Multiparametric MRI and Prostate Cancer: Pitfalls and Tricks

Prostate cancer (PCa) is the most common cancer in men [1]. Until a few years ago, digital rectal examination, serum prostate-specific antigen (PSA) measurement, and prostate biopsy were the main tools in the diagnosis of PCa. Now, the role of multiparametric MR (mpMR) in the detection of PCa is widely accepted, but it is also recognized that prostate mpMR probably represents one of the most demanding challenges in radiology. The technique has relatively high variability in intra- and interobserver agreement [2], and its learning curve is not easy [3]. At the same time, a wide spectrum of technical MR parameters influence the mpMR evaluation. A major effort has been made to standardize the technical mpMR parameters and the mpMR reading model, as reflected in Prostate Imaging—Reporting and Data System version 2 (PI-RADS v2) [4]. PI-RADS v2 was developed by an international expert committee created by the American College of Radiology (ACR), the European Society of Urogenital Radiology (ESUR), and the AdMeTech Foundation with the aim of updating and improving upon PI-RADS v1. Certainly, the extended use of PI-RADS v2 has facilitated the reading of mpMR and improved the diagnosis of PCa [5]. However, anatomic variants and benign pathologies frequently make radiological evaluation difficult in daily practice [6].