Nonacademic practices need prostate MRI education

As the use of prostate MRI increases in the clinical care of men with prostate cancer in the U.S., education of nonacademic practices about prostate MRI acquisition could improve the uniformity and quality of screening, according to a study published online Jan. 2 in the Journal of the American College of Radiology.

Despite its evolving utilization, use of prostate MRI has not become a standard procedure at all institutions in the U.S. A lack of definitive and universal protocol for screening creates variability in the way in which prostate MRI is performed, leading to debate amongst medical professionals. Lead author James L. Leake, MS, of the University of Texas Health Science Center at San Antonio, and colleagues created a survey to assess the access and practice of prostate MRI in academic, private practice and community groups.

Leake and colleagues requested participation in their online survey through the email lists of the Society of Abdominal Radiology and the Texas Radiological Society. The researchers analyzed 66 survey responses received from 40 academic radiology groups, five large private practice groups, and 12 community groups.

Of the submitted responses, 89 percent of the academic institutions performed prostate MRI in comparison to 60 percent of the large private practice groups and 30 percent of the community groups. Nine of the academic groups performed prostate MRI at 1.5T with endorectal coil, 11 performed at 3.0T without endorectal coil, and ten performed at 3.0T with endorectal coil. Prostate MRI with an endorectal coil was not performed at any of the private practice or community groups.

Studies performed per month at the institutions greatly varied. The most common ranges found were six to ten studies per month and 11 to 20 studies per month. Of the groups performing prostate MRI, 37.8 percent have used the technique for less than five years and 40.5 percent have used it for six to ten years.

All groups that use prostate MRI include axial T1-weighted, axial T2-weighted and coronal T2-weighted images in their protocol. Several institutions also performed sagittal or coronal T1-weighted images and only three institutions did not perform sagittal T2-weighted images. Imaging sequences like diffusion weighted imaging (DWI), dynamic contrast enhanced (DCE) MR and MR spectroscopy were additionally performed by all institutions. Almost 60 percent of the academic groups used the common protocol combination of T1-weighted axial, T2-weighted axial, T2-weighted coronal, DWI and DCE image sequences.

MRI-guided biopsy was performed at twelve of the academic institutions, while six could biopsy by MRI guidance, two by MRI-transrectal ultrasound fusion, and four with access to both techniques.

Limitations to the study data included a low response rate from community and private practice groups. The authors also hypothesized that the participating academic institutions submitted biased answers and believe that rates for prostate MRI may be lower in nonresponding institutions.

Leake and colleagues wrote, “Potential areas to further evaluate include DWI parameters, such as b-values, DCE parameters including time duration and temporal resolution, MRI preparation including glucagon or enema use, and image interpretation processes.”