introduction

Magnetic resonance imaging (MRI) is one of the leading methods for screening, diagnosis and treatment planning and treatment of prostate diseases - especially prostate cancer: 85% of all cases of prostate cancer can be detected by MRI.

On the other hand, if there are no specific changes in the prostate on MRI, these are actually excluded with 90% certainty.

The MRI of the prostate is considered to be the most reliable diagnostic tool before ultrasound, elastography and punch biopsy.

Another advantage of MRI imaging is its non-invasive, painless property and lack of radiation exposure (as opposed to CT or conventional X-ray imaging).

But not every disease of the prostate is also an indication for an MRI examination, precisely because it is also a very costly procedure.

Indications for an MRI of the prostate

The MRI is - in contrast to the CT or X-ray - especially good for soft tissue imaging and thus the prostate.

The cross-sectional images generated by means of a magnetic field make it possible to draw conclusions regarding the morphology, the blood circulation (as well as possible hemorrhages), calcifications, and ultimately also to draw on benign or malignant changes of the prostate,

The most important indication or the main application of prostate MRI is the diagnosis of prostate cancer.

This includes, on the one hand, the early detection procedure: if elevated PSA levels occur or if the physician detects a noticeable palpation during the physical examination, a malignant change can be detected or excluded by means of the MRI, so that an unnecessary biopsy may possibly be avoided.

On the other hand, the MRI can enable targeted planning for a possibly necessary punch biopsy, in case that the PSA value continues to increase despite previous biopsies without cancer detection.

However, if a prostate cancer has already been detected, then the MRI is used to assess the exact extent and progress of the disease in the pelvic area as well as the further treatment planning and control of the course of therapy.

Finally, it may also serve the search for a possible recurrence after already proven austerapination of prostate cancer.

On the other hand, an MRI scan is less useful if prostate cancer is prevalent because it makes it difficult to detect any potentially malignant changes.

Even a simple, benign prostate enlargement (benign prostatic hyperplasia, BPH) is not an indication.

procedure

The MRI scan of the prostate is supine and takes about 30-40 minutes.

In preparation for the MRI scan of the prostate, the patient is usually advised to stop eating about 4 hours before the start of the study.
Small amounts of water and possibly necessary tablets, however, can be taken as usual before.

Shortly before the examination begins, the patient is asked to remove all metallic objects (jewelry, watches, piercings, dentures, hair clips, etc.) and to dispose of the clothing with metallic components (eg underwired bra, buttons, zipper, etc.). The underwear and usually also a (metal-free) T-shirt can stay put on.

Next, the patient is asked to completely empty the bladder for best imaging.

After the patient has placed himself supine on the examination couch, on which he is later pushed into the MRI tube for imaging, headphones are passed against the loud knocking sounds of the device and an emergency bell.

In addition, an indwelling cannula is usually placed in the celiac vein to allow for any necessary contrast agent delivery for MRI of the prostate before or during the exam.

In order to avoid image disturbances and to improve the image quality, it may also be necessary to additionally administer a drug which relaxes and calms the bowel movements (eg Buscopan®).

duration

The duration of an MRI scan of the prostate is on average about 30-40 minutes, with individual deviations always possible.

Cost of an MRI of the prostate

The cost of a pure prostate MRI examination and thus a pelvic presentation, amount to an amount of about 800-900 € for privately insured (billing according to GoÄ).
The costs for a legal insurance are lower and will be taken over by a doctor if the appropriate regulation.

However, the costs may vary individually, depending on what additional costs such. B. added to a contrast agent or medication.

The costs incurred by private patients are fully covered by the private health insurance companies.

Also, the statutory health insurance companies usually take the cost of an MRI examination of the prostate, as this is in the associated service catalog.

According to the S3 guideline, the indication must correspond to prostate cancer (prostate cancer) in the fields of early detection, diagnosis and treatment of the various stages of prostate cancer.

Special MRI examination forms, such as MR spectroscopy or MRI-assisted punch biopsy, on the other hand, are not borne by the statutory health insurance companies, but offered as so-called individual health services (IGEL) that are completely paid by the patients (all costs, including the MRI). even have to be paid.

As a rule, private health insurances even undertake the examinations regarded as IGEL services by the statutory health insurances.


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