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Mri prostate

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Mri prostate

  1. 1. MR IMAGING IN PROSTATE CANCERA REVIEW OF DEPARTMENTAL CASES Sarbesh Tiwari
  2. 2. INTRODUCTION2nd most common malignant tumor in male.95% are adenocarcinomaHigher incidence in African Americans, incidenceraising in IndiaAge : 6th to 7th decade.Symptoms: Dysuria, hematuria, urgency+/‐frequency of micturition, bone painDiagnosis: Combination of DRE & PSA.Confirmation of diagnosis-Transrectal biopsy under Ultrasound guidance
  3. 3. ZONAL ANATOMY OF PROSTATE MC NEAL 1968
  4. 4. ZONAL DISTRIBUTION OF PROSTATE CANCER 70 % prostate CA ------ In Peripheral Zone of Prostate 20 % prostate CA ------ In Transitional Zone of Prostate 10 % prostate CA ------ In Transitional Zone of Prostate
  5. 5. NORMAL MRI APPEARANCE OF PROSTATENormal prostate has homogenous low signalon T1WIZonal anatomy is best demonstrated on T2WIComprise of low signal central zone andhigher signal peripheral zoneTZ and CZ appears similar in SI and looselytermed the central gland
  6. 6. NORMAL T2 APPEARANCE OF PROSTATE
  7. 7. MR IMAGING IN PROSTATE CA INDICATION – To stage the extent of prostate cancer once the diagnosis is established To identify the presence of recurrent disease following treatment Persistent raised PSA with repeated negative TRUS biopsies.MRI is not used in the primary diagnosis of prostatecancer. This is usually established following biopsy atTRUS
  8. 8. MR IMAGING PROTOCOLMRI is usually performed on 1.5T or 3T MRI using endorectal and pelvic phase array coil.Standard Sequences : 1. Axial T1WI of pelvis 2. Axial + Sagittal + Coronal T2WI 3. MR Spectroscopy of selected volume of prostateOthers, 4. Diffusion Weighted Imaging 5. Dynamic contrast enhanced MRI.
  9. 9. CONVENTIONAL MRI FINDINGSTIWI : Tumor is isointense relative to glandT2WI : Tumor appears as a region of low signalintensity within normal high signal peripheralzoneDetection of extra capsular extension: 1. Asymmetry into neurovascular bundle 2. Obliteration of recto-prostatic angle 3. Irregular bulging or breech of prostate capsule 4. Invasion of bladder / rectum / seminal vesicle.
  10. 10. MRI FINDINGS CONTD…Diffusion Weighted Imaging : Restricted diffusion with reduced ADC value. : Increased cellularity of malignant lesions, with reduction of the extracellular space and restriction of the motion of a larger portion of water molecules to the intracellular spaceDynamic contrast enhanced MRI : Early, rapid, and intense enhancement with quick washout of contrast material : Increased tumor neovascularsation and thus increased micro vascular density as compared to normal prostate.
  11. 11. MR SPECTROSCOPY OF PROSTATENORMAL METABOLITE OF PROSTATE Citrate : Produced by normal epithelial cells of prostate Normal Peak at 2.6 ppm Choline : Precursor of phospholipids cell membrane Normal Peak at 3.2 ppm Creatine : Involved in cellular energy Normal peak at 3 ppm
  12. 12. NORMAL MR SPECTROSCOPY At 1.5 T At 3 T
  13. 13. MR SPECTROSCOPY OF PROSTATEClassic spectral signature of prostate cancerconsists of increased choline and decreased citrateRatio of (Choline + creatine)/ Citrate is usuallymeasured.Normal range : 0.22 +/- 0.013, range upto 0.5.Lower values for the Cho+cr /Cit ratio in theperipheral areas than in the central glands.Choline / creatine to citrate ratios: > 0.5 : suspicious > 1 : very suspicious > 2 : abnormal
  14. 14. DEPARTMENTAL CASES
  15. 15. Case 1:Clinical Detail : A 69 yrs old patient with post TURP status and biopsyproven adenocarcinoma, presented for MR evaluation and staging ofthe disease. T1WI Axial T1WI Sagittal
  16. 16. T2WI AxialT2WI Axial T2WI Sagittal
  17. 17. DWI MR Spectroscopy Spectroscopy : Results Table
  18. 18. DIAGNOSISPROSTATIC CA WITH EXTRACAPSULAREXTENSION INTO LEFT SEMINAL VESICALWITHOUT ANY LYMPHADENOPATHY.BLADDER WALL HYPERTROPHY DUE TOPREVIOUS BOO.
  19. 19. CASE 2•56 yrs old male presenting withdifficulty in micturition, poorurinary stream and back pain• Raised serum PSA- 20ng/ml T2WI - Axial T2WI - Axial T2WI - Axial
  20. 20. T1WI T1WI-post contrast
  21. 21. MR SpectroscopySpectroscopy : Results Table
  22. 22. DIAGNOSIS Prostate ca arising from the peripheral zone with extra capsular extension into left posterolateral periprostatic fat with infiltration of anterior rectal wall. Associated secondary deposits noted in sacrum and lumbar vertebra
  23. 23. CASE 362 yrs old male presenting with urgency and increased frequency ofmicturition with pain in left hip joint T2WI : Axial
  24. 24. DIAGNOSIS BENIGN PROSTATIC HYPERPLASIA WITH NORMAL SPECTROSCOPIC FINDINGS. UNILATERAL PAGETS DISEASE OF LEFT ILLIAC BONE.
  25. 25. CONCLUSIONMRI serves as a powerful modality forlocalization and staging of prostate cancerNon ionizing and non invasive.Excellent soft tissue resolution, allows betterdelineation of primary tumor and nearbyextension.Combination MR + MRS: Sensitivity 91% Specificity 95%
  26. 26. REFERANCE1. David Bonekamp, Michael A. Jacobs et.al Advancements in MR Imaging of the Prostate: From Diagnosis to Interventions. RadioGraphics 2011;31:677–7032. Textbook of radiology and imaging . Volume 2 David Sutton 7th edition.

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