0:00

Let's have a look at this 71-year-old with

0:04

prostate cancer diagnosed one year ago.

0:07

And the PSA level is at

0:09

4.03 nanograms per mL.

0:12

So not a very high PSA.

0:14

Maybe we're dealing with a, a lower grade

0:17

cancer or not a very aggressive cancer.

0:20

But this case is illustrating two major points.

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The Charcot side in the transition

0:29

zone, or central region of the prostate.

0:32

And, and here we are with our,

0:34

our Charcot smearing the gland.

0:37

I'm gonna scroll it for you in a second.

0:39

But there's the smear right there, just

0:40

like you'd smear cream cheese on a bagel.

0:45

Let's scroll, and there's a lot

0:46

of smearing going on in here.

0:48

We threw a lot of cream cheese on our bagel.

0:51

Alright, we're going up, we're going down.

0:53

Now we're starting to get out of it.

0:55

Things are looking a little more

0:56

heterogeneous, like they should.

0:58

In the central region of the prostate.

0:59

Now we're down by the apex.

1:02

Now we see the anterior fibromuscular stroma.

1:04

Let's go back up again.

1:06

Smearing right there.

1:08

So we've wiped out the architecture.

1:11

The nodular heterogeneity of the

1:15

transitional zone of the prostate.

1:18

This is a fat suppression 3D image.

1:21

Doesn't add a tremendous amount.

1:22

Although it does show you that the

1:24

lesion is approaching the midline.

1:27

And perhaps anteriorly crossing the midline.

1:30

The midline.

1:31

Now, it's common for BPH patients to have

1:36

hypervascularity in the middle of the gland,

1:38

but that hypervascularity usually does this.

1:40

It comes in pretty strong,

1:43

but not all that strong.

1:44

And then it continues to go up and up and up.

1:47

And usually in the form of innumerable

1:49

nodules, often not one big dominant nodule.

1:53

And if there's a big dominant nodule,

1:55

it's often pretty round, or it

1:57

may be oval, but it usually isn't.

1:59

Lentiform like this.

2:02

Look how lentiform our lesion is.

2:04

If I trace it out, pretty lentiform, isn't it?

2:08

So now, let's go to our DCMRI.

2:12

Even though any DCMRI, you know, can be

2:16

complementary or non-complementary, in other

2:19

words, it's not a major criteria at all, and for

2:22

screening, a lot of people don't use it at all,

2:24

or for surveillance, people don't use it at all,

2:27

in situations like this, it can be comforting.

2:30

So let's go to the mask, and what

2:34

we don't want to see is immediate,

2:37

large, intense, lentiform enhancement.

2:43

And do we?

2:44

Let's go right to the first 10

2:45

seconds after our dynamic, bang!

2:48

That's the only thing that shows up in the image.

2:51

We've got a problem.

2:53

Now let's see what it does as we

2:56

continue into our 20-second, and our

3:00

30-second, and our 40, and our 50.

3:03

The rest of the gland is catching up to it.

3:05

Our tumor is washing out, so its

3:07

curve looks something like this.

3:09

Even though it's in the central zone, where

3:11

we get a lot of curves that go up, this one is

3:14

going up really quickly and then coming down.

3:17

A washout-type curve.

3:19

So here the DCE MRI helped us corroborating

3:24

the diagnosis of our Charcot sign.

3:27

And yet, our diffusion image, which I'll pull

3:30

down right now, wasn't all that impressive.

3:33

There's our lentiform lesion right there.

3:36

And let's pull down our ADC map.

3:42

Remembering that in the central

3:44

region of the prostate gland in

3:46

the TZ, the diffusion restriction

3:49

characteristics are not a major criteria.

3:52

It's the morphology, the blackness,

3:57

the homogeneity, the smearing, the

4:00

boundary crossing that you use in the

4:04

central region of the prostate gland.

4:06

And this case, illustrating

4:08

the Charcot sign of the TZ.