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Prof. Jelle Barentsz

Hands-on PI-RADS Workshop. Prof. Jelle Barentsz. Radboudumc Prostate MR Reference-Expert Center. Jelle Barentsz@JelleBarentsz. jelle.barentsz@radboudumc.nl. www.mri -prostate- barentsz.nl. NO CONFLICT OF INTEREST. WHAT IS MULTI-PARAMETRIC MRI. Integration of 3 techniques.

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Prof. Jelle Barentsz

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  1. Hands-on PI-RADS Workshop Prof.JelleBarentsz Radboudumc Prostate MR Reference-Expert Center JelleBarentsz@JelleBarentsz jelle.barentsz@radboudumc.nl www.mri-prostate-barentsz.nl

  2. NO CONFLICT OF INTEREST

  3. WHAT IS MULTI-PARAMETRIC MRI

  4. Integration of 3 techniques

  5. multi-parametric MRI Tissue Structure CellDensity Vascularity T2-Weighted Imaging (T2W) Diffusion Weighed Imaging (DWI) Dynamic Contrast enhanced

  6. Tissue structure: T2W

  7. Uniformly hyperintense signal intensity(normal) Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin T2-W: Tissue Structure

  8. T2-W: Tissue Structure BPH: Organised Chaos Organised Chaos

  9. Uniformly hyperintense signal intensity(normal) Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin T2-W: Tissue Structure PCa: Erased Charcoal Erased Charcoal

  10. Uniformly hyperintense signal intensity(normal) Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin Disruption of Organised Chaos

  11. Uniformly hyperintense signal intensity(normal) Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin Size >15 mm 16 mm

  12. Uniformly hyperintense signal intensity(normal) Linear, wedge-shaped, or diffuse mild hypointensity, usually indistinct margin In TZ → PI-RADS 5 16 mm

  13. Tissue structure: T2W

  14. Tissue structure: T2W Low SI: PCa + hematoma + prostatitis + BPH

  15. Glandular tissue Gleason 1-2 Cell Density: DWI

  16. Tightly packed cells Gleason 5 Glandular tissue Gleason 1-2 Cell Density: DWI

  17. Tightly packed cells Gleason 5 Glandular tissue Gleason 1-2 Cell Density: DWI ADC: Velocity Map

  18. Vascularity: T2W

  19. mpMRI to detect CS Prostate Cancer

  20. mpMRI to detect CS Prostate Cancer Acquisition

  21. mpMRI to detect CS Prostate Cancer Acquisition Reading

  22. mpMRI to detect CS Prostate Cancer Acquisition Targeted Biopsy Reading

  23. ACQUSITION

  24. GUIDELINES FOR ACQUISITION

  25. Acquisition Magnetic field strength

  26. Acquisition Magnetic field strength • 3T preferred

  27. Acquisition Magnetic field strength • 3T preferred • 1.5T in patients with a MR-conditional pacemaker

  28. Acquisition Magnetic field strength • 3T preferred • 1.5T in patients with a MR-conditional pacemaker Coils

  29. Acquisition Magnetic field strength • 3T preferred • 1.5T in patients with a MR-conditional pacemaker Coils • No Endo-Rectal Coil

  30. Acquisition Magnetic field strength • 3T preferred • 1.5T in patients with a MR-conditional pacemaker Coils • No Endo Rectal Coil Contrast

  31. Acquisition Magnetic field strength • 3T preferred • 1.5T in patients with a MR-conditional pacemaker Coils • No EndoRectal coil Contrast • DCE-MRI preferred

  32. Acquisition protocol GOOD CHEAP FAST

  33. Local prostate MRI <30 min Buscopan/Glucagon

  34. Local prostate MRI <30 min Buscopan/Glucagon 2x T2W ax + sag + cor 4/3 x 1/0.5 x 1/0.5 9 min

  35. Local prostate MRI <30 min Buscopan/Glucagon 2x T2W ax + sag + cor 4/3 x 1/0.5 x 1/0.5 9 min DWI ax b 0/50, 500, ≥800, Calculated: ADC-map, b>1400 image 18 min

  36. PI-RADS v2 • DWI Lowest high b-value >1400s/mm2 (may be acquired or calculated) ADC Calc b1400 Calc b2000

  37. Local prostate MRI <30 min Buscopan/Glucagon 2x T2W ax + sag + cor 4/3 x 1/0.5 x 1/0.5 9 min DWI ax b 0/50, 500, ≥800, Calculated: ADC-map, b>1400 image 18 min DCE ax GRE, time res. <15 sec 25 min

  38. Motion artifact

  39. Motion artifact

  40. Rectal gas: poor DWI

  41. Remove gas: good DWI

  42. READING

  43. PI-RADS V2.1

  44. 2009: Need for Standardization

  45. Large variability NPV for csPCa (56-99%)

  46. Large variability NPV for csPCa (56-99%) Variability of acquiring, interpretation and biopsy should↓

  47. Risonanzamagnetica We need to speak one language: PI-RADS 磁共振 Магнитно- резонансная

  48. PI-RADS v1Prostate Imaging Reporting and Data System Barentsz, EurRadiol 2012;22: 746-757

  49. GUIDELINES

  50. PI-RADS v2: Assessment Categories Each lesion is assigned a PI-RADS Assessment Category using a 5-point scale based on the likelihood (probability) that findings on T2W, DWI, & DCE correlates with the presence of a clinically significant cancer at a particular location 1 very low clinically significant cancer highly unlikely 2 low clinically significant cancer unlikely 3 intermediate clinically significant cancer equivocal 4 high clinically significant cancer likely 5 very high clinically significant cancer highly likely

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