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Image Acquisition T2WI

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

Dr. P back on revisions and clarifications of PI-RADS 2.1. We're talking T2 weighted image acquisition.

So let's draw in a bladder. I'll use my yellow pencil here. So there's your bladder filled with urine, and then right at the base of the bladder, here's the urethra, and then we'll make the prostate something a little different, perhaps the orange. So here's your prostate right underneath it. You can see the prostate is slightly angled from craniad anterior to caudad posterior. This is posterior, this is anterior, and urethra would come down something like this. So your axial plane can be either as we discussed in a prior vignette, we use red, a straight axial, or it can be perpendicular to the axis of the prostate this way. Either way is fine. They don't mind and I don't mind.

Now there must be at least one additional orthogonal plane. This is a sagittal, but the one plane you have to have as an axial, so you can have an axial and a sagittal, an axial and a coronal, I personally have axial, sagittal, and coronal. Here's a point of potential confusion. You can either acquire the two or three planes, you must have an axial, 2D, which means you acquire an axial 2D, a sag 2D, and maybe a coronal 2D. Or you could acquire with very thin sections in the axial projection and reconstruct the sagittal and the coronal projection.

A reason why you might have to perform a 3D acquisition in addition to a 2D acquisition is because when you do image fusion biopsy, you need those reconstructed images so that you are perfectly registered for the ultrasound truce guided biopsy fusion with the MRI. And you might say, "Well, why not just get the 3D?" Some people do that. They get the 3D and the axial projection and reconstruct everything else. That saves some time. What's the downside of doing that? The contrast resolution of 3D T2 [inaudible 00:02:18] not as good internally in the prostate as 2D. So in my practice, I perform a 2D sag ax and core, and then if I'm doing fusion related biopsy, I do a 3D ax and reconstruct the rest. Let's move on. Shall we? Dr. P out.

LESSON 2, TOPIC 7

Mastery Series: PI-RADS 2.1 Update

Mastery Series

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Content reviewed: December 29, 2021

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