T2 mapping for the characterization of prostate lesions
By
Tobias Hepp
Laura Kalmbach
Manuel Kolb
Petros Martirosian
Tom Hilbert
Wolfgang M. Thaiss
Mike Notohamiprodjo
Jens Bedke
Konstantin Nikolaou
Arnulf Stenzl
Stephan Kruck
Sascha Kaufmann
March 31, 2022
Clinical Scorecard: Characterization of Prostate Lesions Using T2 Mapping Techniques
At a Glance
Category Detail
Condition Prostate cancer and chronic prostatitis differentiation Key Mechanisms Quantitative T2 mapping and ADC values from mpMRI to characterize prostate lesions Target Population Men suspected of prostate cancer with PI-RADS v2.1 score ≥ 3 Care Setting Radiology and urology departments performing mpMRI and robot-assisted prostate biopsy
Key Highlights
Prostate cancer is the most common non-cutaneous cancer in men with up to 37% lifetime risk. Differentiating prostate cancer from chronic prostatitis on mpMRI is challenging due to overlapping imaging features and PSA elevation. Quantitative T2 mapping provides absolute T2 relaxation times independent of signal intensity variations, potentially improving lesion characterization. Guideline-Based Recommendations
Diagnosis
Use multiparametric MRI including T2-weighted imaging, diffusion-weighted imaging, and dynamic contrast-enhanced imaging per PI-RADS v2.1. Apply quantitative T2 mapping sequences to obtain absolute T2 relaxation times for lesion assessment. Perform robot-assisted mpMRI-TRUS fusion targeted biopsy for histopathological confirmation. Management
Interpret T2 mapping values alongside ADC values to differentiate prostate cancer from chronic prostatitis. Consider histopathological correlation via targeted biopsy for lesions with suspicious imaging findings. Monitoring & Follow-up
Monitor serum prostate-specific antigen (PSA) levels, recognizing elevation can occur in both prostate cancer and chronic prostatitis. Use follow-up mpMRI with quantitative T2 mapping to assess lesion changes over time. Risks
Potential misclassification of chronic prostatitis as prostate cancer due to similar imaging features. Elevated PSA levels are not specific and require imaging and biopsy correlation. Patient & Prescribing Data
Men with suspected prostate cancer undergoing mpMRI and biopsy
Quantitative T2 mapping may aid in non-invasive differentiation of prostate lesions, potentially reducing unnecessary biopsies.
Clinical Best Practices
Perform mpMRI at 3T with standardized protocols following European Society of Urogenital Radiology guidelines. Use PI-RADS v2.1 scoring to classify lesions and guide biopsy decisions. Annotate regions of interest on T2 maps and ADC maps for quantitative analysis. Combine imaging findings with histopathology from robot-assisted targeted biopsy for accurate diagnosis. References
