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Central Zone (Cz) Pitfalls

3 min.
Pomeranz, Stephen
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
CME Eligible

Dr. P here talking central zone pitfalls. Let me do a little drawing using my rudimentary artistic skills. I've got my bladder filled with urine. Coming out of the bladder is the urethra, kind of the urethra, makes a turn anteriorally. All part of the prostatic urethra coming down towards the membranous, and then the penile urethra. And the urethra approximately is going to be surrounded by the prostate gland. So here's our prostate gland.

And then the portion of the prostate gland that corresponds to the central zone, I'm going to make it green, is up in here posterosuperiorally. So it's in the upper posterior quadrant of the prostate gland, which is a little bit weird. Now if we turn our attention to this axial, this axial is taken at the level of the central zone. So right about here is where the slice is obtained. These two structures right here that I've highlighted, I'll use a different color to highlight them so you can see them better, I'll use blue, the ejaculatory ducts. So you can see the central zone on either side, pretty good size. Now, what if one side was bigger than the other? That would be okay as long as we don't have intense early enhancement on one side and we don't have intense diffusion restriction on the high B value acquisition.

So those are two things that are extremely helpful when you have CZ asymmetry, which by the way is not rare. Another scenario that you might see is one central gray nodule. And for the purposes of art, I'm going to make it gray. But in fact, you see it best in the axial projection, kind of right behind and next to the ejaculatory ducts. It's a gray nodule, almost always dead center. Now remember, it can occur anywhere from the verumontanum up because the central zone is located just above the verumontanum and superficial, sorry, and proximal to this. So this gray to somewhat dark gray nodule, I've even seen them almost black, can be defined as an incidental pitfall because A, it's in the mid line. B, the mass effect that it generates is scant to none. C, does not enhance. D, doesn't diffusion restrict. But you're going to see this a lot. CZ pitfalls. Dr. P out.

LESSON 2, TOPIC 22

Mastery Series: PI-RADS 2.1 Update

Mastery Series

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Content reviewed: December 29, 2021

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