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 
74-year-old with rising PSA to 7. No urinary symptoms. 

BIOPSY 
No prior biopsies. 

GENERAL ASSESSMENT 
PROSTATE METRICS 
X: 5.3 
Y: 3.5 
Z: 5.0 
Volume: 48.2 

ZONE ASSESSMENTS 
Peripheral zone: Uniformly T2 bright except for one sub-cm lesion as below. No focal diffusion restriction. 
Transition zone: Large focal lesion as below. 
Central zone: Normal. 
Stroma: Normal 
Nodes: None 
Bone marrow: Normal 
Extracapsular: Seminal vesicles, rectoprostatic angles, and neurovascular bundles image normally. 

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

SCORES 

Sequence: T2 weighted
Score: 5
Description: Lenticular or noncircumscribed, homogeneous, moderately hypointense, ≥ 1.5cm in greatest dimension or definite extraprostatic extension/invasive behavior

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

Sequence: Dynamic contrast enhanced
Description: Arterial phase images not present. Enhances on equilibrium phase imaging.

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

Extracapsular extension: no 
Comment: ADC 500 3.2 cm


 LESION 2: PERIPHERAL ZONE 
See Case Review topic for key images of the lesion(s).

SCORES 

Sequence: T2 weighted
Score: 4
Description: T2 weighted description should read "Circumscribed, homogenous moderate hypointense focus/mass confined to prostate and <1.5 cm in greatest dimension

Sequence: Diffusion weighted
Score: 3
Description: Focal (discrete and different from the background) hypointense on ADC and/or focal hyperintense on high b-value DWI; may be markedly hypointense on ADC or markedly hyperintense on high b-value DWI, but not both.

Sequence: Dynamic contrast enhanced
Score: -
Description: No arterial phase images but not enhanced on the equilibrium phase images

Total
Score: 3
Description: PIRADS 3: intermediate (the presence of clinically significant cancer is equivocal)

Extracapsular extension: no 
Comment: 6 mm ADC 1300

Case

What is the PI-RADS assessment for the dominant lesion in this case?