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 
55-year-old with PSA to 5. No urinary symptoms. No family history. Hard left gland. 

BIOPSY 
No prior biopsies 

GENERAL ASSESSMENT 
PROSTATE METRICS 
X: 3.6 
Y: 2.9 
Z: 3.9 
Volume: 21.2 

ZONE ASSESSMENTS 
Peripheral zone: Normal T2 bright except for the focal lesion described below. Transition zone: Normal. 
Central zone: Normal.  
Stroma: Thickened in the anterior midline without enhancement  
Nodes: None  
Bone marrow: Normal  
Extracapsular: Seminal vesicles, recto-prostatic angles, and areas of the neurovascular bundles image  normally. 

LESIONS 
LESION 1: PERIPHERAL ZONE: LEFT MID POSTERIORMEDIAL PERIPHERAL ZONE 
See Case Review topic for key images of the lesion(s).
SCORES 

Sequence: T2 weighted
Score: 5
Description: Circumscribed, homogenous moderate hypointense focus/mass  ≥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
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: 1.4 cm ADC 590


Case

The DWI images are distorted by susceptibility artifact from the adjacent right total hip arthroplasty, limiting optimal measurement of maximum size of the left posterolateral peripheral zone midgland lesion. Which of the available sequences is the best alternative to use to measure this lesion?