BEWARE: Not All Prostate MRIs Are the Same

Over the past few years, prostate MRIs have become popular. In the quest to find prostate cancer early, more physicians and patients are turning to magnetic resonance imaging to help detect suspicious lesions and guide the collection of tissue samples during biopsies. For the most advanced form of biopsy—MRI fusion-guided biopsy—the resolution of the MRI plays an especially important role. 

“With an MRI fusion guided biopsy, we’re fusing the prostate MRI picture with a live ultrasound image that we take during the man’s biopsy,” explains Richard Bevan-Thomas, M.D., medical director of USMD Prostate Cancer Center. “During the ultrasound, the MRI image is pulled over and superimposed on top of the live ultrasound image. By aligning the two images, we have a better chance of identifying suspicious lesions that might not be found otherwise.”

For MRI fusion-guided biopsy to be truly effective, the sharpness of the MRI image is critical—and not all MRIs are equal.

Magnet Strength Matters
“Men must have their prostate MRI performed at a true center of excellence that specializes in prostate MRIs for a couple of reasons,” says Dr. Bevan-Thomas. “The center must have a very powerful magnet—a 3 Tesla (3T) magnet is best. Only a 3T magnet is powerful enough to clearly delineate really small lesions—7mm or 8mm—from normal tissue.

“While many MRI centers will gladly perform a prostate MRI, the image will invariably not have the clear resolution needed to see small cancer lesions if the center uses a less powerful magnet—say a T.75, T1, T1.5 or a T2 magnet. In addition, many of the centers place a balloon in the rectum to improve the visibility of the prostate, which is very uncomfortable for the patient.”

Sequencing Software
In addition to a 3Tmagnet like the one used at USMD Prostate Cancer Center, a prostate MRI requires special sequencing software to properly set up the images so they can be correctly evaluated by a pathologist. 

“If the images are set up incorrectly, the MRI can be misread, lesions can be missed and the whole validity of the MRI is undermined,” Dr. Bevan-Thomas warns. “Not only is there a very likely chance the pathologist will not be able to see any lesions you may have, your MRI could be read as normal. And if your MRI is classified as normal, it’s very likely you’ll be told you don’t need a repeat biopsy—even though you could be walking around with an intermediate or high-grade lesion in your prostate.”

The Right Pathologist
Finally, a prostate MRI must be evaluated by a genitourinary-trained pathologist. 

“At USMD, we have a GU fellowship-trained radiologist, Dr. Kurt Shoppe, who works with us and knows what to specifically look for in the prostate MRI sequences,” Dr. Bevan-Thomas explains. “You can have the best MRI around, but these lesions are often very small and can be easily missed by someone who isn’t trained to evaluate prostate MRIs.” 

Dr. Bevan-Thomas sees one or two patients every month who come in with a negative MRI.

“They say, ‘I’m just coming here as a formality because I know I don’t have prostate cancer.’ And then we find they do. Unfortunately, cancers were probably missed in a lot of men.”

Dr. Bevan-Thomas recently treated a fireman who was originally cleared by a sub-optimal prostate MRI.

“He was told that his prostate MRI was negative. The pathologist marked it as normal and there were no visible lesions on that MRI. He brought his MRI to me for a second opinion, and I said I don’t think we have sharp enough definition with this MRI to confirm you’re clear.”

Dr. Bevan-Thomas performed a biopsy, and found that six out of 12 cores were positive for prostate cancer.

“He had multiple areas of prostate cancer” Dr. Bevan-Thomas says. “The MRI center he originally went to didn’t have a powerful enough magnet or the prostate MRI sequencing software to find these lesions within his prostate,” Dr. Bevan-Thomas says.

As a Siemens Center of Excellence, the specialists at USMD Prostate Cancer Center understand men’s lives often depend on the findings of prostate MRIs and prostate MRI fusion-guided biopsies.

“There are no short cuts,” Dr. Bevan-Thomas says. “We’ve invested in the technology, equipment and medical expertise needed to perform prostate MRI fusion-guided biopsies the correct way so we don’t miss a deadly cancer. We are committed to serving men in the best possible way.” 

If you would like to schedule a prostate MRI and MRI fusion-guided biopsy, contact us online or call us at 1-888-PROSTATE (1-888-776-7828).

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