0:00

This is a 68 year old with a PSA of 5, a nodular

0:04

gland on exam, and no obstructive symptoms.

0:07

So, we have our axial T2, our ADC map, windowed at 1400x1400,

0:13

our high B value, it's an interpolated B equals 1600

0:18

image, and an arterial phase from the post contrast series.

0:23

We start in the peripheral zone.

0:25

Peripheral zone is predominantly.

0:27

Look, it's high signal on the ADC map, nothing focal,

0:30

nothing focal, nothing focal, here's something focal.

0:33

So here we have, it measures about 1.

0:36

3 centimeters, it's a well defined region of focal

0:39

diffusion restriction on the ADC map, the ADC values.

0:45

Measure 618, 620.

0:49

There's corresponding high signal on the high B value image.

0:53

So this is gonna score up high RAD score of four for

0:57

the diffusion, which is gonna be the final score.

0:59

But look on the T two, there's a corresponding

1:02

well defined area of low T two signal.

1:04

You can always pluck it off the image.

1:06

So that's also a PI RADS four appearance.

1:08

And on the post contrast Dynamic

1:10

Imaging arterial phase, it's focally.

1:13

enhancing.

1:14

So if we go through the remainder of the

1:15

peripheral zone, there's no other findings.

1:18

This area here has no convincing evidence

1:20

of extracapsular disease, so no ECE.

1:23

So this stays a PI RADS 4 lesion.

1:26

This was biopsied and came back Gleason 4 plus 3 disease.

1:30

So now we've finished with the peripheral

1:33

zone and we'll go to the transition zone.

1:37

heterogeneous appearance that you see with hypertrophy.

1:41

And now anteriorly, this is a great

1:43

example of thickened anterior stroma.

1:46

We've had some cases of this previously.

1:48

But look, it's anterior.

1:50

It insinuates around the nodules

1:51

anteriorly, especially in the midline.

1:53

It's a very typical appearance

1:55

for thickened anterior stroma.

1:56

And of note, this is arterial phase.

1:58

This area shows no contrast

2:00

enhancement at all, none whatsoever.

2:03

It corresponds very nicely with the T2 images.

2:06

Disappearance would be the same on delayed

2:10

images, which I'm not providing for you.

2:13

Uh, so we also look at the, uh, central zone, which is

2:16

poorly seen in these axial images, right here and here.

2:19

Normal-looking seminal vesicles go in the wrong direction.

2:24

And there's no abnormal tissue in the

2:26

region of the neurovascular bundles.

2:27

And there's no abnormal appearance

2:30

between the prostate and the rectum.

2:31

Again, wouldn't be expected, um, well,

2:34

could be expected posterior tumor.

2:37

But even in this region here adjacent to the tumor, uh, this

2:40

area where the neurovascular bundle runs looks pretty normal.

2:43

Uh, so this is a PI-RADS 4 lesion that looks

2:46

confined to the gland, biopsied as Gleason 4

2:48

plus 3, uh, Gleason 4 plus 3 disease, and also a

2:53

very nice example of thickened anterior stroma.