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MRI of patient with adenocarcinoma in prostate

Case Study
Scappatura, Giuseppe Bianchi Melacrino Morelli • Italy

Patient history

This patient with PSA level of 4 ng/ml was referred to MRI by the urologist because a prostate mass was suspected after transrectal ultrasound. Gleason score was 4+3. The patient underwent his MRI examination in the radiology department of hospital Bianchi Melacrino Morelli of Reggio Calabria, Italy.

MR examination

The MRI examination was performed on Achieva 1.5T using the 32-channel SENSE Cardiac coil.

This multi-parametric MRI exam was slightly adapted from the PI-RADS V2 guidelines for prostate MRI.

 

Related ExamCard

Images

 Coronal T2W TSE Paraxial T2W TSE Sagittal T2W TSE
Coronal T2W TSE
Paraxial T2W TSE
Sagittal T2W TSE
 ADC DWI b1400 DWI b1400 inverted contrast
ADC
DWI b1400
DWI b1400 inverted contrast
 DWI b0 DWI b500 DWI b1000
DWI b0
DWI b500
DWI b1000
 DWI b0 inverted DWI b500 inverted DWI b1000 inverted
DWI b0 inverted
DWI b500 inverted
DWI b1000 inverted
 eTHRIVE eTHRIVE eTHRIVE
eTHRIVE
eTHRIVE
eTHRIVE
 eTHRIVE eTHRIVE T1W TSE
eTHRIVE
eTHRIVE
T1W TSE

Postprocessing

Click on an image to enlarge
 Image fusion T2W TSE and DWI b1400
<br><br><br> Image fusion T2W TSE and DWI b1400
<br><br><br>
Image fusion T2W TSE and DWI b1400


Image fusion T2W TSE and DWI b1400


 <em>Click image to enlarge<em/>
<br><br><br> Comparing ADC of ROI in suspicious area and ROI in normal area.<br><br><br>
Click image to enlarge


Comparing ADC of ROI in suspicious area and ROI in normal area.


The quantitative evaluation of ADC was performed with a cut-off reference for distinguishing the suspicious tissue from normal conditions This was done by placing ROIs (25 mm2) in both the suspected area and in a healthy tissue area.

 

An average ADC value of 0.404 mm2/s was determined in the ROI positioned in the suspected area on the ADC map. This value seems consistent with the Gleason score of 4+3 that was determined for this patient.

Diagnosis

By the use of this protocol and additional clinical and diagnostic findings, the patient was finally diagnosed with adenocarcinoma in the left lobe of the prostate.

Clinical impact

In this case study, using Achieva 1.5T with 32-channel SENSE Cardiac coil and a protocol set up closely similar to PI-RADS V2 provides excellent imaging of the prostate.

More information

Prostate imaging and reporting and data system (PI-RADS) version 1 was introduced by the European Society of Urogenital Radiology (ESUR) as a standardized scoring system to grade lesions on prostate MRI in 2012. In 2015, the updated PI-RADS Version 2 was introduced in a collaboration between the American College of Radiology (ACR), AdMeTech Foundation and ESUR.

 

Prostate MRI acquisition protocols should be tailored to the specific patient, clinical questions, management options and MRI equipment, but according to this guideline it should at least include:

 

• T2W – ideally 3 planes

• DWI – to a maximum b-value of 1400 sec/mm2 or greater

• ADC

• Dynamic series

 

High b-value DWI series are important in peripheral zone assessment. T2W series are important in transition zone analysis. The findings are subsequently labeled as PIRADS 1 to 5 for focal abnormalities.

 

 

  

Results from case studies are not predictive of other cases. Results in other cases may vary.



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Case Study
Achieva 1.5T
ADC, Body, DWI, eTHRIVE, Oncology, PIRADS, PI-RADS, Prostate, SENSE Cardiac coil, THRIVE
 

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