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- 59 year-old
- PSA 4.3
- standard biopsy: 3+3=6 but large volume left
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
Example Report for This Case: Surgical Planning
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)|
|Overall Suspicion||High (4/5)|
Seminal vesicles and neurovascular bundles appear normal.
- Technical quality: excellent
- Left anterior lesion highly suspicious for aggressive disease may involve anterior capsule
- 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