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Table 3 Pros and cons of performing DCE imaging in prostate mpMRI compared to the combination of T2WI and DWI

From: Evolution of prostate MRI: from multiparametric standard to less-is-better and different-is better strategies

  Pros Cons
Detection and localisation Gain in sensitivity for cancers located in hypovascular and fibrous zones (anterior fibromuscular stroma, central zone) or showing challenging appearance such as non-nodular infiltrating lesions in the peripheral zone Gain in sensitivity compared to T2WI alone, but no added value compared to T2WI and DWI
Gain in specificity (up to 17%) in differentiating cancer from atrophy, necrosis, haemorrhage, prostatitis, calcifications Variable enhancement patterns in cancer, overlapping with benign conditions
Problem solver in PI-RADS version 2 for peripheral zone lesions
Rescue of examinations with inadequate or absent T2WI and/or DWI
Primary role in detecting recurrence after treatment
Research: prediction of tumour volume, prediction of biological aggressiveness (microvessel tissue density or Gleason score)
Staging Gain in accuracy in less experienced readers (“first localise, then stage” approach), especially for seminal vesicle invasion Conflicting results in literature
Gain in assessing extraprostatic extension by detecting extraprostatic contrast enhancement False positives related to inflammation
Patient-centred care Negligible extra time in magnet Extra time in magnet reducing patient comfort and compliance
Adverse reactions to gadolinium-based contrast agents are rare and usually of limited clinical significance Safety issues related to gadolinium-based contrast agents, including adverse reactions and gadolinium deposition in the brain
Costs Increased costs (up to 20–30% of the whole examination).
  1. See references: [13, 28, 30,31,32,33]. DCE dynamic contrast-enhanced, DWI diffusion-weighted imaging, mpMRI multiparametric magnetic resonance imaging, PI-RADS Prostate Imaging Reporting and Data System, T2WI T2-weighted imaging