The importance of multiparametric imaging in combination with innovative image processing methods has increased significantly in recent years for the planning of surgical interventions. In recent years, information on suspected and confirmed tumours based purely on anatomy has been supplemented by information on metabolism or disease-specific markers such as PSMA in prostate carcinoma. Information on blood flow and other tissue properties such as cell density are also incorporated into the analysis of tumours and the planning of surgical procedures.

Additional information has been obtained in recent years through advanced image analyses that combine and record the texture (radiomics) of the tumours in combination with further information from MRI and PET imaging (mpRadiomics). Machine learning approaches with large amounts of data also aim to derive prognostically relevant information from imaging, which could benefit patient care in the future. These areas are currently the subject of intensive research.

To optimise the collection of representative sample material, the biopsy is planned using all the necessary imaging techniques to reach the most aggressive or metabolically enhanced parts of the mass. This also makes it possible to determine the optimal access route and the appropriate method for taking the sample (ultrasound or CT-guided, open) for analysis for pathology, molecular pathology or microbiology.

Planning a biopsy of the prostate if a malignant tumour of the prostate is suspected
(PET/MR-TRUS fusion biopsy)

The combination of multiparametric MRI (mpMRI) and transrectal ultrasound for fusion biopsy of the prostate has become established in recent years. The combination of mpMRI with prostate-specific membrane antigen (PSMA)-PET imaging (mpPET/MR) can provide additional relevant information for biopsy planning, especially in complex cases and after a negative biopsy but high clinical suspicion for the presence of prostate carcinoma. This examination takes only slightly longer than an mpMRI of the prostate and supplements the information on PSMA expression, which occurs on prostate tumour cells.

The combination of multiparametric MRI (mpMRI) and metabolic information from FDG-PET can provide relevant additional information about aggressive tumour components and deep growth in the bladder muscles in bladder cancer. This combination examination is offered in the surgical planning of clinically significant cases. This examination also allows analyses of several parameters to be carried out at the level of the smallest unit of information (voxel).