Pi rads 3 prostate cancer. Obiectivele investigației IRM multiparametrice de prostată
Cuvinte cheie pi rads 3 prostate cancer benignă de prostată IRM multiparametrică cancer de prostată PI-RADS imagistică medicală Introduction Benign prostatic hyperplasia BPH is a histologic diagnosis characterized by proliferation of the prostatic cellular elements.
Benign hyperplastic nodules are most commonly seen in the transition zone, but they can also protrude into the peripheral zone or even beyond the prostatic capsule, appearing as an exophitic pelvic mass or as a mass within the bladder 2. Usually, there is a direct relationship between prostate enlargement and symptoms severity, although many patients with small prostates also present urinary obstruction, because of the strategically position of the adenoma, sitting right on the bladder outlet 2.
Articole Examinarea RM multiparametrica a prostatei Cancerul de prostata CaP este cel mai frecvent tip cancer la barbat la nivel global si a treia cauza de mortalitate prin cancer in Europa.
The initial evaluation should asses the frequency and severity of symptoms by using the International Prostate Symptom Score IPSS 4 and it should also include a digital rectal examination and urinalysis. Enlargement of the prostatita vindecata cu uleiuri associated with a palpable nodule and elevated PSA prostate specific antigen level requires imaging methods of diagnosis, such as transrectal ultrasonography which provides a more accurate assessment of prostate volume than digital rectal examination does 5 and MRI for the characterization of the prostatic tissue, due to its excellent contrast resolution.
Case report We present the case of a year-old patient who was referred to the urology department of our clinical institute three years ago, with lower urinary tract symptoms LUTS. PSA value was Digital rectal examination and transrectal ultrasonography revealed an increased prostate. The patient was directed to our department, where we performed an MRI investigation, in order to rule out prostate cancer, possibly associated with BPH.
A written consent was taken from the patient before entering the scanner room, after he was interviewed about his medical history, possible allergies, previous examinations and MRI contraindications. An intravenous antispasmodic agent is routinely used, in order to decrease the artifacts generated by intestinal motility, after a venous line is secured. He was investigated on a Toshiba 1.
Beneficiile investigației IRM multiprametrice de prostată Investigația imagistică prin rezonanță magnetică RMN multiparametrică pentru diagnosticul cancerului de prostată Imagistica prin rezonanță magnetică IRM sau RMN multiparametrică a prostatei este o metodă nouă și promițătoare pentru diagnosticul cancerului de prostată, care poate ajuta la reducerea supradiagnosticării cazurilor de cancer de prostată lipsite de semnificație clinică. Examinarea IRM RMN multiparametrică a prostatei combină informațiile anatomice obținute cu ajutorul secvențelor ponderate T1 și T2 cu informații funcționale obținute cu ajutorul secvențelor de difuzie și scanarea dinamică după injectarea intravenoasă a substanței de contrast paramagnetice.
High-resolution multiplanar T2 WI are morphological sequences ideal for the prostate anatomy evaluation. Dynamic contrast enhancement DCE and diffusion-weighted DWI are functional sequences, corresponding to angiogenesis and cellular density, respectively.
Despre Cancerul de Prostată
MR-spectroscopy MRS is another functional sequence that correlates with cellular turnover, but we do not perform it routinely. The scanning protocol is listed in Table 1. Contrast media is injected in a volume of 0. Table 1.
The routine multiparametric MRI protocol for prostate imaging used for the patient Imaging findings showed an enlarged prostate, with its three diameters of 51 mm, 61 mm and 41 mm longitudinal diameter, axial diameter and anteroposterior diameter, respectivelywith an estimated total volume of The transitional zone TZ appeared asymmetrically enlarged, predominantly on the right half of the prostate, which led to the compression of the urethra being displaced to the left and thinning the peripheral zone PZespecially on the right side of the base.
The PZ showed diffuse decreased signal intensity on T2WI and no restricted diffusion, typical aspect for chronic inflammatory lesions. The TZ presented multiple small cystic areas and a multinodular structure because of the presence of stromal and glandular nodulesthe biggest one being located in the right middle third and apex of the TZ, with an axial diameter of 38 mm.
We noticed a bulging aspect of the macronodule described in the right TZ, protruding into the neighboring PZ, with a central area of increased signal intensity on diffusion WI and decreased signal intensity on ADC map, but a negative dynamic contrast enhancing DCE curve Figures 1 and 2.
El are o evolutie clinica lenta, insidioasa, fara manifestari imediate, net sesizabile, fiind de cele mai multe ori descoperit intimplator, in cadrul unui examen clinic general. Epidemiologie Ca frecventa, cancerul de prostata se afla pe locul trei la barbati, dupa cancerul pulmonar si cel gastric, constituind a patra cauza de deces prin cancer. Distributia pe glob arata o crestere importanta, in special in tarile nordice: Suedia, Norvegia, Danemarca si Finlanda si in cel occidentale. In Statele Unite, de exemplu, in ultimii cinci ani, numarul de cazuri de cancer de prostata s-a dublat, iar in Franta, peste Cancerul de prostata este mai rar in Europa de Est si foarte rar in Asia.
Figure 1. This particular right TZ nodule has been marked with a final PI-RADS score of 3, which means that the presence of clinically significant cancer is equivocal.
IRM multiparametric de prostată
Discussion BPH nodules appear as a mixture of signal intensities, ranging from hypointense to hyperintense on T2 WI, depending on the proportion of their stromal and glandular components.
They are well-delineated nodules that arise in the TZ, involving the periurethral regions, but sometimes they can bulge the surgical capsule, so they can be found in the PZ. The patient was referred for prostatic biopsy one month after the MR examination, considering the elevated PSA value, which revealed a benign appearance of the sample: polymorphic aspect on account of pi rads 3 prostate cancer chronic inflammatory, non-specific process.
Retrospectively, we can conclude that DWI changes and elevated PSA value may be due to this chronic inflammatory, non-specific process. The patient received anti-inflammatory treatment and remained under urological surveillance.
Conclusions Multiparametric MRI is a precious tool in prostate tissue characterization, completing clinical and biological information, but in case of BPH, a suspected prostate carcinoma in the TZ may represent a real challenge for the radiologist. Often, biopsy is mandatory for a definitive differentiation between inflammatory lesions and prostate cancer.
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Oncologia de precizie în cancerul de prostată
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