How to cite: Raman SS. “Integration of MRI with Histology, Genomics, and Proteomics.” September 15, 2025. Accessed Mar 2026. https://grandroundsinurology.com/integration-of-mri-with-histology-genomics-and-proteomics/
Summary
Steven Raman, MD, Professor of Radiology, Urology, and Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, explains that MRI now enables extensive correlation with histology and disease aggressiveness, providing insights into radiogenomics, proteomics, transcriptomics, and metabolomics. He notes that the goal of this integration is precise risk stratification, enabling the selection of aggressive cancers, avoiding overtreatment, and guiding treatment, such as whole-gland therapy, focal therapy, or active surveillance.
Dr. Raman emphasizes the multiparametric nature of MRI, including T2, diffusion, and perfusion imaging, with applications in image-guided biopsy and treatment. Techniques such as 3D-printed molds allow precise correlation of MRI and prostate-specific membrane antigen (PSMA) positron emission tomography (PET) with histology.
He reports that MRI identifies index lesions with approximately 80 percent accuracy. Combining MRI with PSMA PET improves detection rates to about 87 percent, enhancing biopsy targeting. Diffusion-weighted imaging is a powerful biomarker of histology, as lower apparent diffusion coefficient (ADC) values correlate with higher-grade cancers. Multiparametric MRI also predicts aggressive histologic features, such as intraductal and cribriform carcinoma, and radiomic approaches extend predictive capacity.
Dr. Raman notes that commercial assays, including 4Kscore, SelectMDx, and Decipher, show improved performance when combined with MRI. MRI-visible cancers are enriched for aggressive molecular features, while MRI-invisible cancers demonstrate more favorable profiles.
Dr. Raman argues that multiparametric MRI, when integrated with molecular data and commercial assays, enhances patient selection and risk assessment, with radiogenomics and artificial intelligence likely to play central roles in future diagnostics.
The Global Summit on Precision Diagnosis and Treatment of Prostate Cancer is a unique multi-disciplinary forum organized to inform the key health care stakeholders about the emerging advances in clinical cases and research and create a consensus-based vision for the future of precision care and educational and research strategy for its realization. The mission of the Summit is to fill the currently existing gap between the key experts of in vivo imaging, the world authorities in the in vitro fluid- and tissue-based molecular diagnostics, including genomics, and thought leaders in the development of novel observation strategies (e.g., active surveillance, or AS) and therapeutic interventions.
ABOUT THE AUTHOR
Steven S. Raman, MD, is the Director of the Abdominal Imaging Fellowship Program, Director of the UCLA Uterine Fibroid Program, and a Clinical Professor of Radiology Sciences at the University of California, Los Angeles. Dr. Raman is also Director of the Abdominal Imaging Fellowship at UCLA, and Co-Director of the Fibroid Treatment Program at UCLA.
