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Magnetic Resonance Imaging MRI is the best imaging modality for evaluating the prostate and accurately diagnose the prostatic carcinoma, especially in cases with aggressive and larger volume tumors. The main objectives of this article are: to review the multiparametric MRI assessment technique used in prostate pathology, to list and illustrate the most common MRI features in prostate cancer, and to present the role of the multidisciplinary team in the diagnosis and management of patients with prostate tumoral pathology.
Keywords prostate cancer, multiparametric MRI, multidisciplinarity Rezumat Cancerul de prostată reprezintă o importantă problemă de sănătate publică.
Imagistica prin rezonanţă magnetică IRM este cea mai bună modalitate de evaluare a prostatei şi de a diagnostica cancerul de prostată, mai ales în cazurile în care tumora este voluminoasă şi agresivă. Principalele obiective ale acestui articol sunt: revizuirea tehnicii utilizate în evaluarea IRM multiparametrică în patologia prostatei, prezentarea şi ilustrarea principalelor aspecte IRM întâlnite în cancerul de prostată şi prezentarea rolului abordului multidisciplinar în diagnosticul şi managementul pacienţilor cu patologie tumorală prostatică.
To become familiar with the MRI features of prostate cancer. To delineate the importance of the multidisciplinary team in the diagnosis and management of patients with prostate cancer. Introduction Epidemiology. Prostate cancer is the most common solid neoplasm in Europe and the second leading cause of male cancer deaths in USA and UK. Age is the most important risk factor Allmost all prostate cancers are adenocarcinomas.
Gleason score grade corresponds to a well differentiated prostatic tumor; grade is a moderately differentiated tumor, and signifies a poorly differentiated prostatic cancer 3. Prognostic indicators. TNM stage is the most important prognostic variable.
Prostate specific antigen PSA is primarily used in the diagnosis and detection of disease recurrence. High levels is correlated with advanced TNM stage at diagnosis 3.
Indications of MRI evaluation in prostate cancer: 1.
Detection localization — detection and characterization protocol. Staging protocol: tumor extension, presence of node and bone metastasis. Follow-up of a known prostatic tumor. Recurrences after treatment. A scale from 1 to 5, stratifying a focal prostatic abnormality according to the MRI findings, obtained with different MRI sequences, improves the reproducibility of radiologists reports and the communication with referring physicians Other sequences and technical requirements.
The prostate and seminal vesicles must be covered entirely slice thickness: 3 mm.
Imaging, parallel to the prostate, perpendicular to the rectal face of the prostate, or oblique into the seminal vesicles plane are essential to evaluate extraprostatic extension Figure 1. Figure 1.
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MRI acquisition planes in prostate cancer evaluation T1-wi SE are useful for detecting enlarged pelvic lymph nodes slices from the pubic symphysis till the aortic bifurcationbone metastases and post biopsy hemorrhage.
The interpretation is based on an attentive qualitative and quantitative analysis of each sequence Figure 2. Post-biopsy intraprostatic hemorrhagic spot hyperintense on T1FS wi, and hypointense T2 wiwhich can mimic image cancer de la prostate tumoral nodule arrow It is very important that the slices obtained on T2 wi, diffusion, dynamic T1 after gadolinium Gd injection have the same plane centeringslices number, slice thickness and identical interslice space for a correct and easy analysis.
Different publications and studies regarding the correlation between ADC value on diffusion-weighted MR imaging and the Gleason prostatita crește burta in prostate cancer have demonstrated that ADC values are lower in aggressive PC and correlated with the Gleason score Prostate cancer located in the PZ corresponds to an area of low signal intensity Figure 3 and Table 1.
Multiparametric Magnetic Resonance Imaging in prostate cancer diagnosis: a must
But T2 hyposignal in the peripheral zone may be present also in noncancerous conditions 12 : inflammation, biopsy-related hemorrhage blood products may persist weeks or longer after prostate biopsypost-radiation therapy fibrosis, and changes after hormone deprivation therapy Figure 2. Table 1. Large tumoral prostatic nodule located into the left PZ white arrow T2-wi has significant limitations for depicting cancer involving the Image cancer de la prostate and CZ Table 2 : cancer and normal tissues have both low signal intensity Table 2.
The diffusion properties of tissue are related to the amount of interstitial free water and permeability 10, Table 3. Figure 4.
PI-RADS scoring system for DCE 7 In many studies, it has been shown that the values of contrast enhancement parameters — mean transit time, blood flow, permeability surface area and interstitial volume — are significantly greater in cancerous tissue than in normal tissue Figure 5. Figure 5. The apex of the prostate should be carefully analyzed, as well as the external urethral sphincter. Medicament infectie urinara barbati analysis of pelvic and retroperitoneal lymph nodes is obligatory.
Abnormal lymph nodes on MRI take into account the size, morphology, shape, and the enhancement pattern. Lymph nodes over 8 mm in short axis dimension are suspicious.
Nodal groups necessary to be evaluated include: common femoral, obturator, external iliac, internal iliac, common iliac, pararectal, presacral, paracaval and paraaortic to the level of the aortic bifurcation.
Bone metastases assessment is also required Figure 6. Figure 6. The importance of structured report in prostatic cancer management — large invasive prostatic tumor T with seminal vesical and urinary bladder invasion, tumoral adenopathies and bone metastasis white arrows In summary, DWI is the best sequence for the PZ. T2 represents the best sequence for the TZ Figure 7.
It has the potential to reduce false negatives and speed up diagnosis, which can make a life-saving difference to patients.
Figure 7. In uncertain cases, the imaging report must contain the recommendations regarding what to do next: biopsy fusion US-MRIor follow-up based on a multidisciplinary team approach urologist, radiologist, laboratory doctor, histopathologist, oncologist, radiotherapist. Conflict of interests: The author declares no conflict of interests.
Clinical practice guidelines in oncology: prostate cancer. Guidelines on prostate cancer. Prostate Cancer Image cancer de la prostate. Eur Radiol. Use of the prostate imaging reporting and data system PIRADS for prostate cancer detection with multiparametric magnetic resonance imaging: a diagnostic meta-analysis. Eur Urol. Updated prostate imaging reporting and data system PIRADS v2 recommendations for the detection of clinically significant prostate cancer using multiparametric MRI: critical evaluation using whole-mount pathology as standard of reference.
Clinical evaluation of a computer-aided diagnosis system for determining cancer aggressiveness in prostate MRI. Prostate cancer aggressiveness: assessment with whole-lesion histogram analysis of the apparent diffusion coefficient.
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Apparent diffusion coefficient value as a biomarker reflecting morphological and biological features of prostate cancer.
Int Urol Nephrol. False positive and false negative diagnoses of prostate cancer at multi-parametric prostate MRI in active surveillance. Insights Imaging.
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Dynamic contrast enhanced MRI for the detection of prostate cancer: meta-analysis. Am J Roentgenol. Abdom Radiol.
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