How to prepare for prostate MRI and get tested
Sometimes a man who comes to the urologist complaining of poor urination and soreness in the perineum can get a referral for MRI of the prostate. This is a standard method of examination, which is widely used in the diagnosis of various diseases, including those manifested in the prostate gland.
Consider who is shown magnetic resonance imaging and how to do it. We will share information about that. what the device shows and how to prepare for the study correctly.
What is an MRI and how is it better than an ultrasound
Magnetic resonance imaging or MRI is an organ research technique that is based on the ability of atomic nuclei to produce electromagnetic waves that can be detected by a device. In fact, MRI allows you to scan an organ in layers, without violating the integrity of the tissues and without affecting the subject.
The tomograph takes pictures in three directions:
- front to back
- top down,
- from right to left.
The received information is processed in the processor and displayed on a computer screen. If necessary, based on the images, you can create a three-dimensional model of the organ, in this case, the prostate.
Ultrasound, unlike MRI, does not have such capabilities. Using this method, the doctor can detect the pathological process, but the organ can be scanned in one or two planes. Therefore, the accuracy of ultrasound is lower and it is not always possible to correctly recognize the pathological process.
In doubtful cases, when examining the prostate gland using ultrasound, the man is sent for MRI.
Indications for MRI
MRI is a relatively expensive method, so in most cases the doctor will cost TRUS or abdominal ultrasound. However, MRI is often not enough.
Indications for magnetic resonance imaging are:
- suspected oncological process in the prostate gland,
- suspected metastasis in organs,
- complaints of prolonged pain in the sacrum, lower abdomen, perineum and genitals,
- pains in the hip joint, which are one of the manifestations of CTS,
- suspected rupture of a cyst or abscess.
In some clinics, MRI is used in the complex diagnosis of prostatitis and vesiculitis, as well as other inflammatory processes in the pelvic organs. The direction for examination is given by a doctor, urologist, oncologist, andrologist.
In modern conditions, magnetic resonance imaging of the prostate can be used for complications of prostate adenoma and chronic prostatitis.
Contraindications to MRI of the prostate
There are several absolute and relative contraindications to the study of the prostate using MRI. The first includes those situations and diseases in which a scan using magnetic radiation is not possible at all. These include:
- an installed Ilizarov apparatus (a structure assembled on a limb during a bone fracture for their correct fixation),
- intolerance to the contrast medium,
- patient weight more than 130 kg,
- body coverage is greater than the diameter of the apparatus,
- chronic renal failure.
Also contraindicated are established pacemakers, implants, coronary stents, coils, prostheses and other devices. True, in this case, a contraindication can be considered not absolute, but relative. It all depends on the material of the parts used in the device.
If the manufacturer claims that the implant has low magnetic properties and is compatible with MRI, the examination can be carried out after consulting a doctor and under close supervision by medical personnel. Otherwise, an MRI of the prostate will be prohibited.
Relative contraindications are claustrophobia and hyperkinesis (increased mobility). These violations lead to the fact that the patient cannot lie calmly in the device, is anxious, moves, and therefore the result will not be clear. Because MRI is done only in emergency cases.
If necessary, the patient can be entered into medical sleep during the examination. This is done in extreme cases.
What shows an MRI of the prostate
The method of MRI of the prostate gland is a translation into the image of the resonating reaction of hydrogen from tissues to a magnetic field. Radiated energy is captured in the radio frequency range and displayed on the screen. The resulting image gives detailed information about discreteness, topography, size, and outline of the prostate. These parameters are needed to determine urological pathologies: MRI can show inflammatory, proliferative, and oncological diseases of the prostate.
A man is sent to an MRI only after simple procedures (this is due to the complexity and high cost of the service). For example, the diagnosis of chronic prostatitis begins with a medical history, rectal examination, laboratory blood and urine tests. If the measures taken did not allow to establish the disease accurately, the patient is given a referral to magnetic resonance imaging.
In addition to differential diagnosis, an indication for MRI is the study of the prostate in the preoperative period. The study will show the degree of organ damage and involvement in the pathological process of neighboring structures (tissue, bone, blood, nerve). According to the pictures, the doctor will get an accurate idea of what exactly during the operation should be removed from the man.
What is MTR of the prostate
Magnetic resonance imaging is one of the most modern methods of diagnosing various kinds of diseases, including in the prostate gland. Based on the results of its conduct, the doctor will have access to the most detailed layered image of this internal organ. In addition, it should be noted that this is the most accurate and at the same time the safest method for detecting pathologies in the body.
The principle of the technique lies in one of the properties of hydrogen - to manifest itself under the influence of a certain kind of magnetic rays. The patient is placed and placed in the zone of electromagnetic radiation. It should be understood that, unlike radiation, it does not have a negative effect on the body.
Ultrasound, MRI, TRI or biopsy: which is better
Australian scientists from the Wesley Institute have done a great deal of research comparing the effectiveness of four types of instrumental examinations: ultrasound, TRUS, traditional tomography and biopsy under the control of MRI of the testicles, bladder and prostate gland. 489 patients with elevated PSA levels were examined. Subjects with their consent conducted all four types of diagnostics. Prostate cancer was detected in 234 people.
The largest inaccuracy according to the results of the study was found in the ultrasound examination - cancers were detected in only 62%. TRUS, to be exact - it helped to detect oncological formations in 77%. MRI accuracy without biopsy is 89%, with biopsy is 100%.
The paradox is that despite the minimal likelihood of a false diagnosis in MRI, ultrasound and TRUS are much more often done. The reason is a large number of contraindications and the high cost of tomography.
How to prepare for the study
Before magnetic tomography, it is necessary to refrain from foods with a high content of coarse fiber (fibrous vegetables, fruits, whole wheat bread) for 24 hours. Excludes food that increases gas formation (mineral water, beans, beans, kefir). A prerequisite - do not eat at all for 4 hours before an MRI.
Prostate MRI is always performed with an empty rectum. The patient prepares for the procedure on his own: 12 hours before the procedure, it is recommended to clean the intestines (drink a laxative or make an enema). Psychological preparation for the study is based on the fact that the patient should tune in immobility in the supine position for more than half an hour. The examination does not cause any discomfort (pain, burning).
How long after a prostate biopsy can an MRI be done
According to medical standards, magnetic resonance imaging is performed before transrectal excision of the prostate tissue is performed (a break between procedures does not matter - it can be done within one hour). This method is called fusion (fusion) prostate biopsy - it is done under the control of MRI.
Plus, a “double” procedure - the doctors do not take the material “blindly” (from random sections of the prostate), but aiming (from those areas that the magnetic resonance imaging shows as suspicious). As a result, the number of tissue sampling points is reduced, which significantly reduces the risks of complications. For comparison: during standard tissue sampling, 30–40 punctures are performed, and when combined with MRI, 10–12.
If the order is disturbed, the tissue material was taken before instrumental diagnosis, then MRI can be done no earlier than 25 days after a prostate biopsy. During this time, the wound remaining after the introduction of the needle into the gland will have time to completely heal.
How to do prostate MRI
A study is conducted inside a long pipe of approximately 60 cm in diameter. A man can use his pajamas, which are given in the clinic, or be in his clothes during the procedure if she does not pull the body and does not have metal elements.
With prostatitis, cancer, prostate abscess or prostatic hyperplasia, only the pelvic area should be examined, so the person is not completely placed in the device - the head, shoulders, arms remain outside the tomograph. This allows the patient to keep his eyes open, listen to music, read a book (most importantly, do not move your lower body during radiation).
For an MRI of the prostate, a man is not completely placed in the device - the head, shoulders, arms remain outside the tomograph.
The duration of MRI is from 30 to 70 minutes. During the procedure, 10–20 surveys are carried out. When a scan is done, the patient needs to lie as motionless as possible. In the periods between them (breaks last no more than 2-3 minutes), you can move your legs a little, which the doctor will report additionally.
The simplest type of MRI is a study without using contrasting material. It is rarely used because of the high probability of skipping cancer. The only case when it is done is the presence of contraindications for using contrast:
- Allergy to the composition of the contrasting drug.
- Chronic renal failure.
- Recently suffered a heart attack.
- Phlebothrombosis and clotting pathology.
The advantages of a non-contrast MRI are the reduced cost of the service, eliminating the likelihood of an allergic reaction. Less - without contrast, it is more difficult to recognize areas of cancer. For example, in the case of small sizes of cancerous tumors in the prostate, the probability of their detection is 78%, since there are no changes in the structures surrounding it.
Preparation for MR examination of the prostate gland in men
Proper preparation for prostate MRI includes several points:
- Diet. Two days before an organ scan, you should remove from the diet all foods that cause flatulence: legumes, any raw vegetables and fruits, milk and products from it, fried foods, smoked meats, pickles, marinades, brown bread, pastries, pastries, carbonated drinks.
- Bowel cleansing. During normal operation of the digestive tract, it is enough to go to the toilet as usual. With a tendency to constipation, they put an enema or use a laxative.
- Taking antispasmodics and drugs to prevent gas formation. Medicines are prescribed only by the attending physician.
One way to cleanse the intestines before an MR scan of the prostate is by setting an enema
They come to the procedure on an empty stomach. If the scan of the prostate is scheduled for the morning, breakfast is skipped, if the appointment is in the afternoon, meals are allowed 4-6 hours before the appointed time (you can eat something easily digestible - porridge on the water, yogurt, a cheese sandwich with low-fat varieties) . For drinks, lightly brewed tea and still water are preferred. 4 hours before the examination, the intake of fluids is stopped.
During the procedure, the bladder should be medium full. It is emptied no later than two hours before the start of the MRI session.
Prostate MRI in contrast mode: preparation
Contrast drug for intravenous administration
If an MRI of the prostate with a paramagnetic contrast medium is expected, the preparation of the patient for the examination is carried out in the same order. With a tendency to develop allergic reactions, a man needs to make a test in advance. If kidney or liver diseases are identified or suspected, a blood test may be required to evaluate the functionality of these organs.
MRI of the prostate: what shows?
Most often, nuclear magnetic diagnostics are used to detect malignant tumors of the prostate gland. MRI finds the smallest neoplasms in the anterior regions of the peripheral zone, inaccessible for imaging by transrectal ultrasound.
Prostate: comparison of magnetic tomograms of a healthy and sick person
- determine the size of the tumor,
- establish the spread of pathology beyond the capsule of the gland,
- to identify the involvement of the urethra, bladder, seminal vesicles, surrounding fiber, lymph nodes in the oncological process,
- see metastatic lesions on the pelvic bones and sacrum.
Also, MR imaging shows:
- inflammatory lesions of the body (prostatitis, abscesses),
- congenital malformations (hyperplasia, hypoplasia, etc.),
- consequences of traumatic injuries.
How do MR scans of the prostate
There are several ways to study the prostate:
- Classic - ordinary non-contrast magnetic resonance imaging.
- With the involvement of the endorectal coil - for maximum accuracy of the examination results in the immediate vicinity of the prostate gland, an additional sensor is placed on a flexible wire.
- With contrast, an intravenous injection of the drug with a dye is made, which is distributed over the tissues and improves the visibility of pathologically altered areas.
- MR spectroscopy - performed specifically to study the chemical composition of the prostate gland. A healthy organ is characterized by a high concentration of citric acid. When malignant tumors occur, its amount decreases with a simultaneous increase in the level of choline, which is part of the cell membrane.
- Multiparametric MRI. This study combines all types of tomography.
The patient should be brought to the diagnosis for the results of previous examinations, if any.
Magnets of a tomograph create a powerful field, so before you enter the office, you must remove objects with metal:
- clothes with rivets and zippers,
- jewelry for piercing,
- dentures, etc.
Phones, wallets, bank cards, pens and other personal items are left behind the door of the equipment room.
The session lasts 30-40 minutes. If the use of an endorectal coil is provided, an anesthetic may be given to the patient half an hour before the scan.
The tomograph is a complex device that includes a cylindrical tunnel and a retractable table. The man lies on his back.To prevent involuntary movements, the body and limbs are fixed with straps. To muffle the noise of a working device, use headphones or anti-noise earbuds.
For endorectal examination, the coil in a special case is lubricated with a lubricant and placed in the rectum. The balloon surrounding the sensor inflates, allowing the scanner to take the correct position.
After preparation, the device takes native pictures. If necessary, the patient is injected with a contrast during the examination process and the procedure continues. At the end of the tomography, the balloon is deflated, the coil is removed, and the patient can stand up from the table.
Indications and contraindications for MRI of the prostate gland
Indications for MRI of the prostate are:
- suspected malignancy, metastases,
- infectious (including sexually transmitted) diseases,
- congenital malformations of the prostate gland,
- viral, fungal diseases,
- inflammatory processes
- complications after surgical treatment of an organ.
Using MRI, you can visualize the structure of the prostate, detect hidden pathologies, assess the degree of involvement of surrounding tissues in the process.
On magnetic resonance imaging (a - axial section, b - sagittal section) arrows indicate progressive cancer with spread to the mouth of the seminal vesicles
Magnetic resonance diagnostics are absolutely contraindicated in the presence in the (on) the body of a man of metal objects or electronic devices, which include:
- middle ear implants
- joint prostheses
- plates, staples, screws, screws, etc., used in surgery,
- compression distraction apparatus,
- damaging elements (bullets, shot, fragments, etc.), metal shavings,
- insulin pump
- vessel clips
- muscle stimulator with ferromagnetic elements,
- artificial heart valve (if it is not made of polymers or biological tissue).
- fear of confined spaces (with a mild form of claustrophobia, sedatives help prepare for MRI),
- the inability for a long time to be in the same position,
- weight more than 120 kg (this restriction is associated with the design features of tunnel-type tomographs).
Examination with contrast is not carried out with:
- allergies to the components of the drug,
- severe liver damage during rehabilitation after an organ transplant,
- renal failure in the terminal stage.
Decoding MRI images of the prostate gland
During the procedure, the doctor receives detailed information about the condition of the prostate itself and the organs that are adjacent to it (bladder, lymph nodes, lower intestine). In the absence of deviations, the sizes of the prostate gland, testes, nerves and blood vessels are normal, tumors are not detected. Pathologies can appear in the pictures in the form of an enlarged prostate, changes in its contours, and the display of single or multiple neoplasms inside or outside the capsule.
Discussion with a specialist of the results of prostate MRI
Decoding of tomograms is done by the specialist who conducted the study. A conclusion on the nature of the changes is not considered a diagnosis. The final analysis of the information received and the selection of an adequate method of therapy is the task of the attending physician.
What is the difference between MRI of the prostate and pelvis
In our country, it so happened that if there is a suspicion of prostate cancer, the doctor prescribes the patient a referral for MRI of the pelvis, which is not entirely correct and appropriate. These two types of tomography are fundamentally different from each other. Having done an MRI of the pelvic organs, the doctor will see a generalized picture, and with an MRI of the prostate - only this organ. In the latter case, the picture will be more accurate and detailed.
How to prepare for an MRI of the prostate
MRI of any organs, including the prostate gland, requires preparation of the subject. The doctor will do something, for example, conduct a test for sensitivity to contrast medium and check the condition of the kidneys. But the man himself will have to make an effort:
- 2 days before the appointed date, remove from the diet any foods that can cause bloating - dairy products, soda, legumes and cruciferous vegetables,
- do not eat on the day of the study (if the MRI is without contrast, a light breakfast will not hurt),
- an hour before the trip to the doctor to make a cleansing enema.
If only a prostate check is planned, then the bladder should be full. To do this, you need to drink a liter and a half of water without gas, but do not go to the toilet. If the doctor believes that other pelvic organs need to be checked, then the bladder will need to be emptied. It is advisable to clarify these nuances in advance.
Drug preparation consists in taking an hour before the examination of No-shpa, Drotaverin or another antispasmodic. An intravenous injection of hyoscine butyl bromide may also be performed to reduce intestinal motility.
Prostate tomography: varieties and their features
In addition to the standard method of MRI, in the case of prostate diagnostics, there are several more methods that allow you to get an even more accurate examination result:
- coil, in which a thin latex tube is inserted into the rectum - this is how the magnetic field is focused in the studied area,
- contrast, during which a substance, even better detected by MRI, is injected into the blood,
- A spectrogram conducted in parallel with MRI allows you to accurately determine the chemical composition of the tissues of the investigated organ.
How do prostate MRI
Before starting the examination, the doctor talks with a man. First, information is collected on whether there is an allergy to the drugs, which implants are installed. They also ask about tattoos and the time of their application - more than 20 years ago, high-metal inks were used, because such tattoos can become warm during the examination.
The doctor also talks about the procedure and gives instructions for action in case of fear or deterioration of well-being.
Further examination is carried out in approximately the following order:
- A man enters an MRI room, strips and takes off all metal things, including a pectoral cross, a watch, an engagement ring, etc.
- He lays down on a special table of the device, the doctor fixes his arms and legs - this is necessary so that random movements do not interfere with the study.
- After making sure that the man is feeling fine, he pushes the table with him into the tomograph tunnel.
- Scanning begins. A man can determine this by rhythmic clicks and various sounds, and a feeling of light heat may appear in the area of the examined area.
- If you have an MRI of the prostate with contrast, a catheter will be inserted into the vein first, through which the substance will enter automatically. In this case, a periodic feeling of cold or warmth is possible.
MRI of the prostate gland lasts no more than 45 minutes, sometimes it takes less time. MRI with contrast can last up to an hour or a little longer. If a man is afraid that the sounds will be annoying, you can ask a nurse for special sound-absorbing headphones. In them, some patients may even fall asleep, which is not prohibited by the examination regulations.
Results will be ready about an hour after the end of the survey. They will be issued personally to the patient or referred to the attending physician.
How to prepare for an MRI of the prostate
This procedure requires some preparation by the patient. In particular:
- three days before the examination, you should follow a diet, abandoning the use of products that provoke increased gas formation,
- if a coil MRI is prescribed, a cleansing enema must be delivered on the day it is performed.
The doctor must instruct the patient on the features of the examination and give recommendations on how to prepare for it.
The patient also needs to know about the existence of a number of contraindications and limitations to magnetic tomography:
- the examination is not carried out for patients in whose body there are any metal objects (implants, shunts, valves, clips, etc.),
- any metal objects (jewelry, clothing with a zipper, belts, hearing aids, etc.) must first be removed from oneself,
- kidney problems may be a contraindication to MRI with contrast,
- with decompensated heart failure,
- in case of mental illness
- the features of this device are such that if the patient has a rather severe degree of obesity, it can cause a significant distortion of the results, and in some cases cause the impossibility of an examination.
The consequences of MRI for men
You should not be afraid of any negative consequences for health or potency - the magnetic resonance imaging procedure is absolutely harmless to the patient. In some men, allergic reactions to a contrast medium are possible, expressed in the following symptoms:
- skin rash,
- burning sensation in the area of drug administration,
- itching on the skin.
In severe cases, respiratory failure, coughing, shortness of breath, and chest tightness are possible. These are signs of an allergic reaction to a contrast medium.
To avoid trouble, you need to notify the doctor of possible problems and truthfully answer his questions.
Advantages and disadvantages of the technique
MRI of the prostate is a technique for diagnosing diseases of this organ, which has been used for quite some time and actively. This is especially true in Western Europe. Among its undoubted advantages are three important factors in which it has no equal:
- absolute patient safety
- high precision technology
- speed of carrying out and receiving results.
If we talk about the shortcomings, then first of all, one cannot fail to note the high cost of such a procedure. It is unlikely that it will be possible to cheapen it, because, firstly, the equipment itself is incredibly expensive, and secondly, only a highly qualified narrow-profile specialist, who are very few, can carry out the procedure, and thirdly, the duration of the procedure is up to 30 minutes or more.
Our country has introduced the practice of free MRI examinations for privileged categories of citizens, however, the enormous queues on these lists sometimes make it long for months to wait for the day of examination, and in cases with diseases such as cancer, delay is unacceptable.
Diagnosis of prostate diseases using MRI
Using magnetic resonance imaging gives high accuracy and allows you to identify the following diseases:
- Prostatitis - inflammation of the prostate gland in acute and chronic forms, as well as in the abscess phase with layering of pus.
- Hyperplasia (adenoma) - the proliferation of connective tissue, as a result of which the urethra is compressed. The disease is dangerous with serious complications. Early detection is the key to effective treatment.
- Crayfish. The cure problem is diagnosing the disease in the first phase. At the beginning, the disease does not have specific symptoms. Examination of the prostate gland using MRI provides the most qualitative and reliable data on the presence of cancer, its stage and localization.
The organ under investigation is small and immersed deep enough in the body. In this regard, for a high-quality diagnosis, classical magnetic exposure is not enough. In this case, additionally assigned:
- MR spectroscopy. The result of the study is the chemical composition of the gland.
- MR diffusion / perfusion, which distinguishes between normal tissue and diseased.
Types of MRI studies of the prostate:
- A classic study without the introduction of contrasting markers and a probe. The patient lies on the table, which slides into a large tube surrounded by a magnet. Within 30-40 minutes, the desired area of the body is scanned.
- With contrasting. Before the procedure, the patient is injected with a substance, its traces are clearly visible on the screen. Blood carries the drug to all tissues, including the tumor. Contrast is not harmful, it only helps to better see the borders of the disease.
- With an endorectal coil. A thin flexible wire covered with an elastic braid is inserted into the rectum. It creates an additional magnetic field in the desired area, which makes the image more distinct.
- Multiparametric MRI is a combination of all types of magnetic tomography.
Magnetic resonance imaging, including the prostate gland, has a high reliability of the results, higher than that of other diagnostic methods. In addition to this advantage, it, unlike computed tomography of the prostate gland, does not expose the patient to the harmful effects of x-rays. An exception are people who have contraindications to MRI. CT of the prostate is provided for them.
Advantages of magnetic resonance examination methods:
Prostate MRI is a safe but effective technique for detecting problems in organs. The tomograph allows you to get pictures of the prostate gland in three planes, these images can be converted into a 3D model.
Such opportunities make MRI indispensable in the diagnosis of prostate cancer, gland adenoma, or features of the chronic course of prostatitis. The examination lasts about 45 minutes, and the result will be ready in an hour.
Such a speed of examination, as well as a small number of preparatory procedures allow the use of MRI, even in emergency cases.
MRI with a contrast agent is performed to determine the parameters of the prostate and identify tumors of any size. As a contrast, use:
The listed products contain gadolinium salts. This is a metal that has a silver tint and is clearly distinguishable during an MRI of the prostate with contrast. The drug is injected (an injection is made with a syringe into a vein). In 2-3 minutes, blood reaches the prostate with contrast; magnetic resonance imaging can be performed. A day after the procedure, the contrast agent is excreted from the body with urine.
What is an MRI of the prostate?
The study of the prostate by magnetic resonance imaging is based on the reaction to the interaction of tissue structures of the human body with a magnetic field. In this way, you can check the status of the prostate gland and adjacent organs (lymph nodes, bladder, rectum). The results, which are reflected in the pictures, help to objectively assess the organic changes in the tissues, to establish the kind of pathologies, their prevalence. If a person is healthy, the device will reflect the absence of signs of disease.
To increase the accuracy of diagnosis, an algorithm for multi-parameter analysis of tomography data has been developed. Another name for the system is PIRADS (Prostate Imaging Reporting and Data System). The study itself is carried out on standard equipment (now targeted MRI is often used, which is an examination of the prostate on an ultra-high floor tomography scanner).
Multiparametric MRI of the prostate takes longer than standard tomography (20-30 minutes). Time to analyze the information received is also extended.
The advantages of multiparametric MRI is the ability to carry out the procedure without a biopsy.The likelihood of “overlooking” the tumor compared with traditional magnetic resonance imaging is reduced by 12%.
MRI for prostate cancer
An indication for MRI is elevated PSA in the blood. An increase in antigen levels occurs with prostate adenoma, purulent prostatitis, bladder abscess and cancer. Magnetic resonance imaging will determine the exact pathology.
When diagnosing prostate cancer, it is confirmed if dense clots are detected in the picture, which should not be present here according to the anatomy of the gland. MRI allows you to determine the form of oncology: whether the tumor is adenoid, mucinous or fibrous. For example, a weak resonant signal is characteristic of prostate cancer formed by cells with mucin (this information helps determine the appropriate type of treatment for a cancer patient). To understand the nature of the tumor (malignant or benign), a biopsy is done after magnetic resonance imaging.
Deciphering the results
Analysis of MRI data is the task of the diagnostician and urologist. If you wish, you can use medical standards that allow you to independently analyze the images.
- Healthy prostate. The size of the gland, its capsule, testes, surrounding tissues, blood vessels, nerves - everything is normal. No tumors.
- Benign hyperplasia. The MRI image shows a symmetric or asymmetric proliferation of the gland while maintaining uniform contours.
- Prostatitis. MRI shows that the gland becomes larger, but its contours, unlike adenomas, are fuzzy (due to weakening of the blood supply from the venous plexus).
- Cancer on MRI is characterized by single or multiple neoplasms. They are localized pointwise or spread over the capsule of the prostate.
Be sure to ask the specialist for interpretation of the MRI results (an accurate diagnosis is made according to the results of MRI, PSA, ultrasound, etc.). You yourself can incorrectly decrypt the image data and start the wrong treatment (or consider yourself healthy, do nothing and start the disease).
How much is the procedure
The main disadvantage of tomography is that it is not included in the list of services that are done for free under an insurance policy. The price of MRI is quite high (in comparison with other diagnostic methods) - this is justified by the complexity of the procedure, expensive equipment, and highly qualified personnel.
|Type of MRI of the prostate||The average cost in rubles.|
|With contrast agent||6500|
|With a parallel study of all pelvic organs||12000|
For comparison, a prostate CT scan will cost 2,600-4,000 rubles. An ultrasound scan costs from 900 rubles. To make TRUS, you need to give about 1200 rubles.
Free magnetic resonance imaging can also be done. In city polyclinics, quotas for several preferential procedures per month are allocated. The medical institution distributes these quotas among patients, to whom such a study is more important than others. Since there are few offers, sometimes patients expect a free MRI for six months or longer. If the examination is required urgently, you will have to use paid services.
“MRI was prescribed after palpation of the prostate, analysis for PSA, ESR and ultrasound. There was a suspicion of cancer. The procedure took place in Kirov, in a private diagnostic center. I gave about 6,500 rubles. Of the minuses - a terribly noisy device, for half an hour my head ached due to the monotonous buzz and cod. For some reason, they didn’t give me headphones with music, although I read that they always give them out. By the way, oncology has not been confirmed, which is insanely happy. "
“I have been living with 2nd degree prostate cancer for 10 years. Operated 6 years ago and 3 years ago, as there were relapses. I do magnetic tomography every 7-10 months. The procedure is better than CT, since there is no radiation exposure. There is no discomfort in the process - you just lie and think about your own. Before the introduction of contrast, be sure to check for creatinine, if it is not normal, then the procedure is canceled. "
This article will address issues related to magnetic tomography:
- what kind of examination
- why do
- which shows
- how is it carried out
- what the snapshot and the doctor’s opinion looks like,
- which can show additionally
- what type of research to choose - tomography or ultrasound,
- can tomography detect prostate cancer in the initial stage,
- how much is the procedure.
And also, what are the following tests to be performed after diagnosis, when you can do an MRI after a biopsy.
The device creates a strong magnetic field that excites hydrogen atoms in the human body. Atoms give a response.
All diagnostics are based on the behavior of positively charged hydrogen particles..
A feature of magnetic resonance imaging is that it “sees” soft tissues better, and therefore is well suited for examining the prostate gland in men.
Sensitive detectors pick up the radio waves passing through the tissue and record the results as an image. On the computer, the doctor receives sectional body images, that is, in layers.
Take note! The examination makes it possible to determine prostatitis in the initial stage.
Neoplasms that have just appeared are already visible, so treatment can be carried out immediately after receiving the results.
Comparison of the magnetic method and TRUS
Diagnosis of the prostate is carried out by other methods:
- ultrasound - ultrasound,
- transrectal ultrasound - TRUS.
These methods are similar in principle, as they are based on ultrasound, which is reflected from the tissues. During a routine examination, an ultrasound scanner is located in the lower abdomen. In the second, it is administered rectally.
Which is better and more informative: ultrasound or TRUS? A sensor located in the rectum gives a more complete image of the organ. But for the procedure, special events are required:
- an enema just before the start of the examination,
- lack of contraindications - the acute stage of hemorrhoids, anal fissures,
- full bladder.
Ultrasound of the prostate may be a more acceptable method when an urgent study is needed and there is no time for preparation.
If you choose an MRI or ultrasound, then both methods are used. Usually in turn. Ultrasound is cheaper, allowing you to see the problem in general terms. Next comes the turn of tomography to make an accurate diagnosis.
Prostate MRI with contrast
The method of conducting an MRI study of the prostate with contrast involves the introduction into the patient's blood of a special substance that is well distinguished by the apparatus. This type of diagnosis is prescribed by a doctor in most cases with suspected prostate cancer. The contrast medium is injected through the patient’s vein just before the procedure. Before choosing an MRI with contrast, the doctor directs the person for analysis, which should establish his sensitivity to the substance.
Indications for tomography
TRANUSES or MRI of the prostate is prescribed after the patient complains of difficulty urinating or with urinary retention. Indications may be pain:
- lower abdomen
- after intercourse,
- during ejaculation,
- in the urethra.
In case of sexual disorders - premature ejaculation, lack of erection, problems with potency - a diagnostic examination with the help of a tomograph is also prescribed.
Is it worth it to do two studies? The organ on the tomography is fully visible, so it does not make sense to spend money on additional events.
This is the most expensive and effective method at any stage of the disease.
It is better to go directly to magnetic resonance imaging than do a few semi-informative analyzes, collect information in parts.
Prostate hyperplasia - tomography is prescribed after a manual examination in the doctor’s office. Hyperplasia is a growing node, the number and location of which remains to be determined by making a diagnosis. After infectious diseases, changes in the hormonal background, with poor heredity, a sedentary lifestyle, there is some probability that the tomograph will show changes in the gland.
Examination of the organ helps to accurately determine the benign or malignant tumor process. The initial stage is adenoma. MRI of prostate adenoma is done before surgery to accurately determine the volume of tissue, the number of nodes. MRI for adenoma can distinguish it from cancer.
If there is a suspicion of cancer, the study is carried out before the biopsy procedure, so as not to injure the organ in vain. Diagnosis of prostate cancer with a tomograph makes it possible to find out which tissues of the organ grow, since only glandular tissue grows with a malignant neoplasm. The presence of metastases in the lymph nodes and neighboring organs allows you to determine the area of surgical intervention.
The process can be diagnosed before the onset of characteristic pain, treated and prevent the occurrence of metastases. Modern diagnostic methods make it possible to recognize the nature of the tumor even with its microscopic size.
MRI without contrast
Magnetic resonance imaging of the prostate without contrast can be performed in 2 ways:
- Classic - this method does not provide for additional procedures, except for preparation and direct research. A person is placed on a movable table, which is immersed in a capsule with magnets installed in it.
- With an endorectal coil - in this case, a special flexible wire is inserted into the rectum of the patient. Such a device creates an additional magnetic field located in close proximity to the prostate. An endorectal coil probe mechanism contributes to a more accurate diagnosis.
What is an MRI of the prostate done for?
The method of MRI of the prostate is used to confirm or deny the presence of certain diseases:
- genital cancer
- sexually transmitted diseases
- viral and fungal infections,
- prostate adenomas
- diphallia, cryptorchidism - congenital pathologies of the prostate gland,
- complications after surgery.
In men, such a disease develops due to the action of pathogenic microflora or a violation of microcirculation in the prostate gland with venous insufficiency. Stagnation and prolonged inflammation provoke a decrease in local immunity. If prostatitis is not detected during, it can cause the development of an abscess. The treatment of this complication boils down to surgery. To accurately determine the ailment and its stage, doctors recommend that the patient, if suspected of prostatitis, undergo an MRI scan using a contrast medium.
With prostate cancer
Malignant prostate tumors are often found in older men. The first alarming signs are manifested in problems with urination, incomplete emptying of the bladder. As education increases, signs of intoxication, increased fatigue, depression, irritability, and general weakness occur. When the patient has such symptoms, indicating a possible development of a tumor in the prostate gland, the urologist prescribes an MRI for a detailed study of the presence, size and type of neoplasm in the prostate.
With prostate adenoma
With an increase in the intensity of prostate cell synthesis, adenoma or prostatic hyperplasia may occur. Tissue proliferation provokes difficulty in urinating, impaired sexual function, urinary incontinence and the formation of constipation. In the early stages of the adenoma is often asymptomatic, is detected by ultrasound. Doctors prescribe an MRI of the prostate to confirm or deny the presence of a diagnosis, to determine the degree of tissue overgrowth. Based on the study, a treatment plan is formed.
Types of MRI of the prostate
The examination is carried out in several ways, depending on the evidence:
- the usual method - without the use of contrast agents,
- MRI of the prostate with contrast,
- multiparametric research,
The type of study is chosen by the doctor, based on previous tests, the patient's condition, equipment capabilities.
The device can be of two types - open or closed. A closed device is a pipe surrounded by a magnet.
During the procedure, the doctor is in another room, but can talk with the patient through a special intercom.
If suddenly a person felt ill or scared, the procedure can be interrupted and find out what exactly happened.
Some patients are unaware that they are ill with claustrophobia - a fear of confined space.
In an open apparatus, the magnet is located on the sides. The quality of the study does not change from this. In the presence of psychological fear of a closed room, you need to use an open type apparatus.
Prostate MRI with contrast is used if necessary to identify atypical cells in the tissues. In normal cells, the amount of water is greater, in atypical cells is reduced. This criterion determines which cells predominate. The device sees the difference and transfers it in the form of an image to the doctor’s computer. For MRI with contrast, a substance containing iron oxide or manganese is used. More modern drugs are based on gadolinium. This rare metal is very toxic, so some countries have already banned its use.
In Russia, they continue to use substances that are derivatives of gadolinium:
- for MRI with adenoma,
- MRI for prostate cancer
- Testicular MRI
- multiparametric MRI of the prostate gland.
Drugs are administered intravenously. For tomography of the prostate gland with contrast, one of the types is used:
The contrast medium must be strictly timed and coincide with the start of the procedure.
In order for the procedure to show the most accurate result, important conditions must be met. Specialists distinguish the following stages of preparation for MRI of the prostate:
- The patient is shown a diet that should exclude the possibility of gas formation in the digestive tract. To do this, before the MRI procedure, it is strictly forbidden to eat cabbage, fresh baked goods, beans, cereals, carrots, sour-milk and carbonated drinks. This diet should last 3 days.
- Unreliable results can be obtained if there is excess fluid in the body, so the last drink should be done no later than 6 hours before the start of the study.
- If an MRI is done with the introduction of a coil, an anesthetic may be given to the patient, if necessary, by injection in half an hour.
- If a patient develops gas and bloating, the test person is given an active sorbent that eliminates the symptoms.
- Before starting the MRI procedure, you need to remove all metal objects from yourself, since they provoke image distortion.
- The bladder should be moderately full, so urination should be done 2 hours before an MRI.
MRI examination of the prostate
Today, MRI research is the most accurate method for diagnosing prostate pathologies. Experts highlight the objective advantages of tomography:
- during the study, the human body is not exposed to ionizing radiation,
- Compared to computed tomography, soft tissue images are more accurate and clear.
- due to the reaction of the apparatus to diffuse changes in tissues and cells, it is possible to recognize an ailment at an early stage,
- MRI accurately determines the properties of benign and malignant tumors, sets the dynamics of their development.
With all the safety of the procedure, there are contraindications to its implementation:
- an allergic reaction to the substances that make up the coloring preparation with a contrast method,
- the presence of fibrosis,
- diseases of the adrenal glands and kidneys,
- overweight can be an obstacle to conducting research inside the apparatus of a closed type.
When spectroscopy, a special endorectal cuff is used for better visual reflection of tissues. It is lubricated with petroleum jelly or another lubricant and injected into the rectum. The cuff is inflated and fixed motionless for the whole time, contributing to a qualitative study. Diagnosis is performed within half an hour, then the cuff is removed. The anatomy of the structure of the small pelvis contributes to the painless installation and removal of the cuff, so it does not cause discomfort.
The procedure for an MRI scan of the prostate is as follows:
- Depending on the type of MRI, the patient is given a special staining agent intravenously or rectally in the rectum.
- To make an MRI scan efficiently, the patient is placed on the surface of the device motionless, if necessary, special holding devices are used. Then the patient either gets inside the capsule of the device, or a large magnet is placed above it.
- The MRI procedure takes about half an hour, if contrast is used, the time is doubled. The patient must remain motionless so that the pictures are clear.
- The doctor monitors the progress of the study and the condition of the person using audio and video communications.
- Such a study is painless and safe. The body can react to the action of a magnetic field by the appearance of a sensation of heat in the area of monitoring.
Contraindications and side effects
Tomography of the prostate gland, testes and other internal organs is absolutely contraindicated in the presence of:
- metal particles in the body - prostheses, pacemakers, pins,
- various implants, including those located far from the site of the study,
- artificial heart valves
- dentures made of metal.
A magnetic field can change the operation of electronic devices in the human body, therefore, examination of the prostate by the tomography method must be carried out using other available methods.
The procedure is contraindicated in contrast to pregnant women.
Side effects of the procedure may be dizziness, reactions to a contrast medium. Signs of ill health do not require special treatment.
Inspection progress step by step
For the procedure using rectal sensors, you need to empty the rectum. To prepare for the examination, you need:
- restrict foods causing flatulence,
- do not eat 4 hours before the study,
- tell your doctor if you are allergic to any drugs.
The preparation should include the use of sedatives to reduce anxiety during claustrophobia.
Further, tomography is performed according to this algorithm:
- Before research, dress in special clothing. You can stay in your own, if there are no metal objects on it. Take off watches, jewelry made of metal.
- Then the patient lies down on the table, and until the end of the procedure lies motionless - the quality of the readings of the device depends on this.
If the patient is being examined for the first time, he may be confused by the loud sound made by the device. He no longer experiences any unpleasant sensations. The prolonged immobility, which is necessary for high-quality results, is also unusual.
In men, a rectal probe study causes more discomfort in men. If there are problems in the anus, painful symptoms may be of a low degree of intensity. This method uses lubricants to facilitate the penetration of the sensor into the rectum.
The price of the procedure depends on the power of the device, its convenience for people with great weight and psychological problems.
Take note! In public institutions, the cost of magnetic resonance imaging starts from 4000 rubles.
The problem is that the queue is formed in advance and you can wait about a month.
Private clinics charge higher prices, but conduct examinations faster. The expert opinion can be obtained one hour after the diagnosis.
Useful video: how is an MRI of the prostate
To perform a qualitative examination, preparation of the patient is necessary, namely:
- Prepare documents for the doctor - referral, conclusions about previous studies.
- During the day before the procedure, limit the use of products that cause increased gas formation - cabbage, legumes, fruits, milk, brown bread. In order to avoid flatulence, Espumisan should be taken.
- Empty the intestines. If necessary, make an enema.
- Stop eating 4 hours before diagnosis.
- Drink water 2 hours before the procedure to fill the bladder.
- Half an hour before the examination, take an antispasmodic (No-shpa, Spazmalgon, others).
- If the patient is worried, a mild sedative can be used.
Stages of the procedure
Magnetic resonance imaging is a complex device consisting of a retractable table and a cylindrical tunnel surrounded by a magnet. For patients with claustrophobia or weighing more than 130 kg, models of devices with open side walls are provided. MRI examination of the prostate is carried out as follows:
- The patient must change clothes in the locker room and deposit valuables, watches, electronic devices.
- The doctor introduces a gadolinium-based contrast compound into the vein, if contrast was prescribed. In a dynamic study, a patient is given a dropper with a saline solution, into which, after the start of scanning, a marker is added.
- If you intend to use an endorectal coil, then the specialist prepares it as follows. A special cuff is smeared with petroleum jelly or gel. A sensor is placed in it. The cuff is inserted into the rectum, after which it is inflated. At the end of the procedure, it is blown off and removed from the patient's body.
- The patient lies on a sliding table on his back. He puts on headphones or puts earplugs in his ears. Inside the tomograph there is voice communication for communication with staff. The specialist instructs the patient about the upcoming procedure and the rules of conduct with her, including the obligation to maintain complete immobility.
- Scanning lasts 30-40 minutes. If necessary, the session can last as long as necessary to obtain a qualitative result.
- The specialist decrypts the images and passes it to the attending doctor.
Contrast to increase accuracy
The injected substance is instantly carried by blood throughout the internal organs, reaching the prostate and tumors. On the computer screen, the borders of the prostate and neoplasms are clearly visible. You can accurately determine the geometric parameters, the structure of not only the tumor, but also the smallest metastases.
When using contrast, side effects may occur in the form of fever, an external taste in the mouth, rapid breathing and a heartbeat. Such manifestations should be immediately reported to the doctor. To do this, the device provides voice communication.
MRI for prostate cancer
Malignant prostate cancers often affect older men. The disease first manifests itself in difficulty urinating, incomplete outpouring of the contents of the bladder. Then intoxication, weakness, and depressive state appear. Already when such signs appeared, you should contact a urologist and undergo an MRI of the prostate gland.
The most important advantage of endorectal MRI in diagnosing cancer of the gland is the accurate visualization and localization of the size, nature and location of the tumor. The source of information is foci of low signal intensity in the peripheral region of the prostate. Irregular, uneven contours, diffuse distribution are signs of a malignant disease.
Advantages of the Multiparameter MRI Method
Multiparametric MRI is a joint study where all methods of magnetic resonance diagnostics are involved. This procedure gives the most accurate result of all known. Using this integrated approach, it is possible to evaluate the following:
- with dynamic contrasting, the work of blood vessels in the prostate and neighboring organs is analyzed,
- diffuse-weighted tomography shows the parameters of water metabolism in the studied tissues,
- MRI spectroscopy determines the level of concentration of various substances in the prostate gland,
- three-dimensional modeling creates an overall picture and eliminates the misinterpretation of various parameter values obtained during the survey.
The use of such an integrated approach to the diagnosis of pathologies is especially effective when combined with a biopsy. This allows you to identify the most aggressive areas of the cancerous tumor. The advantage is that a conventional biopsy is done at random with multiple punctures. With multiparametric MRI, the doctor knows the location of the neoplasm and takes point samples under the simultaneous control of an ultrasound machine and tomograph, which minimizes the error of penetration of the needle into the tumor body.
When is a CT scan indicated?
There are patients who are contraindicated in MRI. CT and other diagnostics of the prostate are prescribed for them, despite the fact that this is a less accurate method, because the tissue of the organ under study contains many liquid components and is surrounded by bone structures. The procedure can be applied to the category of patients in whom:
- allergy to contrast agents,
- metal implants
- insulin pumps
- surgical clips in vessels and tissues,
- middle ear hearing aid
- weight over 130 kg.
A CT scan of an affected prostate cancer is performed in the following cases:
- in order to determine the degree of cancerous lesions of neighboring tissues with a high risk of spread, calculated on the basis of the Glisson scale,
- to detect regional screenings in the pelvic lymph nodes,
- for the precise planning of surgery and radiation therapy,
- to clarify the diagnosis already made.
In severe patient condition, the procedure is performed to distinguish between acute parenchymal prostatitis and prostate abscess. CT scan is carried out as follows:
- the doctor examines the patient, fixes his condition, finds out if there is an allergy to contrasts, chronic diseases,
- the patient lays on the couch of the tomograph, a catheter is inserted into the vein to enter a contrast marker,
- the catheter is connected to the injector,
- scanning is performed, sometimes several times in different phases of contrast absorption,
- the results are decrypted by a specialist and transmitted to the attending physician.
During an MRI scan, the patient is placed on a movable table, which is rolled into a cylindrical structure that is surrounded by magnets. If necessary, patients are fixed in the correct position with straps or pillows. It is extremely important to lie still during the study, it is this factor that guarantees the accuracy of the results, otherwise a mistake is possible.
Prostate MRI with contrast
A contrast agent is injected into the blood intravenously, which on the screen of the device differs well. This allows you to determine where the affected, and where healthy tissue. Only a specialist decides on the need for an MRI scan with contrast. The examination is prescribed mainly for suspected oncology of the prostate gland.
Preparation for MRI with contrast has some nuances - the patient must be tested for sensitivity to a substance that is administered intravenously. Before going to bed, they make a cleansing enema. Do not take food until the examination.
Contrast material is injected into the vein by patients immediately before the procedure. The rest of the procedure is carried out in the same way as with the traditional method.
MRI with endorectal coil
Before going to the procedure, the patient leaves outside the office where the study will be conducted, a bank card, jewelry, keys or other metal objects. Clothing should also be without metal buttons, staves and other jewelry. As a rule, the patient is dressed up in special clothes.
The patient is located on a movable table. Its position is fixed with pillows or belts. The man must be completely motionless during the scan. The accuracy of the research results depends on this. If there is a need for MR spectroscopy, the doctor carries out the appropriate procedure.
The endorectal coil, with the cover on, is inserted into the anus, lubricated with a lubricant. After preparatory procedures, the patient is placed inside the device. After the examination, the coil is removed, and the patient is asked to wait until the image quality is determined.
A radiologist examines the results of a study in which he evaluates the condition of the prostate, capsule, seminal vesicles, surrounding tissues and regional lymph nodes. Decryption allows the attending physician to exclude or confirm pathologies, as well as obtain all information about the state of the prostate gland.
The method combines all types of MRI of the prostate. The advantage of diagnosis is the detection of a malignant tumor at an early stage.
Multidimensional and multifaceted image reconstruction allows to completely eliminate the possibility of error. The doctor assesses the condition of the organ at different viewing angles and for various parameters.
Often the technique is combined with a biopsy, which allows you to detect the most aggressive areas. Having determined the location of the tumor, the doctor performs a point biopsy. In other biopsies, multiple punctures are performed at random at different points.
Multi-parametric MRI allows you to accurately determine the degree of spread of oncology. This makes it possible to determine the stage and risks of the development of pathology, and, accordingly, prescribe effective therapy.
Diagnosed prostate diseasesMagnetic resonance imaging makes it easy to diagnose the following diseases:
Prostatitis of any form of its development
Acute, infectious, chronic, congestive. The most serious is the chronic form, complicated by purulent discharge and an abscess, which immediately reveals an MRI of the prostate.
Hyperplasia (adenoma) of the prostate
The connective tissue of the gland grows and presses on the urethra, which causes a malfunction of the urinary system. All this entails the most serious complications. With the help of MRI, an early diagnosis of adenoma is performed, which gives more chances for a successful treatment.
Oncology has signs similar to other diseases of the urinary system, so it is extremely rarely diagnosed in the early stages. MRI for diagnosis is the most informative and high-quality examination method.They can be carried out in the traditional way, or using additional research methods that allow you to get the most accurate results.
Contraindications to the study
The list of indirect contraindications
Disadvantages and advantages of the method
MRI of the prostate, like all methods of hardware research, has its drawbacks and advantages.
Watch the video: What to Expect from a Prostate MRI Exam (February 2020).
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