Multiparametric magnetic resonance imaging of the prostate—a basic tutorial

Prostate cancer is the second most common cause of cancer related death in the United States and the most commonly diagnosed malignancy in men. In general, prostate cancer is slow growing, though there is a broad spectrum of disease that may be indolent, or aggressive and rapidly progressive. Screening for prostate is controversial and complicated by lack of specificity and over diagnosis of clinically insignificant cancer. Imaging has played a role in diagnosis of prostate cancer, primarily through systemic transrectal ultrasound (TRUS) guided biopsy. While TRUS guided biopsy radically changed prostate cancer diagnosis, it still remains limited by low resolution, poor tissue characterization, relatively low sensitivity and positive predictive value. Advances in multiparametric magnetic resonance imaging (mpMRI) have allowed more accurate detection, localization, and staging as well as aiding in the role of active surveillance (AS). The use of mpMRI for the evaluation of prostate cancer has increased dramatically and this trend is likely to continue as the technique is rapidly improving and its applications expand. The purpose of this article is to review the basic principles of mpMRI of the prostate and its clinical applications, which will be reviewed in greater detail in subsequent chapters of this issue.