0:03

PSA to 5 and obstructive urinary symptoms.

0:07

So we have our axial T2, our ADC map windowed

0:12

at 1400xss1400, a high B-value diffusion image.

0:17

This is an interpolated B equal

0:19

1600 image and a coronal T2.

0:22

I don't have post-contrast images in this case.

0:26

We start in the peripheral zone, and again, you notice

0:31

the ADC map and the high B-value image are a bit ugly.

0:34

So you know it's going to be a

0:35

bit of a difficult case to read.

0:37

So the peripheral zone is very heterogeneous.

0:40

There are areas of bright signal, there's

0:42

poorly defined, streaky areas of low signal.

0:45

There's also some more focal mass-like areas of low signal.

0:48

So we'll start here.

0:49

We have a well-defined area of decreased T2

0:51

signal in the left lateral peripheral zone.

0:54

It has corresponding diffusion restriction.

0:57

This is a black hole on the ADC map.

0:59

The ADC value, I think, was around 600,

1:02

but you can check the text to confirm.

1:05

It's focally bright on the high B-value.

1:07

It measures less than 1.5 centimeters,

1:08

and there's no evidence

1:11

that this is going outside of the capsule.

1:12

So, this is PIRADS 4, based on

1:15

the diffusion images and size.

1:19

It also gets a PIRADS score of 4 for T2,

1:21

but the diffusion score outweighs that.

1:24

Um, and this was biopsied.

1:28

I can't remember from just 30 seconds

1:30

ago, this was a Gleason 3 plus 4 disease.

1:35

Elsewhere in the peripheral zone, as we

1:36

continue to scroll, we come to another

1:39

area of well-defined low T2 signal, right?

1:43

It looks like you can almost

1:44

pluck it right off of the picture.

1:47

There is a corresponding area of diffusion restriction.

1:50

Again, it's a black hole.

1:51

It's kind of hard to see, but it looks like someone's

1:53

taken a bite out of the, uh, peripheral zone, and

1:56

there's not a lot of distortion, so I think it's

1:58

reasonable to say this is a real, uh, lesion.

2:01

The ADC was well below 1,000, as the text will tell you.

2:04

It is focally bright on the high B-value

2:06

image, so again, it measures less than 1.5 centimeters,

2:09

so its diffusion characteristics

2:12

give it a PI-RAD score of 4, its T2

2:14

characteristics give it a PI-RAD score of 4.

2:17

The diffusion characteristics outweigh that.

2:19

You get the total PI-RADS score of 4.

2:21

Um, it does kind of have a broad bulge against the capsule,

2:25

but there's no evidence there's macroscopic abnormal tissue

2:28

on the other side of the capsule.

2:29

This was biopsied and also, I believe,

2:31

was a Gleason 3 plus 4 neoplasm.

2:36

There's really no other area in this prostate peripheral

2:39

zone that looks like there's focal diffusion restriction.

2:42

The gland looks nice here, looks nice here.

2:45

Going all the way around.

2:47

When we look at the transition zone, it

2:48

has this normal heterogeneous nodular

2:51

appearance with high signal and low signal.

2:53

Here's a nice example of some thickened anterior stroma.

2:56

It has that typical appearance.

3:00

The central zone is, let's keep the

3:04

coronal up, let's see if we can find that.

3:06

Central zone is this tissue right here.

3:08

It looks normal.

3:09

There's a big utricle cyst in the central zone.

3:12

Uh, so this had two fairly typical PI-RADS for peripheral

3:17

zone lesions, which both biopsy to be significant neoplasm.