Example of Change to Nerve Sparing

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  • 59 year-old
  • PSA 4.3
  • standard biopsy: 3+3=6 but large volume left


Example of Change to Nerve Sparing

LEFT: T2-weighted imaging: hypointense focus left anterior apex (horizontal arrow) with uninvolved neurovascular bundle (vertical arrow)

CENTER: Colorized apparent diffusion coefficient (ADC) map: moderately restricted diffusion (yellow arrow)

RIGHT: Colorized dynamic contrast enhanced (DCE) perfusion map: focal intense enhancement

Spectroscopic imaging for Nerve Sparing
Spectroscopic imaging: elevated choline (left peak) to citrate (right peak) ratios (blue arrows)

Example Report for This Case: Surgical Planning

* Findings

No suspicious lymph nodes or bone lesions. Prostate measures 38 gm with mild prostatic hyperplasia. A single suspicious area is identified:

Location Left anterior central apex 2:00
Capsule Bulges anteriorly only
T2 Asymmetric, ill-defined (4/5)
Diffusion ADC 0.82, highly restricted (4/5)
Perfusion Early and intense + washout (4/5)
Spectroscopy Abnormal
Overall Suspicion High (4/5)

Seminal vesicles and neurovascular bundles appear normal.

* Impression

  1. Technical quality: excellent
  2. Left anterior lesion highly suspicious for aggressive disease may involve anterior capsule
  3. Organ-confined disease.


Final Path: 3+4=7, T2c

Advantage: UCLA Prostate MRI

  • In cases of suspected high volume but organ confined disease, MRI can help with the decision to spare one or both nerves and still achieve negative surgical margins
  • Spectroscopic imaging is the most specific of the functional parameters of prostate MRI, but requires focused experience to accurately tune the magnet