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A 60-year-old with an elevated PSA of 5,

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no family history, and no obstructive symptoms.

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So we've opened up the four sequences that we rely

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on most for diagnosing things in the prostate.

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We have our axial T2-weighted image,

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our ADC map, our diffusion image with

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a high b-value, in this case 1600.

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And this is the arterial phase or early

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enhancement phase of the post-contrast series.

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And I've just taken images from that one

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phase instead of from all the phases.

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And we start in the, well, I always

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start in the peripheral zone.

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And even though we use diffusion to make diagnosing

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the peripheral zone, I still tend to look at the.

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The peripherals load on T2 first, and we see that

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it's predominantly T2 bright, which is normal.

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We do have two dark areas in it.

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We'll start with the large one first.

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So this large area here it is a

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well-defined low T2 signal nodule.

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If we measure it, it's going to measure about 1.

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centimeters.

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There we go, 1.55, 1.52 centimeters.

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On the diffusion images, it's Sorry, on

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the ADC map, it is an absolute black hole.

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This is windowed at a windowing level of 1400 and 1400.

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If we draw an ROI on this, the ADC value

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is going to be well less than 1000.

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It also is very, very bright on the B equals...

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1600 images, and it enhances focally.

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In the arterial phase, and by focal, it means that

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the area of enhancement really does correspond

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to the appearance on the other sequences.

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So this gets a PI-RADS score of 5 for the...

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diffusion because it's a large black hole...

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and it's bright on the b equals 1600 images.

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It gets a score of 5 on the T2 and...

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it gets a plus for the dynamics.

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So this is a PI-RADS 5 lesion.

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And when this was biopsied...

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We got six cores of Gleason 8 disease...

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so that was nice and concordant.

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You'll notice there's one other area of...

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diffusion restriction within the peripheral zone.

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That's located here.

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This measures less than a centimeter.

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It is a well-defined area of very black signal...

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though the ADC value is less than a thousand.

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It has a corresponding low T2...

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signal nodule, very well-defined.

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On the b equals 1600 images, it is also bright.

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And it doesn't really definitely show any...

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focal early enhancement on the contrast images.

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Maybe right here, it's kind of equivocal, but in this...

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case, it doesn't matter because the diffusion images...

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give it a score of PI-RADS 4, dark on the ADC map.

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Bright on the high b-value image, the T2

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image gives you a PI-RADS score of four.

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This can be plus or minus, but this then scores

2:59

as a PI-RADS 4 lesion, and that biopsied as two

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scores of Gleason seven and one core of Gleason six.

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So that's very concordant.

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So you continue to scroll.

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There are no other areas in the peripheral

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zone that show diffusion restriction.

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Then we move to the transition zone, and

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this is the typical appearance of some.

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Prostatic hypertrophy in the transition zone.

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So heterogeneous signals, some

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nodules that are very well defined.

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This is a normal transition zone.

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So the next thing we look at is the

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central zone which is this region right here.

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We can bring over the coronal images.

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Then we have to zoom those up a little bit.

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About that, let's close that off.

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And that's this tissue here.

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And that looks normal for central zone tissue.

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So we're quite happy with that.

3:56

The anterior stroma is a little bit thickened up here.

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This is normal thickened anterior stroma.

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It has this appearance.

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It may show some diffusion restriction on the ADC map.

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It doesn't really show up right on the b equals 1600

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image and it doesn't show any early enhancements.

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That's going to be normal anterior stroma.

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Seminal vesicles look normal.

4:17

There's no abnormal soft tissue sitting in the region

4:19

of the neurovascular bundles and there's no evidence of

4:22

extracapsular extension or anything touching the rectum.

4:25

There's note of a small utricle cyst here. So on the whole,

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there are two targets or lesions in the peripheral zone.

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One of them scores a PI-RADS 5, one scores a PI-RADS 4.

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And on histology, this one turned out to be a Gleason 8

4:39

tumor, and this was a Gleason 7 with also some Gleason 6.