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Prostate Cancer MRI Scan Quality Boosted by 'Simple' Steps

A UK-led international study has identified steps that can be taken to improve the quality of MRI scans for prostate cancer screening.

Research, published in Radiology, found "relatively simple and reproducible" methods that could treble the number of scans that are of optimal diagnostic quality.

Improved MRI imaging would allow clinicians to rule out cancer in more cases without resorting to tissue biopsy, as well as identifying cancer more reliably, the researchers explained.

Multiparametric magnetic resonance imaging (mpMRI) of the prostate was now the "standard of care" in patients with suspected prostate cancer and reduced the need for an upfront tissue biopsy. However, the demand for scans had risen sharply, the authors said, and a major concern about more widespread use of this technology was its ability to produce high-quality images with the existing health care infrastructure. 

Towards Shorter, Cheaper, and Less Invasive Screening

The study authors set out to prospectively evaluate the quality of MRI scanners taking part in the quality control phase of the global PRIME (Prostate Imaging Using MRI ± Contrast Enhancement) trial using the Prostate Imaging Quality (PI-QUAL) standardised scoring system. 

Prostate Imaging Quality (PI-QUAL) is the first standardised scoring system that evaluates image quality using a five-point scale, with a score of five indicating the scan being of 'optimal quality' for diagnosis. To overcome existing capacity issues, and to ensure that all men could access an MRI scan, the PRIME trial was setup to assess whether an "even shorter, cheaper and less invasive" MRI scan could become the new standard of care. This latest study, called GLIMPSE (Global Variation in Magnetic Resonance Imaging Quality of the Prostate), formed part of that trial.

For the study, data between September 2021 and August 2022 from 355 MRI scans from 41 medical centres across 18 countries was evaluated by two genitourinary radiologists using the PI-QUAL scoring system. 

They found that only around one in three (32%) achieved a PI-QUAL score of five, with 13% achieving a score of three (sufficient image quality), and just over one in two (55%) scoring four (adequate image quality).

The research team then provided feedback to the centres to improve the quality of their scans. When 36 centres from 17 countries resubmitted the MRIs, the percentage of scans achieving a PI-QUAL score of five jumped to 97%, with 3% obtaining a score of 4.

First author Dr Alexander Ng, from the division of medicine, University College London (UCL), explained that MRI scan image quality could be improved by following a few recommendations. "This could be changing the duration of certain sequences by a few seconds, for example. In terms of impact, we will see a big difference to prostate cancer detection for very little effort and cost."

Men Should Get More Accurate Diagnoses

Associate professor Veeru Kasivisvanathan, from UCL's division of surgery and interventional science, and senior author, said: "The long-term goal of our work on prostate cancer screening is to see whether we can effectively diagnose or rule out cancer using a shorter, cheaper MRI scan. The results of the GLIMPSE study are an important step towards making MRI imaging as quick, cheap and effective as possible."

Other potential benefits included a reduction in the time needed to perform an MRI from on average 30 minutes to 20 minutes, fewer clinical staff being required, no need for intravenous contrast, and potential cost-savings for healthcare providers. In addition, "a more concise MRI will mean that more men will be able to get a scan and more will be diagnosed accurately, which means less anxiety and the possibility of no biopsy if no cancer is seen," emphasised the authors.

"Basic evaluation and modifications to MRI protocols using PI-QUAL can lead to substantial improvements in quality," they underlined.

Asked to comment for Medscape News UK, Dr Hayley Luxton, senior research impact and intelligence manager at Prostate Cancer UK, highlighted the "massive impact" the research had had on how hospitals around the globe took mpMRI images. The "incredible boost" in how many were generating the best quality images would not only help researchers, but meant that "huge numbers of men worldwide will be getting a better and more accurate diagnosis", she said.

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