Interactive Transcript
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At 1.5 Tesla, we do not have balloon
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inflation of the rectum.
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Therefore, we don't have compression of
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the peripheral zone of the prostate gland.
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And now, with a one millimeter
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cut, let's make it even bigger.
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We can see a round but slightly
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irregular mass near the midline.
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Let's scroll it, and it is
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invading the capsule, isn't it?
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There's the T2 2D image at three
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millimeter slice thickness.
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The 3D T2 at one millimeter slice thickness.
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And here is the diffusion image demonstrating
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diffusion restriction of that nodule,
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which was somewhat hidden by the balloon
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inflation at 3 Tesla and the associated
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artifacts from periodic and aperiodic motion.
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Let's look at this portion of the gland.
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There is some diffusion restriction present.
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The left gland is a little more swollen and
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bigger than the right gland, at the mid level.
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And there is diffusion restriction, but
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again, that's a minor criteria in the
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central region of the prostate, or TZ.
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Now remember, nodularity is a
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good thing in the central region.
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Let's go down to the apex
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of the gland, down lower.
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There's some nodularity, but there's
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also some diffusion restriction.
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So this one's more well-circumscribed.
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But nodularity is not a good
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thing in the peripheral zone.
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So, nodularity Pz, danger.
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Nodularity Tz, not danger.
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Let's take a look at these areas
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in the sagittal projection.
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Let's go to our nodule down low.
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Here it is.
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And there it is in the sagittal projection.
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Better seen without balloon inflation.
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We don't have all the motion
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artifacts that we described at 3T.
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We don't have the susceptibility
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artifacts that we saw at 3T.
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Here is the mid and upper portion, or
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base of the gland, where there was some
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mass effect and diffusion restriction.
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And what about our lesion posteriorly?
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That one's right there.
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It's a little harder to see sagittally, but
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it's clear as day in the axial projection.
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Let's look at the coronal, just for giggles.
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The coronal projection, mass effect
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in the left gland, ill-defined.
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And the apical nodule area, let's go down there,
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down to the nodule, down low, there it is.
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And pretty hard to see in the coronal, admittedly.
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Let's look at the ADC map.
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I think mapping with the axial
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is probably our easiest bet.
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Let's go to our lower lesion here.
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There is diffusion restriction, not that
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helpful, but a supplementary finding.
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Let's go to the larger area of mass effect here.
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Some diffusion restriction, but ill-defined.
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And then finally, the key lesion
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back here, clearly well-defined.
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So at the very least, we've got a PIRADS 4
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in the PZ, in the middle, PZM, corresponding
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to a focal nodular area of well-defined
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diffusion restriction that shows up bright on
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the diffusion image and dark on the ADC map.
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These other areas are suspicious.
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I would personally read them as PIRADS 3s.
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One was read as a three
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and one was read as a four.
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And at surgery, we have the patient's report.
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We actually have the biopsy report,
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but not the surgical report.
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7 of 17 cores positive.
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Gleason 7, 8, and 9.
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All of them.
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The left gland was affected
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in all three of those areas.
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The lower-lying nodule near the apex.
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The more ill-defined mass effect in
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the middle and base of the gland.
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And this lesion in the midline
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entering the capsule was a Gleason 9.
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So this is an example of 3 Tesla up against
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1.5 Tesla.
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In this example,
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the 1.5 Tesla wins for the 3 reasons we mentioned.
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No inflation, very convenient for the patient,
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don't have to put anything in the rectum.
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No compression of the prostate gland.
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Motion artifacts are less.
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Susceptibility artifacts are less.
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The case is proven.
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The patient underwent radical prostatectomy
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with sparing of the right neurovascular bundle.
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The left neurovascular bundle was taken down.
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The patient has scant microscopic
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midline capsular invasion.
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The case is proven.
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