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Mastery Series: PI-RADS 2.1 Update


MRI Mastery Series: PI-RADS 2.1 Update Pre-Course Activities
1 topic
Course Evaluation
1 topic

Philosophical Approach to Central Zone (Cz) Malignancy

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

Dr. P here to give you some philosophical approaches in various scenarios and zones of the prostate.

I'm starting with this diagram of PI-RADS designations one through five and PI-RADS 2.1 assessments, and you can read it at your leisure or just pause and by now, you should have grasped this. Let's start out with the central zone. The normal central zone is visible on T2 and ADC images as bilateral, symmetric, low signal intensity tissue and circling the ejaculatory ducts for the prostate base to the verumontanum. It's symmetrical, it's mildly hyperintense on the DWI, and it does not demonstrate early enhancement or asymmetric increased signal intensity on high b-value DWI.

Let's make a diagram and see what we mean. So here's a sagittal, here's a bladder right here, here's the urethra coming down, and here's my prostate gland and urethra is going to make a turn and go down, and your central gland is going to be up in here somewhere. And the axial projection, if we're at the base, there's the base of the gland, and we'll make a transitional zone for giggles or up near the base, the ejaculatory ducts are coming and we'll make them another color like light blue, and our central zone is going to be sitting, we'll make it kind of brown, it's going to be right about here. And sometimes you'll even get a little coalescent nodule right in the middle, almost looks like a scar dead center, that people will confuse with a potential peripheral zone nodule, even though it does not diffusion restrict or have an abnormality on the ADC map.

Now in the next vignette, let's talk about prostate carcinoma originating in the CZ, the central zone, which is located posterior and superior in the sagittal projection and has an element of symmetry to it.

LESSON 2, TOPIC 20

Mastery Series: PI-RADS 2.1 Update

Mastery Series

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Content reviewed: December 29, 2021

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