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

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).