Comparison of 5 T and 3 T Biparametric MRI for Clinically Suspected Prostate Cancer: Image Quality, Lesion Visualization, and Artifacts

ABSTRACT Background Biparametric MRI (bpMRI) is important for prostate cancer (PCa) diagnosis. Higher field strength at 5 T may improve image quality versus 3 T, but clinical value remains unclear. Purpose To compare image quality, imaging artifacts, and PCa visualization between 3 T and 5 T bpMRI. Study Type Prospective. Population One hundred and five patients with clinically suspected PCa, including 56 with histologically proven prostatic lesions. Field Strength/Sequence 3 T and 5 T; T2‐weighted imaging (T2WI) using fast spin echo and echo‐planar diffusion‐weighted imaging (DWI). Assessment Signal‐to‐noise ratio (SNR) measured at both field strengths; in the biopsy‐proven cancer subset, contrast‐to‐noise ratio (CNR), apparent diffusion coefficient (ADC), and lesion‐boundary sharpness measured using the “plot profile” function. Image quality and lesion conspicuity rated on 5‐point Likert scales. Prostate imaging reporting and data system (PI‐RADS) v2.1 agreement was compared using Cohen κ . Participants were grouped by pre‐scan enema (enema n = 61; non‐enema n = 44) for artifact comparisons. Staistical Tests Wilcoxon signed‐rank test, ICC, and Cohen's κ ; p < 0.05 was considered significant. Results 5 T demonstrated significantly higher SNR for T2WI (391.40 vs. 274.41) and DWI (208.82 vs. 106.40). CNR was higher at 5 T for T2WI (median 10.3 vs. 8.5) and DWI (median 31.5 vs. 16.2); lesion‐edge sharpness was greater at 5 T (median 48.1%/mm vs. 30.9%/mm). Median scores for image quality, lesion conspicuity, and anatomy visibility were higher at 5 T than at 3 T (4–5 vs. 3–4). DWI artifacts were more frequent at 5 T in the non‐enema group (5 T 20%–27% vs. 3 T 11%–16%); other artifact comparisons were not significant ( p = 0.059–0.886). PI‐RADS scoring showed excellent inter‐reader agreement ( κ = 0.83–0.95) and good inter‐field agreement ( κ = 0.69–0.89). Data Conclusion In bpMRI, 5 T has significantly better T2WI and DWI image quality than 3 T. Evidence Level 2. Technical Efficacy Stage 3.