Learning objectives
-Discuss prostate MRI protocol with advantages and pitfalls.
-Discuss PI-RADS objectives, version 2.1 changes, and assessment categories.
-Review prostate anatomy.
-Provide examples and radiopathologic correlation of prostate lesions with associated PI-RADS classification.
Background
Prostate cancer is the most commonly diagnosed male cancer, becoming the 2nd leading cause of death in males in the United States. In current practice, diagnosis is achieved via PSA levels and digital rectal examination, and confirmed with US-guided transrectal biopsy. Limitations to this practice include low specificity, detection of clinically insignificant cancers, under detection of clinically significant ones, and overlooking disease extension. Because of this, prostate MRI has become importantin the assess prostate cancer by improving detection of clinically significant cancer, which is critical...
Findings and procedure details
Multiparametric prostate MRI (mpMRI) has become clinically significant for prostate cancer assessment. It is especially recommended when there are clear risk factors increase the probabilities of prostate disease such as family history, prior negative biopsy, active surveillance, and risk calculator. With PI-RADS version 2.1, classification of prostate lesions has become more standardized among radiologists. PIRADS v2.1 divides the prostate anatomically in 41 regions, with two additional sectors in the right and left posterior medial Peripheral Zone (PZ) when compared to v2 (Fig. 2).
It also...
Conclusion
Prostate mpMRI serves a s a powerful modality for localization and staging of high grade prostate CA. It provides excellent soft tissue resolution, allows better delineation of primary tumor and nearby extension, and is non-ionizing and non-invasive. PI-RADS v2.1 aims to standardize radiologist reports and communication between radiologists and referring physicians, providing a specific lexicon for prostatic lesion/nodule allowing radiologists to aid referring urologists to plan biopsy procedures.
Personal information and conflict of interest
S. C. Torres-Ayala; Mayaguez, PR/US - nothing to disclose V. M. Vargas Figueroa; Mayaguez, PR/US - nothing to disclose P. Delgado-Muñoz; San Juan, PR/US - nothing to disclose G. Ballester; Adjuntas, PR/US - nothing to disclose
References
1. About Prostate Cancer. American Cancer Society 2016. https://www.cancer.org/content/dam/CRC/PDF/Public/8793.00.pdf
2. Esen T, Turkbey B, Patel A, Futter J. Multiparametric MRI in Prostate Cancer. BioMed Research International. 2014 Hindawi Publishing Corporation.
3. Purysko A, Rosenkrantz A, Barentsz, Weinreb J, Macura K. PI-RADS Version 2: A Pictorial Update.RadioGraphics: Volume 35 Number 5.
4. Revisions in PI-RADS v2.1 Presentation. European Society of Urogenital Radiology. American College of Radiology.
5. Steiger P, Thoeny H. Prostate MRI based on PI-RADS version 2: how we review and report. Cancer imaging (2016)...