Weak stream and nocturia in a long standing diabetic. Lab investigation revealed an elevated PSA.
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Prostate is normal in size weighing 16 g, with mild median lobe hypertrophy invading into the urinary bladder. Loss of normal T2 high signal intensity of the left half of the peripheral zone, which is replaced by a T2 hypointense lesion which is crossing the midline, breaching prostatic capsule and invading left neurovascular bundle. Seminal vesicles and vas deferens are normal.
While T2 weighted images are the primary determining sequence for assessing the transition zone using the PI-RADS scoring system, it is useful for detection of peripheral zone lesions as well, whilst the DWI sequence is the primary determining sequence for peripheral zone lesions. Any ambiguity in either of these sequences may be elucidated by the supplemental dynamic contrast-enhanced MRI sequence.
Following the latest version of PI-RADS will enable a standardization in reporting prostate MRI studies.