Andrea Esposito prostate lesion use of multiparametric mr imaging for management jfim ifupi milan 2018

1. Dr. Andrea Esposito
Prostate lesion
Use of Multiparametric MR Imaging for management
1st Italian-French Update Imaging – IFUPI
Advanced Multiparametric Imaging - How to use in daily practice
MILAN March 23-24 2018
www.jfim.org

2. PI-RADS v2

4. PI-RADS 1 PI-RADS 2 PI-RADS 3 PI-RADS 4 PI-RADS 5
PERIPHERAL ZONE PI-RADS CLASSIFICATION
axial T2WI axial T2WI
ADC map ADC map
axial T2WI axial T2WI axial T2WI
ADC map ADC map ADC map

5. TRANSITION ZONE PI-RADS CLASSIFICATION
PI-RADS 1
PI-RADS 2
PI-RADS 3
PI-RADS 4
PI-RADS 5
axial T2WI
axial T2WI
axial T2WI
axial T2WI
axial T2WI
ADC map ADC map ADC map ADC map ADC map

6. Normal anatomic structures Noncancerous abnormalities
Central zone Stromal BPH nodule
Hypertrophic anterior
fibromuscular stroma
Acute and chronic prostatitis
Thickening of surgical capsule Postinflammatory scars and
atrophy
Neurovascular bundle Ectopic BPH nodule
Post-biopsy hemorrhage
PITFALLS
Kitzing Y.X. et al. Benign Conditions That Mimic Prostate Carcinoma: MR Imaging Features with Histopathologic Correlation. RadioGraphics 2016; 36:162–175.
Panebianco V. et al. Pitfalls in Interpreting mp-MRI of the Prostate: A Pictorial Review with Pathologic Correlation. Insights Imaging 2015; 6:611–630.
Rosenkrantz A.B. et al. Radiologist, Be Aware: Ten Pitfalls That Confound the Interpretation of Multiparametric Prostate MRI. AJR 2014; 202:109–120.

7. axial T2WI ADC map
CENTRAL ZONE
After 12 m
Baseline

8. ASYMMETRIC CENTRAL ZONE
Baseline
axial T2WI ADC map
After 12 m

9. TUMOR PROXIMAL TO THE CENTRAL ZONE
axial T2WI ADC map macroscopic specimen

10. Baseline
After 12 m
axial T2WI ADC map
CENTRAL ZONE AT THE MIDDLE THIRD OF THE GLAND

11. Baseline
axial T2WI ADC map axial T2WI ADC map
After 12 m
CENTRAL ZONE AT THE MIDDLE THIRD OF THE GLAND

12. axial T2WI ADC map macroscopic specimen
CENTRAL ZONE TUMOR

13. HYPERTROPHIC ANTERIOR FIBROMUSCULAR STROMA
sagittal T2WI axial T2WI ADC map axial T2WI DCE
Baseline
After 12 m

14. HYPERTROPHIC ANTERIOR FIBROMUSCULAR STROMA
axial T2WI ADC map
Baseline
After 12 m

15. TUMOR OF THE ANTERIOR FIBROMUSCULAR STROMA
axial T2WI ADC map axial T2WI ADC map
axial T2WI ADC map

16. NEUROVASCULAR BUNDLE
3/17
3/17
axial T2WI ADC map
Baseline
After 12 m

17. NEUROVASCULAR BUNDLE
Baseline
After 12 m
axial T2WI ADC map

18. THICKENING OF SURGICAL CAPSULE
axial T2WI ADC map

19. SURGICAL CAPSULE TUMOR
axial T2WI ADC map macroscopic specimen

20. NODULI BPH NODULES
Baseline
After 12 m
axial T2WI axial T2WI axial T2WI ADC map

21. TRANSITION ZONE TUMOR
axial T2WI ADC map macroscopic specimen

22. STROMAL BPH NODULE
Baseline
After 12 m
axial T2WI axial T2WI ADC map DCE)

23. TRANSITION ZONE TUMOR
axial T2WI ADC map macroscopic specimen

24. Baseline
After 12 m
PROSTATITIS
axial T2WI ADC map axial T2WI ADC map DCE

25. PROSTATITIS
axial T2WI ADC map axial T2WI ADC map
Baseline
After 12 m

26. Baseline
After 12 m
POSTINFLAMMATORY SCARS AND ATROPHY
axial T2WI ADC map

27. axial T2WI ADC map axial T2WI ADC map
Baseline
After 12 m
ECTOPIC BPH NODULE

28. POSTBIOPSY HEMORRHAGE
14 days
post-biopsy
axial T2WI ADC map pre-contrast T1 (Twist)
After 1 m

29. • To reduce false positive cases
• To know normal anatomic structures
• In the doubtful cases MRI follow up is a valid
alternative
TAKE HOME MESSAGE
Hauth E. et al. Follow up MR imaging of PI-RADS 3 and PI-RADS 4 prostate lesions. Clinical Imaging 2017; 43: 64-68.

30. Thank you
andrea.esposito@policlinico.mi.it