Changing how MRIs are carried out could triple the number of scans used to detect prostate cancer, potentially making diagnosis quicker and more effective, researchers have said.
MRI scans are standard for men suspected of having the disease and can allow doctors to rule out cancer without the need for a tissue biopsy, but demand has risen sharply.
The scans are currently carried out in three phases, with imaging done without contrast in the first instance.
After this, the patient is injected with an iodine-based liquid fed into the body through a cannula, which helps enhance scan images.
In terms of impact, we will see a big difference to prostate cancer detection for very little effort and cost— Dr Alexander Ng
Researchers from University College London (UCL) and University College Hospital (UCLH) said a two-step MRI, without the need for injection, can be “just as effective”.
Dr Alexander Ng, of the UCL Division of Medicine and first author of the study, said: “The quality of MRI scans can be significantly improved by following a few simple 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.”
The UCL-led PRECISION study, published in 2018, developed a five-point scoring system to rate MRI image quality, five being optimal for diagnosis.
To try and overcome current capacity issues with MRIs for prostate cancer, they have now set up the PRIME trial to explore whether a shorter and cheaper MRI scan could become the new standard of care.
The latest study – GLIMPSE – forms part of the trial.
For the first phase of GLIMPSE, researchers analysed 355 MRI scans from 41 medical centres across 18 countries.
Some 32% had achieved the highest PI-QUAL score of five.
The team contacted each centre and when 36 from 17 countries resubmitted MRIs, the score rose to 97%.
Dr Ng added: “The beauty of our study is that we have provided a glimpse into the international quality of MRI scanners, and found that only a third of scanners were of optimal diagnostic quality.”
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— Veeru Kasivisvanathan
The findings from GLIMPSE, published in the journal Radiology, will feed directly into the PRIME trial.
If successful, researchers said it could “change clinical practice”, cutting MRI scan times from 30 minutes to 20 minutes on average.
The scans would also require fewer staff and would be less invasive as they would not require intravenous contrast injections.
Veeru Kasivisvanathan, associate professor in the UCL Division of Surgery and Interventional Science, and a senior author of the study, added: “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.
“There is growing awareness amongst cancer specialists that variable quality of MRI scans poses a challenge to this approach, hence the results of the GLIMPSE study are an important step towards making MRI imaging as quick, cheap and effective as possible.”
Not only will this help the researchers, but it means huge numbers of men worldwide will be getting a better and more accurate diagnosis— Dr Hayley Luxton
The PRIME and GLIMPSE studies are funded by Prostate Cancer UK and The John Black Charitable Foundation through a Travelling Prize Fellowship Award, the European Association of Urology Research Foundation and the Dieckmann Prostate Cancer Research Foundation.
Dr Hayley Luxton, senior research impact manager at Prostate Cancer UK, said: “Multiparametric MRI (mpMRI) scans have transformed how we diagnose prostate cancer, giving men a more accurate diagnosis and helping avoid unnecessary biopsies.
“But it can also be time consuming and sometimes uncomfortable, as it involves multiple images and requires men to have an injection. That’s why, with The John Black Charitable Foundation, we co-funded the PRIME trial to see if it could be just as effective with fewer images and without the jab.
“What we didn’t anticipate was that it would have such a massive impact on how hospitals around the globe take mpMRI images.
“This incredible boost in how many are generating the best-quality images is all thanks to the knowledge and support shared by the world-leading team at UCL and we’re proud that our funding has helped bring this about.
“Not only will this help the researchers, but it means huge numbers of men worldwide will be getting a better and more accurate diagnosis.”
