MRI Prostate — Multiparametric (MR prostaty)

Multiparametric prostate MRI (mpMRI) at Klinika JL is the gold-standard imaging investigation for prostate cancer detection and staging, performed on the Philips 3 Tesla scanner with gadolinium contrast. The exam combines T2-weighted anatomical sequences, diffusion-weighted imaging (DWI) and dynamic contrast-enhanced (DCE) sequences to assign a PI-RADS score (1–5) to any suspicious lesion — guiding the decision between surveillance, targeted biopsy and treatment. At 3 Tesla without an endorectal coil, image quality is sufficient for PI-RADS scoring in most patients. Self-pay price is 9,000 Kč plus contrast. The clinic is open daily until 21:00 for urgent urology referrals.

Multiparametric prostate MRI (mpMRI) has become the recommended first investigation before biopsy in men with elevated PSA or abnormal digital rectal examination, endorsed by EAU (European Association of Urology) guidelines. The Philips 3 Tesla scanner at Klinika JL acquires the three parameter families required for a complete mpMRI study: 1. T2-weighted sequences (sagittal, coronal, axial) at high resolution assess the zonal anatomy of the prostate — peripheral zone (PZ), transition zone (TZ), central zone — and identify morphological abnormalities: low-signal foci in the PZ (suspicious for significant cancer), ill-defined nodules in the TZ (differentiating BPH nodules from TZ cancer), extracapsular extension (ECE, a staging criterion), and seminal vesicle invasion (SVI, T3b). 2. Diffusion-weighted imaging (DWI) with multiple b-values (including a calculated ADC map) detects hypercellular cancer by restricted water diffusion — cancer has lower ADC values than normal prostate tissue. DWI is the most heavily weighted parameter in the PI-RADS v2.1 scoring system for the peripheral zone (where most significant cancers arise). 3. Dynamic contrast-enhanced (DCE) imaging after intravenous gadolinium provides an additional parameter: focal early enhancement greater than normal prostate tissue elevates the PI-RADS score in borderline cases. PI-RADS v2.1 scores are assigned per lesion: 1–2 (clinically significant cancer unlikely), 3 (equivocal), 4 (likely), 5 (very likely). Lesions PI-RADS 3–5 are typically referred for targeted MRI-guided or MRI/TRUS-fusion biopsy. mpMRI before biopsy increases the detection of Gleason ≥7 clinically significant cancer while reducing unnecessary biopsy of low-risk disease. At 3 Tesla without an endorectal coil (ERC), image quality meets the PI-RADS v2.1 minimum requirements; ERC provides additional spatial resolution and is typically used only in academic centres for research protocols. For most clinical referral questions — pre-biopsy workup, active surveillance re-evaluation, post-treatment response assessment — 3 Tesla surface coil mpMRI is the standard of care. Preparation: a bowel preparation with a phosphate enema the morning of the exam is often recommended to remove gas and faecal material from the rectum, which would otherwise create susceptibility artefact on DWI sequences closest to the rectal wall. The booking team will advise. The exam takes approximately 40–50 minutes. Results are reported using PI-RADS v2.1 terminology and transmitted electronically to the urologist.