Prostate MRI Ordering Protocol
Order a multiparametric prostate MRI at 1.5T or 3T (preferably 3T) with a pelvic phased array surface coil, including mandatory T2-weighted, diffusion-weighted imaging (DWI), and dynamic contrast-enhanced (DCE) sequences following PI-RADS version 2.1 technical standards. 1, 2
Essential Technical Specifications
Field Strength and Coil Selection
- Use either 1.5T or 3T MRI scanner, with 3T preferred for improved signal-to-noise ratio and spatial resolution 1, 2
- Use a pelvic phased array surface coil placed over the pelvis 2
- Do NOT routinely use an endorectal coil - it is neither mandatory nor preferred at either field strength, despite historical practice 1, 2
Required Imaging Sequences
All three sequences below are mandatory and must be included: 1
- T2-weighted imaging (T2W) - provides anatomic detail of prostate zones 1
- Diffusion-weighted imaging (DWI) with ADC mapping - detects areas of restricted diffusion 1
- Dynamic contrast-enhanced (DCE) imaging - requires intravenous contrast injection 1, 2
Critical caveat: A biparametric protocol that omits DCE sequences cannot be used, as DCE is essential for detecting recurrence and assessing lesion vascularity 1
Technical Parameters
- Follow PI-RADS version 2.1 standards for all sequence technical parameters 1
- Optimize parameters for your specific scanner to ensure high-quality images, as image quality is paramount 1
- For DCE sequences specifically: maintain adequate temporal resolution, spatial resolution, and signal-to-noise ratio 1
Clinical Context Requirements
Information to Provide to Radiology
When ordering the MRI, include the following clinical details for optimal interpretation: 1
- Recent PSA values 1
- Gleason scores from any prior biopsies 1
- Details of any prior focal therapy (if applicable) 1
- Indication for the study (initial staging, surveillance, post-treatment follow-up)
Quality Assurance Considerations
- Ensure the interpreting radiologist has adequate experience - ideally reading at least 20 prostate MRI examinations annually if interpreting post-focal therapy studies 1
- For new readers, consider independent double-reporting by an experienced reader 1
Common Pitfalls to Avoid
Sequence Quality Issues
If any required sequence is missing or of inadequate quality: 1
- T2W or DWI sequences missing/inadequate: The sequence must be repeated before any treatment decisions, as comparison images are essential 1
- DCE sequence missing/inadequate: Should be repeated, particularly in post-treatment surveillance settings 1
- T1-weighted sequence missing/inadequate: Does NOT require repeat examination, as the precontrast phase of DCE provides sufficient spatial resolution 1
Timing Considerations
- For post-focal therapy surveillance: Order the first MRI at 12 months after treatment to minimize treatment-induced artifacts that can mask recurrent disease 1
- For initial diagnostic workup: MRI should ideally be performed at least 6 weeks after prostate biopsy to avoid hemorrhage artifact, though this is based on general practice patterns
Practical Ordering Template
Order as: "Multiparametric prostate MRI with contrast at 3T (or 1.5T if 3T unavailable) using pelvic phased array coil. Must include T2-weighted, diffusion-weighted imaging with ADC map, and dynamic contrast-enhanced sequences per PI-RADS v2.1 protocol. Clinical indication: [specify]. PSA: [value]. Prior biopsy Gleason score: [if applicable]."
This protocol ensures comprehensive evaluation while maximizing diagnostic accuracy and minimizing patient discomfort compared to endorectal coil approaches 3, with comparable or superior image quality using modern surface coils 4, 3.