Magnetic Resonance Imaging (MRI) is a scanning technique for creating detailed images of the human body. The scan uses a strong magnetic field and radio waves to generate images of parts of the body that cannot be seen as well with X-rays, CT scans, or ultrasound. Recently, in a video interview with OncLive, Peter Choyke, M.D., F.A.C.R.,*, talked about the advantages and disadvantages of using an MRI for diagnosing cancer, specifically prostate cancer.
Dr. Choyke begins his interview with the listing the challenges, “What to do? How to perform the MRI—what it should look like? What’s a gull post for them [the radiologist, the urologist, and the technician] to achieve in terms of image quality?” So what should be done?
What Should Be Done?
“The first thing is establishing the quality of the image, which, really, on modern equipment should be very possible,” says Dr. Choyke. Are the radiologist and the technician on the same page? Do they both understand the need for the image to be clear? Do they both understand what the focus of the image should be? “There are idiosyncrasies with the way things are done,” Dr. Choyke continues. “If a radiologist places too much reliance on a technologist to get the right image, there can be problems.” This is true because since the equipment standardizes many aspects of scans, this should all be a given. However, a technician is only able to capture the image to the best of his knowledge. But should the urologist need something different, then problems may arise.
Dr. Choyke continues, more important is “understanding what things look like. What abnormalities look like. What normal variances look like. What is important to the urologist.” Thus, are the radiologist and the urologist able to discern what abnormalities look like in an image? Do they have a framework or a reference as to what they are looking for? A technician is usually not able to discern abnormalities since he is not trained to do so. While these are telling aspects that aid in diagnosis, however, this responsibility rests with the radiologist and the physician. Therefore, each member of the team should be sure of what is being asked of him. Furthermore, every MRI has its limits. Thus the radiologist and the urologist should be clear on, “the limitations of the technique,” says Dr. Choyke.
The PI-RAD Scoring System
Lastly, “is to learn the scoring system, which is called the PI-RADSv2#, . . . really understanding how to use that, and getting consistency among the various partners in a group for PI-RAD scoring. So that not one person has to read all the MRIs. It can be something that can be distributed.” The score is assessed on prostate MRI. In that, images are obtained using a multiparametric technique, a dynamic contrast study. If the images, quality, or testing are insufficient for interpretation, the newest guidelines recommend omitting them in the scoring.
Oftentimes, cancer diagnostic and treatment teams are comprised of experts who work closely together. These can include an oncologist, urologist, general physicians, technicians and more. It is vital that they all work together and establish uniformity in the use of MRI for a diagnosis. Yet within all of this, Dr. Choyke assures that variabilities are inevitable. Still, there are also “opportunities for training and education.” Moreover, “there’s been a dramatic improvement in what we’re seeing. Over the last couple years, you can see a decided improvement in the quality of both things—imaging and interpretation [of MRIs].”
The Progress Made Thus Far
Even so, despite any variability and any setbacks, it seems “we’re going in the right direction,” concluded Dr. Choyke. Therefore, if you are a man 50 years or older, or your family has a history of prostate cancer, be sure to speak a doctor about your chances of developing prostate cancer.
* FACR is an acronym that can have several definitions. In this case, Dr. Peter Choyke is a Fellow of the American College of Radiology. Also, Dr. Choyke is the Chief of the Molecular Imaging Program at The National Cancer Institute.
#PI-RADSv2 is short for Prostate Imaging Reporting and Data System, the second version. This system refers to a structured reporting scheme for evaluating the prostate for prostate cancer. It is designed to be used in a pre-therapy patient. For more information, and to visit the Radiopaedia webpage, click here.