PI-RADS Assessment for DCE
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Let's talk about DCE, Dynamic Contrast
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Enhanced MRI, where you're injecting
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20cc's of gadolinium and looking at the
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arrival of contrast in the prostate.
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In a negative, there is no early enhancement.
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Or, there is diffuse, generalized,
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symmetric enhancement that doesn't
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correspond to a focal, worrisome, or
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suspicious finding on T2, DWI, or the ADC map.
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If there is some focal
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enhancement, it is not early.
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And it corresponds to an area that
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looks like a BPH nodule or a benign,
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non-aggressive area on T2 imaging.
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A positive focal early enhancement,
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often corresponding to arterial arrival
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in the neighboring vascular tissues.
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That enhancement occurs before any other
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portions of the prostate gland that
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are not suspicious and corresponds to
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areas that are worrisome on T2 imaging.
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VASP and echo MRI, such as a lentiform
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charcoal-like area in the TZ or a round
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nodular area with mass effect in the PZ.
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And that area often corresponds to a focus of
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diffusion-weighted restriction, high signal with
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a high B value, and low intensity on the ADC map.
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Either a negative or a positive for DCE MRI, which
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by the way, plays a lesser role in the prostate,
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than it does in detection
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of malignancy in the breast.
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
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