# Multiparametric prostate MRI (PI-RADS)

Source: https://onco.cc/technologies/mp-mri/  
OnCo record `mp-mri` (Technology). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Multiparametric prostate MRI combines three scan sequences, scored 1 to 5 under PI-RADS, and is done before a first biopsy in men with a raised PSA. Needles go to suspicious areas and men with a negative scan can often avoid biopsy altogether, but about one in ten clinically significant cancers is missed.

## Summary

Multiparametric prostate MRI combines T2-weighted, diffusion-weighted and dynamic contrast sequences, scored 1 to 5 under PI-RADS v2.1 for the likelihood of clinically significant cancer. It is performed before a first biopsy in men with a raised PSA, so needles can be targeted to suspicious lesions and men with a negative scan can often avoid biopsy. PRECISION (2018) showed MRI-targeted biopsy detected more clinically significant cancer (38% versus 26%) and less insignificant cancer than systematic biopsy, with 28% of men avoiding biopsy; it is now guideline standard before first biopsy. Reader variability remains a limitation and about 10% of significant cancers are missed, so relying on a negative MRI alone in higher-risk men is still debated. AI reading (PI-CAI challenge) matches radiologists. In short, an MRI first finds the cancers that matter and spares many men a biopsy.

## Fields

- Kind: Technology
- Status: standard-of-care
- Last checked: 2026-09-06
- Principle: T2-weighted, diffusion-weighted, and dynamic contrast sequences scored 1-5 for likelihood of significant cancer.
- Since: 2012
- Strengths: Fewer and better-targeted biopsies; Reduces overdiagnosis
- Limitations: Reader variability; Misses ~10% of significant cancers

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/PI-RADS
- Wikipedia: https://en.wikipedia.org/wiki/PI-RADS

## Connected records

- cancers: [Ductal adenocarcinoma of the prostate](https://onco.cc/cancers/prostate-ductal-adenocarcinoma/), [Localised prostate cancer, very low and low risk](https://onco.cc/cancers/prostate-low-risk/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- fronts: [Diagnostics & Biomarkers](https://onco.cc/fronts/diagnostics/), [Imaging](https://onco.cc/fronts/imaging/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [Elastography and contrast-enhanced ultrasound](https://onco.cc/technologies/ultrasound-elastography-ceus/), [MRI](https://onco.cc/technologies/mri/), [MRI field strengths: 1.5 T, 3 T and 7 T](https://onco.cc/technologies/mri-field-strengths/), [PSA and MRI-first prostate cancer screening](https://onco.cc/technologies/prostate-screening-psa-mri/), [Quantitative imaging biomarkers (RECIST, PERCIST, SUV, ADC)](https://onco.cc/technologies/quantitative-imaging-biomarkers/)
- trials: [GÖTEBORG-2 (MRI-based prostate cancer screening)](https://onco.cc/trials/goteborg-2/), [PRECISION](https://onco.cc/trials/precision-mri/)
- terms: [PSA density](https://onco.cc/terms/psa-density/), [PSA kinetics: PSA doubling time and PSA density](https://onco.cc/terms/psa-kinetics/), [TNM staging for prostate cancer, and what changed in the 9th edition](https://onco.cc/terms/tnm-prostate-cancer/)
- bottlenecks: [Overdiagnosis and false alarms](https://onco.cc/bottlenecks/b-overdiagnosis/)

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