![Multiparametric MR imaging of the prostate (65-year-old man, PSA level of 8.3 ng/mL, clinical stage T2c, Gleason score of 7 [3+4])
in screenshot generated by a computer-program, which can be used for image interpretation in multiparametric MR imaging. In
addition to related views of multiplanar multiparametric images (A–E), quantitative information (F) is also displayed. A–E show
tumor with bulging, suspicious for minimal stage T3A disease, in right peripheral zone at level of midprostate to apex (arrow). A,
Axial Ktrans map from dynamic contrast-enhanced MR imaging projected over T2-weighted image (see Fig 2 for parameters). B,
Sagittal T2-weighted image (4290/98; flip angle, 120°) with color overlay showing washout (from dynamic contrast-enhanced MR
imaging). C, Axial ADC map (2900/81; flip angle, 90°). D, Axial DW trace image (b = 800 sec/mm2; 2900/81; flip angle, 90°). E, Axial
T2-weighted image. F, Relative gadolinium concentration–time curve (left) and MR spectrum (right) from chosen point of interest in
tumor (+). In MR spectrum, choline (chol) and citrate (cit) peaks can be evaluated. The low-signal-intensity lesion on E shows
increased Ktrans (on A), restriction on C, high signal intensity on D, gadolinium concentration–time curve type 3 and high choline
peak on F. On a five-point scale, this can be scored 5/5 on T2-w, dynamic contrast-enhanced, DW, and MR spectroscopic images, for
total score of 20/20, indicating intermediate to highly aggressive tumor.](https://image.slidesharecdn.com/presentation1mriimagingoftheprostate-181217173213/75/Presentation1-mri-imaging-of-the-prostate-59-2048.jpg)
Uploaded byAbdellah Nazeer
Presentation1, mri imaging of the prostate
This document discusses MRI for prostate cancer detection and the PI-RADS classification system. It provides details on: 1. Multiparametric MRI which combines T2-weighted, diffusion, and dynamic contrast-enhanced imaging to accurately detect clinically significant prostate cancer. 2. The PI-RADS classification system standardized prostate MRI acquisition, interpretation, and reporting. It describes PIRADS scores from 1 to 5 based on lesion appearance and characteristics on different MRI sequences. 3. Examples of MRI findings for different PIRADS scores, such as restricted diffusion and early enhancement indicating a higher grade tumor warranting biopsy.
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- 1. MR For ProstateCancer. Dr/ ABD ALLAH NAZEER. MD.
- 2. Base has 6sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior and posterior zone CZ: central zone around the ejaculatory ducts Midportion also has 6 sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior, posteromedial and posterolateral peripheral zone Apex also has 6 sectors on each side: AS: anterior fibromuscular stroma TZ: anterior and posterior transition zone PZ: anterior, posteromedial and posterolateral peripheral zone Seminal vesicles are divided into left and right Urethral sphincter is marked in the prostate apex and along the membranous segment of the urethra.
- 13. MRI of theprostate has become increasingly popular with the use of multiparametric MRI and the PI-RADS classification. Multiparametric MRI is a combination of T2-weighted, Diffusion and dynamic contrast-enhanced imaging and is an accurate tool in the detection of clinically significant prostate cancer. The introduction of the Prostate Imaging Reporting and Data System (PI-RADS) classification for prostate MRI in 2012 lead to a more standardized acquisition, interpretation and reporting of prostate MRI. 1- T2: Peripheral zone exhibit high signal intensity. - Peripheral zone cancers have low T2 signal intensity-the lower the intensity the higher grade the disease. - Cancer more difficult to discern in the transition zone due to signal heterogeneity in this region. 2- Diffusion weighted MR images (DWI) at the peripheral zone can help identify high-risk disease. 3-Dynamic contrast enhanced MR allows evaluation of contrast kinetics cancer enhances quickly, more intensely and with a faster washout.
- 32. PIRAD 1: Hyperintense peripheral zones on T2W,no DW restriction, ADC drop or early arterial enhancement on DCE
- 33. PIRAD 2: well definedT2W hypointensity in the left peripheral zone with corresponding mild ADC drop however, with no DW restriction and no early arterial enhancement.
- 34. PIRAD 3: ill-defined T2W hypointensitiesin both peripheral zones with mild to moderate ADC drop and diffuse enhancement on DCE however, no DW restriction. This is an indeterminate lesion requiring further evaluation with a TRUS biopsy.
- 35. PIRAD 4: T2W hypointense lesionin the left transitional zone (less than 1.5cm) with corresponding DW restriction, marked ADC drop and early arterial enhancement on DCE. This is a definitive neoplastic lesion
- 36. PIRAD 5: a largeT2W hypointense lesion involving both peripheral and transitional zones (more than 1.5cm) with corresponding DW restriction, marked ADC drop and early arterial enhancement on DCE. There is breach of the prostatic capsule with involvement of the seminal vesicles and loss of fat plane with the rectum. This is an obvious neoplastic lesion with local spread.
- 45. PI-RADS scoring system -DWI and ADC map. T2-wi: hypointense tumoral nodule located in the central gland at the level of the base of the prostate (arrow); DWI/ADC map: high signal in the lesion on DWI corresponding to low signal on ADC map indicating restricted diffusion (arrowheads).
- 46. T4 stage. Prostatetumor invading both seminal vesicles (blue arrows) and distal rectum (white arrowheads); obliteration of the fat plane between tumor and the bladder wall (blue arrowhead); left iliac adenopathy (white arrow).
- 59. Multiparametric MR imagingof the prostate (65-year-old man, PSA level of 8.3 ng/mL, clinical stage T2c, Gleason score of 7 [3+4]) in screenshot generated by a computer-program, which can be used for image interpretation in multiparametric MR imaging. In addition to related views of multiplanar multiparametric images (A–E), quantitative information (F) is also displayed. A–E show tumor with bulging, suspicious for minimal stage T3A disease, in right peripheral zone at level of midprostate to apex (arrow). A, Axial Ktrans map from dynamic contrast-enhanced MR imaging projected over T2-weighted image (see Fig 2 for parameters). B, Sagittal T2-weighted image (4290/98; flip angle, 120°) with color overlay showing washout (from dynamic contrast-enhanced MR imaging). C, Axial ADC map (2900/81; flip angle, 90°). D, Axial DW trace image (b = 800 sec/mm2; 2900/81; flip angle, 90°). E, Axial T2-weighted image. F, Relative gadolinium concentration–time curve (left) and MR spectrum (right) from chosen point of interest in tumor (+). In MR spectrum, choline (chol) and citrate (cit) peaks can be evaluated. The low-signal-intensity lesion on E shows increased Ktrans (on A), restriction on C, high signal intensity on D, gadolinium concentration–time curve type 3 and high choline peak on F. On a five-point scale, this can be scored 5/5 on T2-w, dynamic contrast-enhanced, DW, and MR spectroscopic images, for total score of 20/20, indicating intermediate to highly aggressive tumor.
- 60.