How to report a Prostate MRI, when ADC is not available
Guideline used: ACR manual PIRADS V2.1 2019- page 11:
https://www.acr.org/-/media/ACR/Files/RADS/PI-RADS/PIRADS-V2-1.pdf
Biparametric MRI can be assessed based on the unavailability of either contrast or DWI images.
T2 W Images and either ADC or Dynamic arterial phase is essential for evaluation.
Case Discussion:
65 / M
PSA: 32 ng/ml
Findings & Interpretation based on available images:
Transition Zone:
Large area of non-circumscribed moderate T2W hypointensity. Restricted diffusion is seen in the medial part of the lesion and measures > 1.5 cm.
PIRADS 5
peripheral Zone:
Index lesion 1:
Moderate hypointensity is seen in the left base and not so well defined. On post contrast, there is intense focal contrast enhancement and measures < 1.5 cm.
PIRADS 4
Index lesion 2:
Moderate T2W hypointense nodule that shows restricted diffusion and measures <1.5 cm.
PIRADS 4
Further Management
1. TRUS guided Biopsy was performed:
- ISUP - 3
- Gleason's Score: 4 + 3
- 60 % core was involved by tumor from the left lateral biopsy
2. PSMA PET :
High uptake seen in the corresponding regions
Prepared by Dr. Sharad Maheshwari
18.11.2022
Update: 19.11.2022
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