PI-RADS committee position on MRI without contrast medium in biopsy naive men with suspected prostate cancer: a narrative review

The steadily increasing demand for diagnostic prostate MRI has led to concerns regarding the lack of access to, and the availability of qualified MRI scanners, and sufficiently experienced radiologists and radiographers/technologists to meet the demand. Solutions must enhance operational benefits without compromising diagnostic performance, quality and delivery of service. Solutions should also mitigate risks, such as decreased reader confidence and referrer engagement. One approach may be the implementation of MRI without the use gadolinium-based contrast medium (also referred to as "biparametric MRI"), but only if certain prerequisites such as high-quality imaging, expert interpretation quality, and availability of patient recall or on-table monitoring are mandated. Alternatively, or in combination, a clinical risk-based approach could be used to decide on protocol selection, specifically which biopsy naïve man needs MRI with contrast (multiparametric MRI). There is a need for prospective studies where biopsy decisions are based upon MRI without contrast. Such studies must define clinical and operational benefits and identify which patient groups can be scanned successfully without contrast. These higher quality data are needed before the PI-RADS Committee can make evidence-based recommendations about MRI without contrast as an initial diagnostic approach for prostate cancer work-up.