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

Wk 1, Case 1 - Practice

Wk 1, Case 1 - Review

Wk 1, Case 2 - Practice

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Wk 1, Case 3 - Practice

Wk 1, Case 3 - Review

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Wk 1, Case 5 - Review

Practice Cases

Wk 2, Case 1 - Practice

Wk 2, Case 1 - Review

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Wk 2, Case 4 - Review

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Wk 2, Case 5 - Review

Wk 3, Case 1 - Practice

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Wk 3, Case 2 - Review

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Wk 3, Case 3 - Review

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Wk 3, Case 5 - Review

Wk 4, Case 1 - Practice

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Wk 4, Case 3 - Review

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Wk 4, Case 4 - Review

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Wk 4, Case 5 - Review

Wk 5, Case 1 - Practice

Wk 5, Case 1 - Review

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Wk 5, Case 2 - Review

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Wk 5, Case 5 - Review

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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Prostate MRI Practice Cases

Faculty Note: This case does not have a formal report because I don’t like the way it was initially reported. However, it is a nice example of getting fooled into thinking there is a focal lesion when there is not.
 
When I first saw this case I called a focal lesion in the right base to mid PZ. On the T2 images it looked like a circumscribed, homogenous moderately hypointense mass (Figure A). Remember that in the PIRADS lexicon circumscribed means well-defined. This would therefore be a score of 4 for T2. However, if you scroll through the axial and coronal images this region looks more like a large area of indistinct, mildly decreased T2 signal. Likewise, on a single image from the ADC map the lesion appears focally mildly hypointense (Figure B). The ADC value was 1150, which is not low enough for me score it as a 4 for DWI but could result in the lesion being given a score of 3 for DWI. However, scroll through the ADC map and DWI with b=1600. This is really a large, indistinct region of mild diffusion restriction. This should be given a DWI score of 2. There is no focal enhancement. The entire mid and basilar right PZ enhances. You need to scroll through the images to appreciate this.
 
This was biopsied because we thought there were focal T2 and DWI findings. In retrospect I do not think this is the case. I would now have reported that there were not areas suspicious for a clinically significant prostate neoplasm. Targeted biopsies yielded five cores of benign tissue. Systematic biopsy showed no cancer.
 
This case underscores an important part of PIRADS 2.1. Areas of mildly reduced diffusion can be upgraded to a PIRADS 4 lesion if there is correlative focally decreased T2 signal and early focal enhancement. However the region of diffusion restriction must be focal and distinct. In this case I initially thought that was the case but I no longer think so.
 
This case is also another nice example of thickened anterior stroma (Figures A, C, and D). The stroma appears dark and restricts diffusion. However, there is no enhancement. It looks like it is growing into the TZ as opposed to growing out of it.



Case

What is the best DWI assessment score for the focal finding in the right posterolateral peripheral zone base?