bpMRI

BpMRI, short for biparametric magnetic resonance imaging, is a prostate MRI protocol that uses two imaging parameters—typically T2-weighted imaging and diffusion-weighted imaging with ADC maps—while omitting dynamic contrast-enhanced imaging. It is presented as a faster, less costly alternative to the broader multiparametric MRI (mpMRI), which adds dynamic contrast-enhanced sequences.

Technique and interpretation are generally performed at 1.5T or 3T with a pelvic phased-array coil (endorectal coils are less common today). The protocol emphasizes high-resolution anatomic T2-weighted images and diffusion-weighted imaging, often with high b-values. Images are interpreted using standardized reporting frameworks such as PI-RADS, with focal lesions categorized by suspicion for clinically significant cancer. Because DCE is not included, some centers rely more on diffusion and T2 findings, while still using consensus criteria for lesion assessment and biopsy targeting.

Clinical use and considerations: bpMRI is used for initial evaluation of suspected prostate cancer, guiding targeted biopsies, and sometimes in active surveillance workflows. Proponents cite shorter exam time, reduced cost, and avoidance of gadolinium-based contrast agents. Studies indicate high negative predictive value for clinically significant cancer in appropriately selected populations, though diagnostic accuracy can be somewhat reduced for certain tumor locations, such as anterior regions. DCE can still aid in equivocal cases or specific patient scenarios, and some guidelines allow mpMRI in settings where the expertise or equipment to implement bpMRI is not available. Overall, bpMRI is part of the evolving approach to balance diagnostic performance with efficiency and safety in prostate cancer imaging.