0:00

This is the case of a 63-year-old with a

0:03

rising PSA to 5 and no urinary symptoms.

0:07

So again, it's not the most beautiful

0:09

diffusion images and high B-value images.

0:12

We have axial T2.

0:13

ADC map, high B-value, and an early post-contrast image.

0:20

And the peripheral zone is pretty heterogeneous.

0:23

And on the right side, there's sort of a

0:26

geographic but vaguely defined area of decreased

0:30

T2 signal, mild diffusion restriction, uh, and

0:34

increased signal on the high B-value images.

0:38

And the ADC map was, had a value of above

0:42

1,000, which is above my normal threshold.

0:45

And when we read this, we kind of said,

0:46

well, it's focal, it's, it's asymmetric.

0:49

It shows up on both the ADC and the

0:52

high B-value, but not really restricted.

0:54

So we'll call it a PI-RADS 3.

0:56

20 00:00:57,990 --> 00:01:01,089 And then since it was enhancing, call it a PI-RADS 4.

1:01

But if you actually look at it, this is not a focal lesion.

1:04

This is a diffuse abnormality throughout the

1:07

entire lateral aspect of the right peripheral zone.

1:10

And that doesn't qualify to be a

1:12

specific, to be a focal PI-RADS lesion.

1:14

So if I were reading this today, I would say there is

1:17

some diffuse signal abnormality along the right lateral

1:19

aspect of the peripheral zone involving decreased T2

1:22

signal, mildly restricted diffusion as evident on the ADC.

1:26

I'm going to be doing a follow-up on the elevated PSA and

1:38

for the kind of indeterminate finding on the MR, but I don't

1:41

think that this warrants a biopsy knowing what I know today.