Dr. P back again with some PI-RADS 2.1, TZ and PZ or transitional zone and peripheral zone caveats. Since the dominant sequences for pirates assessment are T2 imaging for the transitional zone and DWI or diffusion imaging for the peripheral zone or PZ, identification of the zone of origin for a lesion is vital. And sometimes it's obvious. Sometimes you can have the TZ extrude a nodule into the PZ, sometimes you can even have the TZ extrude a nodule outside the prostate capsule, so you have to trace that nodule's origin back and look for potentially a stalk.
I'll tell you one area where this is especially problematic is the interface of the central zone and peripheral zone at the base of the prostate gland, up high, around the ejaculatory ducks. The area that I find most challenging is the interface of the anterior horn of the peripheral zone with the transitional zone and the anterior fibromuscular stroma all the way in the front, especially as one gets closer to the lower apex. Currently the capability of reliably detecting and characterizing clinically significant prostate cancer with multi parametric MRI in the TZ is not as good. It's less than that of the PZ.
Where it gets better is if you're down in these lower areas of the prostate, apex and anterior, if you can figure out the zone of origin, whether it's coming from the peripheral zone and growing around or coming from the mid line and growing straight forward, that may greatly influence your decision making process and your grading of such lesions.
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Content reviewed: December 29, 2021