Dr. P. here talking about PI-RADS 2.1 central zone lesions. What if we have a scenario where something in the central zone is worrisome? In the PI-RADS four or five high or very high risk for cancer. When does that happen? When do we make that designation? While we make it when the CZ shows focal early enhancement, which it shouldn't do, or asymmetry between the right and left sides. Let's look at the axial projection. I'm going to do a little drawing here. I'm going to make my prostate down at the bottom. Here's my prostate gland. That is the peripheral anatomic capsule. I'm going to make the TZ red, so we got our peripheral zone out here. Just put a few dots on it. And then we have our ejaculatory ducts and we're up high near the base, so our ejaculatory ducts are here. And if we were to look sagittally, this would be the sagittal view of the prostate.
Here's the bladder or in the posterosuperior quadrant somewhere. And then our CZ is going to sit right about here. I'm going to draw right over it again. And our CZ is going to encompass the ejaculatory ducts. So if we were to see focal early enhancement between or in the central zone, or asymmetrically between one side and the other, that would be cause for concern. Or on the high B value images, we have pronounced diffusion restriction or dark intensity on the ADC map in this locus, those are signs for CZ malignancy. So in other words, the CZ in an unusual position posterosuperior in the prostate gland is often inert. It does not often enhance very early on. It does not often demonstrate pronounced diffusion restriction as some other benign lesions may do. Like TZ nodules, both extruded and non extruded types, the CZ malignancy signs in PI-RADS 2.1. Dr. P. out.
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Content reviewed: December 29, 2021