Multiparametric Magnetic Resonance Imaging of Penile Cancer: A Pictorial Review

SIMPLE SUMMARY: Accurate preoperative staging and precise outlining of a tumor’s extent are crucial for selecting the most suitable treatment approach and improving outcomes. The current clinical staging of penile cancer is still largely based on physical examination. Multiparametric magnetic resonance imaging (mpMRI) is an important imaging modality that complements physical examination and reduces uncertainties that can easily arise during this examination. However, evidence for the application of MRI in the assessment of penile cancer is scarce; there is no consensus on MRI protocols, and functional MRI techniques have not been widely studied before. This paper focuses on the diagnostic performance of non-erectile mpMRI in evaluating penile cancer, reviewing the use of functional techniques for comprehensive oncological assessments together with the current literature and the latest guidelines. ABSTRACT: The role of multiparametric magnetic resonance imaging (mpMRI) in assessing penile cancer is not well defined. However, this modality may be successfully applied for preoperative staging and patient selection; postoperative local and regional surveillance; and assessments of treatment response after oncological therapies. Previous studies have been mostly limited to a few small series evaluating the accuracy of MRI for the preoperative staging of penile cancer. This review discusses the principles of non-erectile mpMRI, including functional techniques and their applications in evaluating the male genital region, along with clinical protocols and technical considerations. The latest clinical classifications and guidelines are reviewed, focusing on imaging recommendations and discussing potential gaps and disadvantages. The development of functional MRI techniques and the extraction of quantitative parameters from these sequences enables the noninvasive assessment of phenotypic and genotypic tumor characteristics. The applications of advanced techniques in penile MRI are yet to be defined. There is a need for prospective trials and feasible multicenter trials due to the rarity of the disease, highlighting the importance of minimum technical requirements for MRI protocols, particularly image resolution, and finally determining the role of mpMRI in the assessment of penile cancer