathologies. Experts highlight the objective advantages of tomography:

• during the study, the human body is not exposed to ionizing radiation;
• compared to computed tomography, images of soft tissues are more accurate and clear;
• due to the reaction of the device to diffuse changes in tissues and cells, it is possible to recognize the disease at an early stage;
• MRI accurately determines the properties of benign and malignant tumors, establishes the dynamics of their development.

For all the safety of the procedure, there are contraindications to its implementation:

• an allergic reaction to the substances that make up the staining preparation in the contrast method;
• presence of fibrosis;
• diseases of the adrenal glands and kidneys;
• Excessive weight can be an obstacle to conducting research inside a closed device.

How it is done

The procedure for MRI examination of the prostate area is as follows:

• Depending on the type of MRI, a special staining agent is injected into the patient intravenously or a rectal probe is injected into the rectum.
• To make a high-quality MRI, the patient is placed motionless on the surface of the apparatus, if necessary, special holding devices are used. Then the patient either gets inside the capsule of the device, or a large magnet is placed above it.
• The MRI procedure takes about half an hour, if contrast is used, the time is doubled. The patient must remain still in order for the images to be clear.
• The doctor monitors the progress of the study and the state of the person using audio and video communication.
• Such a study is painless and safe. The body may respond to the action of the magnetic field by the appearance of a feeling of warmth in the area of monitoring.

MRI interpretation

The reading of the results of magnetic resonance imaging is done by the specialist who conducted the study. In the photographs, the doctor captures pathological changes in the prostate. The specialist sends the resulting conclusion to the attending physician or gives it personally to the patient. Based on the description of the changes, the urologist prescribes an adequate treatment for the diagnosis. The high accuracy of MRI helps to identify the problem, its specifics in time, and form a system for eliminating the pathology.

Prostate MRI Price

The cost of the procedure varies depending on the region where the clinic is located, the method of performing prostate tomography. The average price in Moscow hospitals can be expressed using the table:

MRI diagnostics of the prostate gland: what does the study of the prostate with and without contrast shows?

Prostate MRI creates a visualized computer model of the anatomy of the organ, which allows you to determine the volume, structure and location of all pathological changes in the gland, as well as the degree of involvement in the spread of the disease of neighboring tissues. This is a harmless and highly informative technology of modern medicine. It differs from CT in safety and more accurate results.

Diagnosis of prostate diseases using MRI

The use of magnetic resonance imaging provides high accuracy and allows you to detect the following diseases:

Prostatitis is an inflammation of the prostate gland in acute and chronic forms, as well as in the abscess phase with a layer of pus. Hyperplasia (adenoma) - proliferation of connective tissues, resulting in compression of the urethra. The disease is dangerous with serious complications. Early detection is the key to effective treatment. Crayfish. The problem of curability consists in diagnosing the disease in the first phase. At the beginning, the disease has no specific symptoms.The study of the prostate using MRI provides the most qualitative and reliable data on the presence of cancer, its stage and localization. The organ under study is small and deeply immersed in the body. In this regard, classical magnetic exposure is not enough for high-quality diagnostics. In this case, additionally assigned:

• MR spectroscopy. The result of the study is the chemical composition of the gland.
• MR diffusion/perfusion that separates normal and diseased tissues.

Types of MRI examination of the prostate:

Classic study without the introduction of contrast markers and probe. Within 30-40 minutes, the desired area of the body is scanned. With contrast. Before the procedure, the patient is injected with a substance, its traces are clearly visible on the screen. Blood carries the drug to all tissues, including the tumor. Contrast does not harm, it only helps to better see the boundaries of the disease. With endorectal coil. A thin flexible wire covered with an elastic braid is inserted into the rectum. It creates an additional magnetic field in the desired area, which makes the image more distinct. Multiparamatic MRI is a combination of all types of magnetic tomography. Magnetic resonance imaging, including the prostate gland, has a high reliability of results, higher than that of other diagnostic methods. In addition to this advantage, unlike a CT scan of the prostate, it does not expose the patient to the harmful effects of x-rays. The exception is people who have contraindications for MRI. For them, a CT scan of the prostate is provided.

Advantages of magnetic resonance imaging methods:

• safety - the technology does not involve the use of ionizing radiation and non-invasive intervention;
• high level of detail and accuracy of results;
• the ability to obtain not only an image and determine the structure of an organ, but also to conduct its chemical analysis;
• Speed of examination - the procedure lasts 30-40 minutes.

Preparation for tomography

To perform a high-quality examination, patient preparation is necessary, namely:

• Prepare documents for the doctor - referral, conclusions about previous studies.
• During the day before the procedure, limit the use of foods that cause increased gas formation - cabbage, legumes, fruits, milk, black bread. Espumizan should be taken to avoid flatulence.
• Empty your bowels. If necessary, give an enema.
• Stop eating 4 hours before diagnosis.
• 2 hours before the procedure, drink water to fill the bladder.
• Half an hour before the examination, take an antispasmodic (No-shpa, Spazmalgon, others).
• If the patient is anxious, a mild sedative may be used.

Steps of the procedure

The magnetic resonance tomograph is a complex device consisting of a retractable table and a cylindrical tunnel surrounded by a magnet. For patients with claustrophobia or weighing more than 130 kg, models of devices with open side walls are provided. An MRI examination of the prostate is carried out as follows:

The patient must change in the locker room and deposit valuables, watches, electronic devices. The doctor injects a gadolinium-based contrast agent into the vein, if contrast was provided. During a dynamic study, a dropper with a saline solution is placed in the patient, into which a marker is added after the start of the scan. If it is intended to use an endorectal coil, then the specialist prepares it as follows. A special cuff is smeared with petroleum jelly or gel. The sensor is placed in it. The cuff is inserted into the rectum and then inflated. At the end of the procedure, it is deflated and removed from the patient's body. The patient lies on a sliding table on his back. Puts on headphones or puts earplugs in the ears. Inside the tomograph there is a voice communication for communication with the staff. The specialist instructs the patient about the upcoming procedure and the rules of conduct during it, including the obligation to maintain complete immobility. Scanning lasts 30-40 minutes. If necessary, the session can last as long as necessary to obtain a quality result. The specialist deciphers the images and sends it to the treating doctor. Contrasting for more precision

The injected substance is instantly carried by the blood through the internal organs, reaching the prostate and tumors. On the computer screen, the boundaries of the prostate and tumors are clearly visible. You can accurately find out the geometric parameters, the structure of not only the tumor, but also the smallest metastases.

When using contrast, side effects may occur in the form of fever, third-party taste in the mouth, rapid breathing and palpitations. Such manifestations should be reported to the doctor immediately.To do this, the device provides voice communication.

MRI for prostate cancer

Prostate cancer often affects older men. The disease first manifests itself in difficulty urinating, incomplete outpouring of the contents of the bladder. Then there is intoxication, weakness, depression. Already when such signs appear, you should contact a urologist and undergo an MRI of the prostate gland.

The most important advantage of endorectal MRI in diagnosing pancreatic cancer is the accurate visualization and localization of the size, nature and location of the tumor. The sources of information are foci of low signal intensity in the peripheral region of the prostate. Irregular, uneven contours, diffuse spread are signs of a malignant disease.

Advantages of multiparametric MRI

Multiparametric MRI is a combined study, where all methods of magnetic resonance diagnostics are involved. This procedure gives the most accurate result known. With this integrated approach, it is possible to evaluate the following:

• with dynamic contrasting, the work of blood vessels in the prostate and neighboring organs is analyzed;
• diffusion-weighted tomography shows the parameters of water exchange in the studied tissues;
• MRI spectroscopy determines the level of concentration of various substances in the prostate gland;
• 3D modeling creates an overall picture and eliminates misinterpretation of the various parameter values obtained during the survey.

The use of such an integrated approach to the diagnosis of pathologies is especially effective when combined with a biopsy. This allows you to identify the most aggressive areas of the cancerous tumor. The advantage is that a conventional biopsy is performed at random with multiple punctures. With multiparametric MRI, the doctor knows the location of the neoplasm and takes point samples under the simultaneous control of the ultrasound machine and the tomograph, which minimizes errors in the penetration of the needle into the body of the tumor.

When is CT diagnostics indicated?

There are patients for whom MRI is contraindicated. For them, CT and other diagnostics of the prostate gland are prescribed, despite the fact that this is a less accurate method, because the tissue of the examined organ contains many liquid components and is surrounded by bone structures. The procedure can be applied to the category of patients who:

• allergic to contrast agents;
• pacemakers;
• metal implants;
• insulin pumps;
• surgical clips in vessels and tissues;
• hearing aid in the middle ear;
• claustrophobia;
• weight over 130 kg.

CT of the affected Prostate cancer is performed in the following cases:

• in order to determine the degree of damage by a cancerous tumor to neighboring tissues with a high risk of spread, calculated according to the Glisson scale;
• to detect regional screenings in the pelvic lymph nodes;
• for accurate planning of surgery and radiotherapy;
• to clarify an already diagnosed diagnosis.

When the patient's condition is severe, the procedure is performed to distinguish between acute parenchymal prostatitis and prostate abscess. The CT examination is carried out as follows:

• the doctor examines the patient, fixes his condition, finds out if there are any allergies to contrasts, chronic diseases;
• the patient lies on the couch of the tomograph, a catheter is inserted into the vein to inject a contrast marker;
• the catheter is connected to the injector;
• scanning is carried out, sometimes several times in different phases of contrast absorption;
• The results are interpreted by a specialist and transferred to the attending physician.

How to prepare for and undergo an MRI of the prostate

3 742 Elena Polyakova, doctor

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Magnetic resonance imaging (MRI) of the prostate is a diagnostic method for confirming or refuting prostatitis, adenoma, abscesses, and cancer. When scanning, the structure, size, position of the organ is determined, abscesses, inflammation, benign and malignant tumors are detected. The accuracy of diagnosis is more than 89%, which is higher than with ultrasound or CT. If you combine an MRI with a biopsy, then the figure reaches 100%.

Prostate MRI shows

Method of MRI of the prostate gland is a translation into a picture of the resonant reaction of hydrogen from tissues to a magnetic field. The radiated energy is captured in the radio frequency range and displayed on the screen. The resulting picture gives detailed information about the discreteness, topography, size, outlines of the prostate. These parameters are needed to determine urological pathologies: MRI can show inflammatory, proliferative, oncological diseases of the prostate.

A man is referred for an MRI only after simple procedures (this is due to the complexity and high cost of the service). For example, the diagnosis of chronic prostatitis begins with the collection of anamnesis, rectal examination, laboratory blood and urine tests. If the measures taken did not allow to accurately establish the disease, the patient is given a referral for magnetic resonance imaging.

In addition to differential diagnosis, an indication for MRI is the study of the prostate in the preoperative period. The study will show the degree of damage to the organ and the involvement of neighboring structures (tissue, bone, blood, nerve) in the pathological process. From the pictures, the doctor will get an accurate idea of what exactly during the operation should be removed from the man.

Ultrasound, MRI, TRUS or biopsy: which is better

Australian scientists from the Wesley Institute have done a lot of scientific work comparing the effectiveness of four types of instrumental examination: ultrasound, TRUS, conventional tomography and MRI-guided biopsy of the testicles, bladder and prostate. 489 patients with elevated PSA were studied. The subjects, with their consent, underwent all four types of diagnostics. Prostate cancer was found in 234 people.

The biggest inaccuracy according to the results of the study was found in the ultrasound examination - cancers were detected only in 62%. TRUS is more precise - it helped to detect oncological formations in 77%. MRI accuracy without biopsy - 89%, with biopsy - 100%.

The paradox is that, despite the minimal probability of a false diagnosis, MRI is much more likely to do ultrasound and TRUS. The reason is the large number of contraindications and the high cost of tomography.

How to prepare for research

Foods that increase gas formation are excluded (mineral water, beans, beans, kefir). A prerequisite is not to eat at all for 4 hours before the MRI.

Prostate MRI is always performed with an empty rectum. The patient prepares for the procedure on his own: 12 hours before the procedure, it is recommended to cleanse the intestines (drink a laxative or make an enema). Psychological preparation for the study is based on the fact that the patient should tune in to immobility in the supine position for more than half an hour. The examination does not cause any discomfort (pain, burning).

How soon after a prostate biopsy can I do an MRI

According to medical standards, magnetic resonance imaging is performed before transrectal excision of prostate tissues (the break between procedures does not play a role - it can be done within one hour). This method is called fusion (fusion) prostate biopsy - it is done under MRI control.

Plus the "double" procedure - doctors take the material not "blindly" (from random areas of the prostate), but aimingly (from those areas that the magnetic resonance imaging scanner shows as suspicious). As a result, the number of points for taking tissue samples is reduced, which significantly reduces the risk of complications. For comparison: during a standard tissue sampling, it is performed through 30-40 punctures, when combined with an MRI - 10-12.

If the procedure is violated, tissue material was taken before instrumental diagnostics, then MRI can be done no earlier than 25 days after prostate biopsy. During this time, the wound left after the introduction of the needle into the gland will have time to heal completely.

How to do an MRI of the prostate

A man can use the pajamas provided by the clinic or wear his own clothes during the procedure if they do not constrict the body and do not have metal elements.

In case of prostatitis, cancer, prostate abscess or prostatic hyperplasia, only the pelvic area should be examined, so the person is not completely placed in the device - the head, shoulders, arms remain outside the tomograph. This allows the patient to keep his eyes open, listen to music, read a book (the main thing is not to move the lower part of the body during radiation).

For an MRI of the prostate, a man is not completely placed in the apparatus - the head, shoulders, arms remain outside the tomograph.

The duration of an MRI is from 30 to 70 minutes. During the procedure, 10-20 shootings are carried out. When the scan is done, the patient needs to lie as still as possible. In the periods between them (breaks last no more than 2-3 minutes), you can move your legs a little, about which the doctor will inform you additionally.

Traditional method

The simplest type of MRI is an examination without the use of a contrast material. It is rarely used due to the high probability of missing cancer. The only case when it is done is the presence of contraindications for the use of contrast:

• Allergy to the composition of the contrast agent.
• Chronic renal failure.
• Recent heart attack.
• Phlebothrombosis and pathologies of blood clotting.

The advantages of non-contrast MRI are the reduced cost of the service, the exclusion of the likelihood of an allergic reaction.Minus - without contrast, it is more difficult to recognize areas of oncological formations. For example, in the case of small cancerous tumors in the prostate, the probability of their detection is 78%, since there are no changes in the surrounding structures.

With contrast

MRI with a contrast agent is performed to determine the parameters of the prostate and to detect tumors of any size. As a contrast, use:

The products listed contain gadolinium salts. It is a metal that has a silvery tint and is clearly visible on contrast-enhanced MRI of the prostate. The drug is administered by injection (an injection is made with a syringe into a vein). In 2-3 minutes, blood with contrast reaches the prostate, and magnetic resonance imaging can be performed. A day after the procedure, the contrast agent is excreted from the body along with urine.

Multiparametric MRI

To improve the accuracy of diagnosis, an algorithm for multi-parameter analysis of tomography data has been developed. Another name for the system is PIRADS (Prostate Imaging Reporting and Data System). The study itself takes place on standard equipment (nowadays targeted MRI is often used, which is an examination of the prostate on an ultra-high-field tomograph).

Multiparametric MRI of the prostate takes longer than standard tomography (by 20-30 minutes). The time for analyzing the information received is also extended.

The advantage of multiparametric MRI is the ability to perform the procedure without a biopsy. The probability of "overseeing" the tumor is reduced by 12% compared to traditional magnetic resonance imaging.

MRI for prostate cancer

An indication for an MRI is an elevated PSA in the blood. An increase in the level of antigen occurs with prostate adenoma, purulent prostatitis, bladder abscess and cancer. Magnetic resonance imaging will determine the exact pathology.

During the diagnosis, prostate cancer is confirmed if dense clots are detected on the image, which should not be present here according to the anatomy of the gland. MRI allows you to determine the form of oncology: whether the tumor is adenoid, mucinous or fibrous. For example, a weak resonant signal is characteristic of prostate cancer formed by cells with mucin (this information helps determine the appropriate type of treatment for a cancer patient). To understand the nature of the tumor (malignant or benign), a biopsy is done after magnetic resonance imaging.

Transcript of results

Analysis of MRI data is the task of a diagnostician and a urologist. If you wish, you can use medical standards that allow you to independently analyze the images.

• Healthy prostate. The size of the gland, its capsule, testicles, surrounding tissues, blood vessels, nerves - everything is normal. Tumors are absent.

• Benign hyperplasia. The MRI image shows a symmetrical or asymmetric growth of the gland with uniform contours.

• Prostatitis. MRI shows that the gland becomes larger, but its contours, unlike adenoma, are fuzzy (due to weakened blood supply from the venous plexus).

• Cancer on MRI is characterized by single or multiple neoplasms. They are localized pointwise or spread beyond the prostate capsule.

It is imperative to ask a specialist for an interpretation of the MRI results (an accurate diagnosis is made according to the results of MRI, PSA, ultrasound, etc.). You yourself can incorrectly decipher the data of the images and start the wrong treatment (or consider yourself healthy, do nothing and start the disease).

How much does the procedure cost

The main disadvantage of tomography is that it is not included in the list of services that are done free of charge under an insurance policy. The price of MRI is quite high (compared to other diagnostic methods) - this is justified by the complexity of the procedure, expensive equipment, and highly qualified personnel.