Prostate MRI Fellowship Practice Cases

Genitourinary (GU)

Prostate/seminal vesicles

Daniel Cornfeld

Stephen J Pomeranz

Gain confidence reading and reporting on Prostate MRI Cases with the Medality Fellowship Certificate Program. Practice using real-world, scrollable cases, earn CME, and receive a Fellowship Certificate™ upon completion!

Case Review

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Practice Cases

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Welcome to the Prostate MRI Fellowship Practice Cases course! In this course, you&rsquo;ll be presented with a series of worklists, comprised of 25 essential cases you must review to receive your Fellowship Certificate.

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Access Full Fellowship Certificate Program at Anytime <a href="https://mrionline.com/proficiency/prostate-mri-fellowship-certificate/" style="text-decoration:none">Here</a>.

Prostate MRI Practice Cases

CLINICAL INFORMATION 
HISTORY 
65-year-old with PSA of 6.5. Benign gland. Obstructive urinary symptoms. 

BIOPSY 
Multiple prior negative systematic biopsies. 

GENERAL ASSESSMENT 
PROSTATE METRICS 
X: 4.3
Y: 4.7
Z: 4.0
Volume: 42 

ZONE ASSESSMENTS 
Peripheral zone: Predominantly T2 bright. Scattered well demarcated areas of T2 hypodensity but  without correlative diffusion restriction. 
Transition zone: Enlarged and protrudes into the bladder base. Multiple encapsulated T2 bright  and dark BPH nodule. Focal suspicious lesion as below. 
Central zone: Poorly demarcated.  
Stroma: Focally thickened in the base but without enhancement to indicate neoplasm.  Nodes: None.  
Bone marrow: Normal.  
Extracapsular: The seminal vesicles are atrophic and low signal. No enhancement or diffusion  restriction. No soft tissue replacing the seminal vesicles. Recto-prostatic angles are intact. No  asymmetric or abnormal soft tissue in the region of the neurovascular bundles. 

LESIONS 
LESION 1: TRANSITIONAL ZONE: LEFT MID ANTERIOR TRANSITION ZONE 
See Case Review topic for key images of the lesion(s).

SCORES 

Sequence: T2 weighted
Score: 5
Description: Lenticular or noncircumscribed, homogeneous, moderately hypointense, and > = 1.5 cm in greatest dimension

Sequence: Diffusion weighted
Score: 5
Description: Focal markedly hypointense on ADC and markedly hyperintense on high b-value DWI

Sequence: Dynamic contrast enhanced
Score: +
Description: Focal, and; earlier than or contemporaneously with enhancement of adjacent normal prostatic tissues, and; corresponds  to suspicious finding on T2W and/or DWI

Total
Score: 5
Description: PIRADS 5: very high (clinically significant cancer is highly likely to be present)

Extracapsular extension: no 
Comment: ADC of 700. 1.7 cm in length.


Case

What is the overall PI-RADS assessment for this case?