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Training Collections
Library Memberships
On-demand course library with video lectures, expert case reviews, and more
Fellowship Certificate™ Programs
Practice-focused training programs designed to help you gain experience in a specific subspecialty area.
Ultimate Learning Pass
Unlock access to our full Course Library and all self-paced Fellowships.
Noon Conference (Free)
Get access to free live lectures, every week, from top radiologists.
Case of the Week (Free)
Get a free weekly case delivered right to your inbox.
Dr. Resnick's MSK Conference
Learn directly from the MSK Master himself.
Lower Extremities MRI Conference
Musculoskeletal Imaging
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For Training Programs
Supplement your training program with case-based learning for residents, registrars, fellows, and more.
For Private Practices
Upskill in high growth, advanced imaging areas.
Emergency Call Prep
Prepare trainees to be on call for the emergency department with this specialized training series.
2 topics, 9 min.
11 topics, 1 hr. 2 min.
Zonal Anatomy
5 m.Subdividing the Prostate Zones in the Axial Plane
4 m.Coronal Anatomy
5 m.Proximal to Distal Anatomy
6 m.Sagittal Anatomy
6 m.Prostate Anatomy on MRI in the Axial Projection
12 m.Prostate Anatomy on MRI in the Sagittal Projection
9 m.Utilizing the Axial Sequence
5 m.Identifying Prostate Zones on MRI
9 m.Prostatic Urethra
4 m.Membranous Urethra
3 m.8 topics, 20 min.
29 topics, 1 hr. 24 min.
Introduction to PI-RADS 2.1
5 m.PI-RADS assessment - Peripheral Zone
2 m.PI-RADS assessment - DWI
3 m.PI-RADS assessment - Transition Zone
2 m.Transition Zone T2 Scoring
3 m.Peripheral Zone DWI Scoring
3 m.PI‐RADS Assessment for DCE
4 m.Prostate Anatomy - Sector Map
4 m.Prostate Anatomy - Cross Sectional Review
5 m.Ellipsoid Volume
5 m.Image Acquisition T2WI
3 m.Image Acquisition DWI
3 m.Image Acquisition: DCE
3 m.Image Interpretation: DWI
4 m.Image Interpretation: DWI Score 2 vs. 3
5 m.Assessment of T2W in the Transitional Zone: Score 1
4 m.Assessment of T2W in the Transitional Zone: Score 2
4 m.T2W Score 2 - Summary
3 m.TZ Nodules and Corresponding Scores
3 m.PI-RADS 2 vs. PI-RADS 3
2 m.Diagrammatic TZ Assessment
7 m.Image Interpretation DCE: Modified Criteria
3 m.Biparametric MRI
4 m.Philosophical Approach to Central Zone Malignancy (1)
3 m.Philosophical Approach to Central Zone Malignancy (2)
3 m.Central Zone Pitfalls
3 m.Normal Anterior Fibromuscular Stroma
2 m.Anterior Fibromuscular Stroma - Malignancy Criteria
2 m.Anterior Fibromuscular Stroma - Advanced Problem Solving
4 m.3 topics, 6 min.
12 topics, 1 hr. 18 min.
Case Review: PI-RADS 4, Stage IIB
4 m.Case Review: PI-RADS 4
5 m.Case Review: Staging a PI-RADS 5 Lesion
11 m.PI-RADS 4/5
9 m.Case Review: PI-RADS 4/5 - Compare With Prior 3T
12 m.Case Review: PI-RADS 5 & 3
11 m.Case Review: PI-RADS 4 – Making Use of the ADC Map
5 m.Case Review: Charcoal Sign in the Transition Zone
5 m.Case Review: Pitfall – T2 Blackout Sign
6 m.Case Review: When the Diffusion Imaging Fails
4 m.Case Review: When not to use the Leikert Grading System
6 m.Case Review: Interesting PI-RADS 4 Case
7 m.4 topics, 18 min.
3 topics, 11 min.
0:00
We're talking BPH on MRI, and there are
0:03
two teaching points to this case.
0:07
The peripheral zone and central
0:09
zone are very hard to discriminate.
0:11
As the peripheral zone, let's take a look at
0:13
the sagittal for a minute, the peripheral zone
0:15
is heterogeneously low in signal intensity.
0:19
So, that makes it really hard to
0:21
identify in the axial projection.
0:24
That being said, you might get a little scared
0:27
by this mass that is seen in the midline.
0:30
This is a not uncommon location to see
0:33
epithelial and stromal hyperplasia and fibrosis.
0:38
This dark pseudomass can be identified as nothing
0:42
more than a benign fibrotic muscular hypertrophic
0:47
process by its position in the midline, by its
0:52
absence of mass effect, and then when you go from
0:55
the B0 to the B1500 diffusion image, there is no
1:01
diffusion restriction in the midline anywhere.
1:04
So, this is not a cancer.
1:07
Another lesion that might scare you a
1:09
little bit, that has been discussed in
1:11
another vignette, is an area of stromal
1:15
hyperplasia and acinar glandular hypertrophy.
1:18
It's very bright, and sometimes
1:20
can be very pedunculated.
1:22
It looks like it doesn't even come off the
1:24
prostate sometimes if it's very exophytic,
1:27
but it is coming off the prostate.
1:29
Now when you look at your lower B value
1:32
diffusion images, it looks scary, right?
1:34
It looks like it's diffusion restricted,
1:37
but the B value isn't high enough.
1:39
You gotta have a B value of 1,200,
1:43
1,500, 1,600, and you will see this.
1:45
Area of proteinaceous fluid fades away,
1:48
and it does, on the B1500 image.
1:52
If this was a cancer, it'd be
1:53
getting brighter, not darker.
1:56
Furthermore, marked hyperintensity on a
1:59
T2-weighted image is a countersign, a sign
2:03
that goes against the diagnosis of cancer.
2:06
For cancers are gray, or
2:07
charcoal; they are not bright.
2:11
So, two teaching points in this case.
2:13
A midline area of stromal and epithelial
2:16
hyperplasia and fibrosis that fades
2:19
away on the high B-value image.
2:22
And an area of stromal hypertrophy and
2:26
glandular acinar hypertrophy that also fades
2:29
away on the B1500 diffusion-weighted image.
Interactive Transcript
0:00
We're talking BPH on MRI, and there are
0:03
two teaching points to this case.
0:07
The peripheral zone and central
0:09
zone are very hard to discriminate.
0:11
As the peripheral zone, let's take a look at
0:13
the sagittal for a minute, the peripheral zone
0:15
is heterogeneously low in signal intensity.
0:19
So, that makes it really hard to
0:21
identify in the axial projection.
0:24
That being said, you might get a little scared
0:27
by this mass that is seen in the midline.
0:30
This is a not uncommon location to see
0:33
epithelial and stromal hyperplasia and fibrosis.
0:38
This dark pseudomass can be identified as nothing
0:42
more than a benign fibrotic muscular hypertrophic
0:47
process by its position in the midline, by its
0:52
absence of mass effect, and then when you go from
0:55
the B0 to the B1500 diffusion image, there is no
1:01
diffusion restriction in the midline anywhere.
1:04
So, this is not a cancer.
1:07
Another lesion that might scare you a
1:09
little bit, that has been discussed in
1:11
another vignette, is an area of stromal
1:15
hyperplasia and acinar glandular hypertrophy.
1:18
It's very bright, and sometimes
1:20
can be very pedunculated.
1:22
It looks like it doesn't even come off the
1:24
prostate sometimes if it's very exophytic,
1:27
but it is coming off the prostate.
1:29
Now when you look at your lower B value
1:32
diffusion images, it looks scary, right?
1:34
It looks like it's diffusion restricted,
1:37
but the B value isn't high enough.
1:39
You gotta have a B value of 1,200,
1:43
1,500, 1,600, and you will see this.
1:45
Area of proteinaceous fluid fades away,
1:48
and it does, on the B1500 image.
1:52
If this was a cancer, it'd be
1:53
getting brighter, not darker.
1:56
Furthermore, marked hyperintensity on a
1:59
T2-weighted image is a countersign, a sign
2:03
that goes against the diagnosis of cancer.
2:06
For cancers are gray, or
2:07
charcoal; they are not bright.
2:11
So, two teaching points in this case.
2:13
A midline area of stromal and epithelial
2:16
hyperplasia and fibrosis that fades
2:19
away on the high B-value image.
2:22
And an area of stromal hypertrophy and
2:26
glandular acinar hypertrophy that also fades
2:29
away on the B1500 diffusion-weighted image.
Report
Editorial Note
Faculty
Stephen J Pomeranz, MD
Chief Medical Officer, ProScan Imaging. Founder, MRI Online
ProScan Imaging
John F. Feller, MD
Chief Medical Officer, HALO Diagnostics. Medical Director & Founder, Desert Medical Imaging. Chief of Radiology, American Medical Center, Shanghai, China.
HALO Diagnostics
Tags
Prostate/seminal vesicles
MRI
Genitourinary (GU)
Body
Acquired/Developmental
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