I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a product in my presentation.

Transcription

1 Prostate t Cancer MR Report

2 Disclosure Information Vikas Kundra, M.D, Ph.D. I have no financial relationships to disclose. I WILL NOT include discussion of investigational or off-label use of a g product in my presentation.

3 T N M MR Report Location in the gland Right, Left, Bilateral Apex, Mid gland, Base Extracapsular extension Neurovascular bundle invasion Seminal vesicle invasion Adjacent organs Lymph node metastasis Bone metastasis t Prostate size in three dimensions Periprostatic vessels Useful term: Organ confined disease

4 MR Report Location in the gland European Consensus Meeting Recommendations Dickinson L et al. European Urology 59 (2011) Divide prostate into multiple regions 16 regions 27 regions Each region is assigned a number

5 Prostate Cancer - Anatomy Imaging Anatomic % glandular %of tissue prostate cancer in the gland Central Transition 5% 25% Central 20% 5% Peripheral Peripheral 75% 70% Fibromuscular Fibromuscular 0% 0% Stroma Stroma

6 A A B B C C Vikas Kundra M D Ph D

7 Prostate - Anatomy Central zone Urethra Peripheral zone Prostate coil T2-weighted MR

8 Prostate - Anatomy Prostate Neurovascular bundle at 5 and 7 o clock Prostate t coil T1-weighted MR

9 Prostate Cancer - Staging Based on Tumor-Node-Metastasis (TNM) system (T) Primary Tumour Early tumors are not well staged dby imaging: i Tumor confined dto gland TX. Cannot be assessed T0. None T1. Clinically inapparent by palpation or imaging Incidentally noted tumor T1a. in < 5% of histologic specimen T1b. in >5% of histologic i specimen Tumor sought T1c. Tumour identified by needle biopsy (e.g., because of elevated PSA) MR becomes important T2. Clinically apparent T2a. <1/2 of a lobe T2b. >1/2 of a lobe, but not both lobes T2c. Both lobes involved (TNM online 2005 by John Wiley & Sons, Inc.)

10 T2 Prostate Carcinoma involving i the left mid gland T2 T1

11 T2 Prostate Carcinoma left mid gland PZ and CZ T2 ADC

12 Multifocal Prostate Cancer T1 T2 T2 T2

13 Prostate Cancer - Staging Based on Tumor-Node-Metastasis (TNM) system (T) Primary Tumour Better staged by imaging (MR and CT) T3. Tumour extends through hthe prostatic capsule T3a. Extracapsular extension T3b. Seminal vesicle(s) invasion T4. Invasion of adjacent structures other than seminal vesicles bladder neck, external sphincter, rectum, levator muscles, or pelvic wall (TNM online 2005 by John Wiley & Sons, Inc.)

14 Focal prostate carcinoma on the right with bl bulge and capsular irregularity i at left lfapex Periprostatic vessels T2 T1

15 Neurovascular Bundle Invasion

16 Seminal Vesicle Invasion

17 Biopsy related hemorrhage is hyperintense on T1 and hypointense on T2. Hemorrhage can mask an underlying tumor in the prostate and seminal vesicles. T1 T2

18 T4 Prostate Carcinoma T1 T2

19 Prostate Cancer - Staging (N) Regional Lymph Nodes (MR and CT) NX. Cannot be assessed N0. None N1. Regional lymph node metastasis (external iliac, internal iliac, and presacral chains) (M) Distant Metastasis (Bone scan, MR and CT) MX. Cannot be assessed M0. None M1. Distant metastasis present M1a. Non-regional lymph node(s) (not in true pelvis, includes common iliac and para-aortic) aortic) Up to 50% of nodal metasasis are para-aortic without concurrent pelvic nodal metasasis suggests hematogenous spread and suggests imaging of the abdomen for staging M1b. Bone(s) M1c. Other locations (TNM online 2005 by John Wiley & Sons, Inc.)

20 Lymph Node Metastasis N1 M1a

21 Osseous Metastasis M1

22 T N M MR Report Location in the gland Right, Left, Bilateral Apex, Mid gland, Base Extracapsular extension Neurovascular bundle invasion Seminal vesicle invasion Adjacent organs Lymph node metastasis Bone metastasis t Prostate size in three dimensions Periprostatic vessels Useful term: Organ confined disease

23 Thank you