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MRI with or without contrast

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Posted 7/27/2018 2:16 PM (GMT 0)
May be dumb question but have wondered about this. I've seen posts that says the with or without and wanted opinion about this. The VA where I am treated doesn't offer the 3T MRI and will probably be facing another biopsy when I go back in October. Can anyone clear this up for me and which is better for prostate cancer if used for fusion biopsy.
Posted 7/27/2018 4:35 PM (GMT 0)
I think the contrast results are not included in the PIRADS score that constitute the standard way to report the results of a mpMRI now. Points are assigned to hypo/hyper T1/T2 signals, depending the apparent lesion location and, very important, to the diffusion constant measured by a gradient field. Therefore, I wonder what is the use of the contrast. It gives curves shapes that are different in lesions and normal tissue, but they are not apparently taken into account in the final score. But I am writing what I can remember of my research one year ago without further verification. Therefore it is easy I can be wrong, maybe somebody can correct me.
Posted 7/27/2018 4:54 PM (GMT 0)
Thanks, That helps clear it up for me. I know the VA has mri imaging but not the Tesla. Appreciate your response
Posted 7/27/2018 6:14 PM (GMT 0)
A multiparametric MRI (mpMRI)used for a fusion biopsy usually includes 3 scans -DWI, T1/T2, and DCE. DCE stands for "dynamic contrast enhanced" - they actually monitor the contrast as it gets taken up. They use all 3 scans to come up with a PIRADS score - and they biopsy from areas that are scored PIRADS 3, 4 or 5. Tesla (T) refers to the magnetic field strength of the MRI. 3 T is the magnetic field strength usually used for an mpMRI - it can also be done with a 1.5 Tesla MRI, but they would usually add an endorectal coil to get adequate image resolution. It also takes an experienced radiologist.
Posted 7/27/2018 7:03 PM (GMT 0)
Thanks, Allen. I had wondered whether the contrast was added for additional scan so that is easy to understand. Thanks for your response.
Posted 7/27/2018 7:19 PM (GMT 0)
I revised the point to remember why I got the notion that contrast is not so important. Strictly, DCE allows to discriminate between PIRADS 3 or 4 but only when the DWI, diffusion, score is 3 (in a 1-5 range) and only for peripherical lesions. Even so, this role is judged as irrelevant or secondary in some publications I read over time ago. I guess this is the reason that contrast is not always recommended.
I had it twice anyway, the first time I notice some itching some days after. Gadolinium or other contrast elements are strange agents in the blood flow but I guess they are not particularly toxic.
Posted 7/27/2018 11:15 PM (GMT 0)
A further, related question:
Is an mpMRI for a subsequent fusion biopsy identical to a 'regular' prostate MRI?


I had a 'regular' one in a 3T machine (with contrast fluid infused in a later phase of the routine) to see if there was a recurrence within my prostate. The technician who was in charge told me that the contrast fluid was to better reveal cancerous areas.
The report from the radiologist (downloaded to my patient portal) didn't have any PIRAD data. It just stated 'no cancer found' (which made me very happy, of course). I am puzzled and hope that someone could elaborate on the different kinds of MRI.

Post Edited (Sr Sailor) : 7/28/2018 8:19:08 AM (GMT-6)

Posted 7/28/2018 3:29 AM (GMT 0)
Thanks, guys. I had a mri years ago and they gave me couple of tall glasses of some lemony tasting liquid that had a slight sting to it. Didn't question what it was. It was for a different issue. Also know they have the dye test for some issues but pretty ignorant when it comes to medical works. But after 2 biopsies and facing another, would think a fusion biopsy would be in order for the next one. Thanks so much for the feedback on this. I will push for the mri when I go to next appointment in October. 6 months seems like a long time when you wonder whether cancer is progressing as my PSA is going up at a slow rate, knowing it could also be the BPH. Thanks again
Posted 7/28/2018 4:29 AM (GMT 0)
Sr Sailor-
You can have a 3T MRI with contrast that is not a mpMRI. It shows the different density of the different kinds of tissue. The really important part of the mpMRI is the diffusion weighted imaging (DWI). In the radiologist's report they would discuss the apparent diffusion coefficient (ADC) and restricted flow that indicates a tumor.
Posted 7/28/2018 11:31 AM (GMT 0)
Not sure, but I think almost any mpMRI output can serve as input in the software used for a fusion biopsy. MRI guided biopsy is another concept, where a MRI guide substitutes the TRUS guide as the biopsy is being carried out.
I just had a cognitive biopsy where MRI results and their location were in mind in a standard TRUS biopsy. My biopsy only detected G6 in a couple of cores, but the path report was more consistent with MRI. Therefore, just based in my experience, afusion biopsy should be more reliable.
Posted 7/28/2018 12:32 PM (GMT 0)

jmadrid said...
Therefore, just based in my experience, a fusion biopsy should be more reliable.


And on mine as well. I'd had a couple of other MRI's for a musculoskeletal problem, no contrast. Then the prostate MRI with a lap coil over my lower abdomen and contrast infused partway into the procedure.

Just recently I had a H&N MRI and CT which both also had the infusion partway thru ("with and without contrast"). My wife has followup CT's twice a year for her lymphoma and they always have her drink the lemony flavored stuff beforehand, and then infuse the IV contrast during the procedure.

I'm guessing there are different reasons for different conditions. But for me it was the fusion biopsy that ultimately saved me from cancer. My original Uro simply told me that he "did not do MRI's", which is why I call my bloody, horrible first TRUS a "blind" biopsy.
Posted 7/28/2018 1:34 PM (GMT 0)
Guys, could you share how the contrast is infused. Is it thru the IV or something you drink? Looks like it would take a while either way for the contrast to get to the prostate. Thanks
Posted 7/28/2018 2:12 PM (GMT 0)
They put an IV in your arm before sliding you into the MRI machine. In my case they didn't set it right and had to pull me back out again and start over. They run a series of baseline images, then start the IV midway thru the procedure. I think the drinkable contrast is only for an organ study, not for prostate. In the case of my H&N scans, the contrast hit my brain within seconds, but the prostate MRI took an hour or so.
Posted 7/28/2018 2:18 PM (GMT 0)
It is infused via IV, usually in the final part of the procedure. You are so bored at that point that it is kind of fun to notice that something starts to flow. (Sorry, I did not read the other answer before I posted mine, it seems that the precise time for the contrat infusion does not obey a fixed rule).
RobLee I think the only reason fusion biopsies are only reserved for persistent psa after an initial biopsy is their cost.
Posted 7/28/2018 2:24 PM (GMT 0)
I second the last two posts.
So happy when the technician told me that the whole procedure (in my case about 45 min) would be almost over with the infusion.
Posted 7/28/2018 7:13 PM (GMT 0)
Thanks Guys. I think this is one of the reasons this forum is so important. To share info with others that you have already experienced. I hate going into something without knowing what is going on and feel better about it already. Now to persuade my uro/oncologist.
Posted 7/31/2018 10:15 AM (GMT 0)
This new link supports that there is a tendency to eliminate contrast in mpMRI since T2 and diffusion maps seem to give all information needed, saving time, money and the use of a contrast agent.
/prostatecancerinfolink.net/2018/07/30/biparametric-vs-multiparametric-mri-scanning-in-diagnosis-of-prostate-cancer/
Posted 7/31/2018 3:22 PM (GMT 0)
That's an interesting idea. And if it serves the same purpose, why not just us the bpmetric. Thanks for posting the link.
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