Dr. P here talking Anterior Fibromuscular Stroma. Classic criteria. Although this area is tough, tough, tough. Here's our AFS right here. Crescentaric shape and bilateral with a little midline septum between the two sides. But look at how close our TZ is, and look at how close our PZ is. So, lesions that come from here and go into the AFS, and from here and go into the AFS can produce a conundrum. Because cancers don't originate in the AFS. So if you have an abnormality in the AFS, you look at its intensity relative to pelvic musculature. It shouldn't deviate on the DWI. It shouldn't deviate or be higher in signal intensity on the T2 weighted image. And it shouldn't deviate or be lower in signal intensity on the ADC map compared to adjacent pelvis muscle intensity. Also look at the shape. Is the AFS symmetric or asymmetric? And I don't mind asymmetry.
But I do mind asymmetry when it starts to distort the adjacent anatomy. When it starts to cross boundaries, when they start to lose the anterior capsule of the prostate, that's when I become truly disturbed about hypo intensities of relative characters in the AFS. More on this and the next vignette, but as you can see, this is a very tough area. Dr. P out.
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Content reviewed: December 29, 2021